r/indiahealthinsurance

I have a 13 years old hdfc optima restore policy, with my wife added to it 8 years back. Of late we have had some medical history- asthma, AxSPA, grade 1 fatty liver, C Section, Fibroid removal etc. Given this, will my switch to optima secure lead to fresh underwriting, premium loading and extra waiting periods?

My father undervent liver surgery due to cancer detection in gall bladder which was removed due to stone last year October. We filed for reimbursement claim later and the process has been sort of mental harassment with HDFC ERGO.

They have been asking all documents for diabetes, fatty lever and high BP with first consultation paper and diagnosis. While we provided the prescription from treating doctor mentioning these ailments but they keep asking for same things like a bot reply.

While diabetes was declared during insurance purchase 7 years ago. we don't have the first consultation paper for high bp and fatter liver detected later. We have lab reports and prescriptions around surgery time.

The documents they have been asking has no relevance to surgery done.

They send 5-6 reminders, we share our grievance and then reminder count resets to 1. No clear communication and same repeated mails. Customer care is a joke as it is AI bot driven, takes lot of time to connect to human support and everytime we have to explain the problem from beginning. Tickets gets created and then no update. Follow up on ticket over mail does not work and they create another ticket.

Complained to IRDAI as well. No resolution.

Extremely bad experience. Paid premiums for years and end up having to face such issue where claim is neither rejected, nor getting processed.

How to proceed ? Going to court and fighting this will be another mental agony.

I am a 30 year old male , seeking to buy health insurance for myself with a cover of 15 lakhs. I am completely new and know nothing of it.

Kindly advice.

My father is an extreme diabetic patient, he has nerve related issues and walking issues due to it. I tried to get health insurance for him around 2 years back but nobody was giving insurance for him. In my family, my mom and I are covered by hdfc ergo optima secure group policy(50 lakhs). For my younger sister I covered using an individual hdfc ergo optima secure policy(25lakhs). My father I am covering using my company's health insurance policy(10lakhs, niva bhupa) with copay. Recently he fainted due to a nerve related heart issue , we did one surgery for a pace maker and another bypass surgery for the heart block. To my luck pace maker surgery was done in April, it cost around 5.6 lakhs. The insurance company gave back 4.5 lakhs. The company renewed the policy in May and increased the cover as well. Bypass again took 6.5 lakhs. Insurance gave back 5.5 lakhs. The thing is with my current job market, I am unsure about layoffs. In this case I don't have the means to cover my father. Please suggest what I should do in this case?

Hello! I wanted some advice regarding getting insurance for my parents and myself.

My father currently 59, will turn 60 in January.
My mother currently 57, will turn 58 in December.
I am 31, will turn 32 in December.

I am looking for health insurance for them and myself. Both have pre existing conditions.

Father has BP, Sugar, diabetes and recently suffered Brain Hemorrhage.

Mother also has BP, sugar, diabetes as well. And got diagnosed with (Auto immune hemolytic anemia).

I don’t have any pre existing conditions.

What health insurance will work best for them and in the long run have claims be not rejected? Okay with paying premium on higher side.

Also what health insurance should i get for myself.

Any advice would be greatly appreciated!

I have no knowledge of coverage, loading period, top ups, room rent limit, co-pay etc. And what do they mean.

Father: 56 years old (diabetic)

Mother: 53 years old

Me: 28 years old

I’ve never bought health insurance before and honestly the whole thing feels quite complicated — waiting periods, co-pay, room rent limits, top-ups, cashless claims, exclusions etc.

Trying to understand:

How much cover is actually needed

Individual vs floater

Whether super top-up is useful

Which insurers are reliable during claims

What mistakes first-time buyers should avoid

Would really appreciate advice from people who’ve gone through this themselves.

Thanks.

I had bought this Star health Women Care policy for my wife through Policybazaar. I specifically chose this policy (despite higher premium) because maternity-related coverage was one of the main things highlighted at the time of buying this

My wife is currently pregnant and unfortunately developed a pregnancy-related complication that required multiple hospitalizations so far.

