r/indiahealthinsurance

Hi, I’m a 29F with no pre-existing diseases and no dependents currently. I already have a ₹7L corporate health insurance cover from my employer.
I’m planning to take a personal health insurance plan (HDFC Ergo Optima Secure via Ditto), but I’m confused about how much coverage I should go for.
Given that I already have corporate insurance, what would be an ideal additional cover amount? Should I still go for something like ₹10L, ₹20L, or higher?

Would really appreciate advice based on your experience or any factors I should consider.

Applied for health insurance with HDFC ERGO. Declared all PED honestly.

They rejected my application citing Gilbert syndrome and posterior pharyngeal wall congestion.

I’m confused because these aren’t really serious diseases, more like mild conditions.

They suggested I apply for Arogya Sanjeevani (₹5L cover), but I was aiming for a regular comprehensive plan.

Has anyone faced something similar? What are my options now - try other insurers or just go with Arogya Sanjeevani?

For six years, Sevashankar Agrawa paid every premium to Star Health Insurance on time. When his wife, Meena, was diagnosed with breast cancer, he thanked God for the Family Health Optima policy. The document said his cover had grown to a substantial ₹16.5 lakh thanks to a no-claim bonus.

He was wrong. Horribly wrong.

As Meena Agrawal underwent grueling chemotherapy and immunotherapy at Mumbai’s Kokilaben Hospital, the bills piled up to nearly ₹19 lakh.

Star Health had a surprise waiting.

Tucked away on page 7 of the policy document (Exhibit OP-09) was a sub-limit clause. It stated that for Immunotherapy - Monoclonal Antibody to be given as an injection, the maximum payable was ₹4 lakh for the entire policy year.

When the family exhausted that ₹4 lakh limit in the first few claims, the insurer said - NOT PAYABLE - IMMUNOTHERAPY SUBLIMIT EXHAUSTED.

When Sevashankar approached the District Consumer Commission, he kept saying that they paid only ₹7.5 lakh out of ₹19 lakh. This is a deficiency in service.  He did not consult with an insurance-legal expert. He expected the court to side with him because he was the victim.

The Chhattisgarh State Commission did not.

The appeal was dismissed, as the court upheld that a clear, specific sub-limit is legally enforceable, even if it leaves a cancer patient bankrupt. The insurer was not found guilty of deficiency in service because the dispute was about the interpretation of a policy term, and not about malafide delay or fraud.

Don’t be Sevashankar Agrawal. Read the fine print before the fine print reads you.

Hi Everyone,

I’m looking for some guidance from people who’ve dealt with major surgeries and cashless insurance claims.

I have a planned surgery coming up at Apollo Hospitals for my father.

The hospital’s TPA team submitted a cashless claim to my insurance provider (corporate policy), and we’ve received a pre-approval for only about 60% of the estimated cost.

Now the hospital is asking us to deposit the remaining 40% upfront, saying that once the final bill is submitted and the claim is fully processed, they’ll refund any excess amount depending on what the insurance ultimately approves.

This is obviously a huge amount of money, so I want to make sure we’re doing the right thing.

I had a few questions for anyone who has gone through something similar:

1. Is this the standard procedure when pre-approvals are low?
2. Did you have to pay a large deposit upfront even under a cashless policy?
3. What written confirmations should I get from the hospital before paying the deposit?
4. What documents or email confirmations should I insist on?
5. Any red flags to watch out for from hospital billing or TPA teams?
6. Are there common charges in transplant surgeries that insurance typically rejects?

Also, if anyone has experience specifically with transplants and insurance claims, I’d really appreciate any insights or things to watch out for.

Thanks in advance for any help—this is a stressful situation and I just want to make sure we’re making informed decisions.

TL;DR:
Father has a planned transplant surgery at Apollo Hospitals. Insurance (corporate policy) has given only ~60% pre-approval under cashless. Hospital is asking us to deposit the remaining 40% upfront, saying excess will be refunded after final claim settlement. Looking for experiences on whether this is standard, how deposits/refunds usually work, what documents to secure, and what costs insurance typically rejects.

I have a health policy from HDFC Ergo since 2015 and had no PED at that time.5 months ago I started taking medication for BP.How do i declare this now after I have already renewed the policy for current year? Will any claims from now be rejected due to non declaration?

Considering porting health insurance for my parents (Father 69, Mother 64)

Living in tier 1 city, India.

Currently, they have 10L (independent) cover from HDFC Ergo for the last 3-4 years.

Given this, I don't think pre-existing diseases clause should matter that much as I'd be porting the insurance (please correct me if I'm wrong here).

Reasons for porting:

I'm looking for something for a higher cover and a bit less premium. I know, this is not a realistic combination but I'm fine with a copay option or options like anything under 2-3L will be covered by me entirely and anything beyond that will be covered by the insurer (one of my friends took this for himself, he's 30M, I'm not sure if any such options would be available for senior citizens).

Please let me know if there are any decent options available.

I would not prefer to compromise on claim settlement rations and other important factors.

Current premium:

Mother: 45k per year (optima restore, took 3 year policy)

Father: 72k/year (energy silver - bp pre existing, renewing this policy for 3+ years). HDFC isn't allowing internal migration to optima plans.

Please do suggest.

Thanks 🙏

Hi, I am working in Coimbatore, Tamil Nadu. I am looking for an insurance for my parents with pre existing conditions

Father - No Pre-existing Conditions

Mother - Diabetic and BP Patient taking medicines

Looking for good insurance with no copay and single room coverage with good cashless network coverage. The policy should cover fractures, ENT and Master health checkup for both every year.

TIA

​

Hi all,

Last year, Ditto Insurance suggested I move my parents (64M, 62F) from Manipal Sigma (/₹57K) to Care Supreme (/₹66K). I agreed mainly because they promised strong claim support if issues arise.