Only when I tried to raise a claim for the first time, the PB guy says pregnancy-related complications are supposedly permanently excluded.

This was never clearly communicated during the sales process.
What frustrates me is that the policy heavily markets things like maternity benefits, delivery expenses, newborn cover etc

So naturally, as a customer, I assumed medically necessary pregnancy-related hospitalization would also be covered unless explicitly told otherwise.
Policybazaar’s defense now is:
“You had 15 days to read the policy wording and cancel.”

My point is:
I didn’t directly buy from Star Health after independently researching the wording document (it’s quite big and too technical for a regular consumer like me). I bought through a broker and relied on their explanation of what the policy practically covers and excludes.

What are my options? I have raised a complaint with IRDAI

Hello,

I need a public view of porting one of family members health policy.

Present Insurer: Niva Bupa Plan: Reassure Inception Year: 2022 Based Sum Assured:5L Sum Assured (inc NCB): 10L Claims: 0 Premium: 24K Age:59

Porting to Insurer: Aditya Birla Plan: Activ One Max+ Based Sum Assured:15L Premium: 34K

I was a bit skeptical of Niva initially, but I feel somewhere down the line after going public their complaint volumes have decreased and products and portfolio have improved. Existing plan seems too outdated. Benefits are restricted.

Lmk your opinion about porting Or migration to Reassure 3.0 is better?

1st Agent Quote

2nd Agent Quote

I am porting from Bajaj Allianz insurance to ICICI Elevate, these are the 2 different quotes i got, i have few questions regarding it,

1. Which one should i choose?
2. Is top up useful (3000) for 50 L
3. Also my old one is expiring by next month first week, can the porting be done within the short period?
4. What else should i consider?

My father, aged 58, had two seizures within a span of three hours. He was initially admitted to a local multispecialty hospital and was later shifted to Yashoda Hospital, Secunderabad, based on their recommendation on the same day. Insurance desk provided all the information requested, but the insurance provider continues to decline the claim, repeatedly asking, “How long have you had the said ailment?” My father experienced seizures for the first time in his life. I was planning to purchase term insurance for myself and my spouse, but after this experience, we have decided not to proceed with this provider.

Elevate, ICICI Lombard.

I have HDFC Ergo my: health Suraksha policy due for renewal in one month. However HDFC has discontinued this product and providing option to migrate current policy to Optima Restore.

I am finding Optima Restore premium substantially expensive thus not interested to migrate to this policy. No other option by HDFC Ergom either. I liked Optima Super Secure but cannot migrate as told by HDFC customer support.

Not sure what to do next.

I (M29) applied for HDFC Ergo Optima Secure+ for myself and my wife(28F). This was through ditto.

• I declared the following PEDs
  • Sinusitis - No Surgery, managed with medication.
  • ADHD - Managed with medication
• My wife declared
  • Generalised Anxiety Disorder - Managed with medication

We received a counter offer where:

• I was declined and was recommended Aarogya Sanjeevni
• Added loading for my wife for anxiety (effectively ~ 42k for 3 years for 25L coverage)

I'm thinking of letting my wife continue with the policy whereas I try to find another one.

The core dilemma right now is who would even insure me with ADHD? I've read accounts of proposals getting rejected for Care Supreme, ABHI Activ One Max.
Anyone who faced similar situation with respect to ADHD?

My mother currently has:

• SBI General Sampoorna Arogya – Group
• ₹5L SI
• Continuous coverage since june 2022 (~ 4 years)
• SBI has issued continuity endorsement confirming no break in coverage.

I am trying to port to Care Supreme ₹10L.

Initially one Care agent told me only the latest year would be considered for continuity because current policy inception date shows 2025 after internal migration.

After multiple emails and sending all policy documents + SBI continuity endorsement, Care officials from official u/careinsurance.com IDs replied:

>

After multiple emails and sending all policy documents + SBI continuity endorsement, Care agents from official .careinsurance.com IDs replied saying:

• portability is allowed,
• continuity benefit of previous SI will be given,
• and acknowledged “4 years seniority from 2022.”

Now my understanding is:

• existing ₹5L should get continuity from 2022 for PED + specific illness waiting periods,
• additional ₹5L should get fresh waiting periods.

Does this sound correct as per standard portability rules?

Also:

• how reliable are such email confirmations if future claim disputes happen?
• once policy is issued with portability accepted, can insurer later deny continuity arbitrarily?
• anything specific I should verify in proposal form / issued policy document before payment?

Would appreciate advice from people who handled portability cases, especially from group policy → retail policy.

After five days without improvement, her doctor recommended that she be transferred to another hospital. She was transferred to CMRI. Approximately 16 hours later, she was dead.

Her son, Kousik Pal, refused to accept this as a simple tragedy and filed a complaint with two facts:

1. The ECHO and ECG that guided her treatment were performed by a doctor and a technician whose medical qualifications were not recognized by India’s medical regulatory bodies.
2. The doctor who wrote stable condition in the discharge summary later admitted to the health commission that it was not a mere clerical mistake.

The state health regulatory commission awarded the family ₹20 lakh in compensation, but the Calcutta HC later cancelled it, saying only medical councils can judge doctors’ qualifications or negligence. In December 2025, the Supreme Court stepped in and restored the compensation, delivering a landmark message for every patient in India.

The Supreme Court held that hospitals cannot hide behind the fact that no negligence was proven when they breach basic regulatory duties. If a hospital hires unqualified staff for critical tests or issues misleading discharge documents, it is legally liable for a deficiency in service.

https://preview.redd.it/yikuvrxkp82h1.jpg?width=736&format=pjpg&auto=webp&s=dd670bc2234d343340346b2438c668f7faa895ed

Don’t hesitate to ask, verify, and insist on it.

Signed up my Mother and Sister for Niva Bupa Reaasure 3.0 Black. Declared illnesses where minor, however during Telecall with Doctor also divulged mother' History of Hepatitis B [contracted and cured 14 years ago] upon enquiry. Was asked to submit USg Abdomen Report, HbvsAg Report and LFT, out of which latter 2 were submitted. Presence of Hepatitis B came negative however AST ALT ratio is slightly high. Niva Bupa mailed counter offer with these permanent exclusions

Other inflammatory liver diseases, Acute delta-(super) infection of hepatitis B carrier, Chronic viral hepatitis B without delta-agent, Chronic viral hepatitis B with delta-agent, Oesophageal varices, Fibrosis and cirrhosis of liver, Acute hepatitis B with delta-agent with hepatic coma, Portal hypertension, Digestive Diseases|Liver|Hepatitis failure, Malignant neoplasm of liver and intrahepatic bile ducts

Any way to bypass this? Do I write an email to them/ how to escalate?

My mother was diagnosed with MOG-associated myelitis after two weeks' of hospitalization on 8th May. The insurance covered approx 87% of the total hospitalization expenses.

She had to re-admitted today for second dose of rituximab, which the doctor adviced to be administered over a two-day period of in patient treatment.

However, my cashless claim was rejected on the following ground:

Rejection reason:

As per submitted documents member got admitted for management of MOG associated myelitis . However, the

proposed line of treatment is clinically not indicated and Unproven. Hence, we regret to inform you that the

cashless facility has been denied

Clause:

Unproven/Experimental treatment means the treatment

including drug experimental therapy which is

not based on established medical practice in India, is

treatment experimental or unproven..

What are the chances of my reimbursement? And what steps should I undertake next?

Hello, Recently ported to HDFC Ergo a few months ago.

Just underwent a master Health Check Up and would like to claim the preventive health check up benifit from my Optima secure insurance.

At the time of purchasing insurance the only PED declared was hypertension. But now in the health checkup which I underwent yesterday the test reports revealed I have Pre Diabetes.

Will it create a problem for me if i reveal the test reports to hdfc ergo or do I just avoid the hassle and pay the health checkup by cash.