Now I’m second guessing after reading mixed reviews.

Current Policy (Care Supreme):

- ₹15L floater

- No room rent / ICU limit

Key Features:

- Hospitalization + daycare cover

- Pre (60 days) + Post (180 days) hospitalization

- AYUSH + domiciliary (home treatment)

- Organ donor + ambulance cover

- Unlimited recharge of sum insured

- Advanced treatments (robotic, immunotherapy etc.)

- Annual health check-up + e-consult

Add-ons I’ve taken (main premium jump):

- Claim Shield (covers consumables)

- Plus Benefit (extra buffer after SI)

- Wellness / health programs

Waiting periods:

- PED: up to 36 months

- Named ailments: 24 months

Concern:

Paying ~₹9K extra vs Manipal, but reviews of Care are mixed. Ditto says they’ll handle claim escalations.

---

Questions:

1. Is Care + Ditto support better than a “cleaner” insurer?

2. Are features like unlimited recharge + claim shield actually useful in real claims?

3. Anyone with actual claim experience (especially large claims) with Care?

4. Continue or reconsider switching?

---

TL;DR:

Switched parents’ policy from Manipal Sigma to Care Supreme (₹57K → ₹66K) based on Ditto’s claim support promise. Features look strong, but reviews are mixed. Continue or rethink?

Hi all,

I have Star health comprehensive policy for my parents. My mother (62F) was hospitalised due to flare of auto immune disease she is having and we have availed cashless option. But star health processed 90k from 1.14l claim (approx 21%). Should I mail them for a challenge and clarification on why they deducted so much amount. They have deducted under following heads : -

1. 4.3k under Consumables

2. 5.9k under RMO General Physician fee + Dietician charge

3. 8.675k under Care hygiene and infection control charge + diet charge + medical history assessment

4. 5.140k under Vitamin B12, Folate serum, blood sugar, CRP test

Total 24.027k

I feel this is very unfair of them. I have been paying premiums since last 6 years. Kindly guide me on how to contest these charges and which heads have maximum probability of reimbursement by them.

Is it better to take another policy with larger SI than taking a super top? What are the downsides of taking a super top up? [I have a 20 L base coverage and 5 L corporate coverage].

I'm 27, no pre-existing disease. I took insurance of 10 SI at the age of 23. I have accumulated 4L NCB over the years. Now I have realised that the X company features are not good and want to Port to Y company for the same Sum Insured.

But, the Y Company is quoting me 2X the standard premium rate for porting. their standard premium rate is half of the rate they are quoting.

question:

Is this normal?

Is there a way to negotiate?

As the title says, I am looking for the best and most efficient parental insurance. I am really not into this; I had company insurance, but it's expensive and has a very low sum insured. My father has hypertension at a borderline level and recently had a knee replacement.

My mother has diabetes, and two years ago, she underwent a femur fracture. Recently, my father had robotic TKR, and my insurance only covers 50% copay of the sum insured, from which I only received 1 lakh from the total bill amount. So, my corporate insurance is the worst. Hence, I am looking to buy outside with a decent sum insured. Please suggest or share your best ideas or plans. Thanks in advance.

I'm a 26F. I'm married recently. I've been asking my parents to take Health insurance but they've been reluctant. Finally convinced them.

I'm a corporate employee and I am insured for a sum of 3L per year as an employee of the organisation.

I also have an option to include my parents in the Voluntary Parental Insurance.

Is it good to go with corporate parental insurance or is it good to take an insurance outside the organization.

Main concern for me is that my dad has been a smoker since 25+ years. He doesn't quit smoking. I'm worried about his health.

I once contacted Ditto and told them all the history of dad's medical conditions. They straight away told there is no insurance for him.

Could someone please help here.

Dad is 54 years old and mom is 49 years old.

Any suggestions and personal experiences would be of great help. Thank you.

Hi Everyone,

I’m looking for urgent advice on a health insurance policy for my father. we’ve recently hit a roadblock regarding his treatment costs.

Medical History & Context:

Initial Diagnosis: Diagnosed ~13 years ago, originally with Ocular Myasthenia Gravis.

Progression: About 5–6 years ago, it progressed to his left arms.

Current Status: He has been on long-term medication, but after a recent Neostigmine test confirmed the MG status recently, he is now undergoing Rituximab (Rituxirel) infusions. It hasn't been officially labeled as "generalized" yet, but it has clearly moved beyond just ocular.

The Financial/Insurance Problem:

Treatment: He needs 500mg Rituximab infusions twice a year.Its cost around 40k+ each including hospitalization charges in our area.

Waiting Periods: Most standard policies have a 2–4 year waiting period for Pre-Existing Diseases (PED). Given he is already starting the infusion cycle, we cannot wait years for coverage.

What I’m looking for:

Low Waiting Period: Are there specific policies or "PED Reduction Riders" that actually work for a long-term autoimmune condition like MG from atleast month 6 or year 1?

Biologics/Modern Treatment Coverage: Since Rituximab is a biologic, I need a plan that covers these infusions up to the full Sum Insured. I’ve heard many plans have "sub-limits" or caps on modern treatments—I need to avoid those.

My Questions:

Has anyone with a long-term (10+ years) chronic condition successfully used a PED reduction rider for immediate claims for autoimmune condition infusions?

Which insurers are "smooth" with the underwriting for Myasthenia Gravis? We want to declare the 13-year history 100% upfront to avoid any future claim rejections.

Has anyone successfully claimed for Rituximab specifically? Did the insurer try to label it as "experimental" or "outpatient"?

Any leads on specific plans, riders, or specialized brokers who handle high-risk/chronic underwriting would be a huge help. Thanks in advance!

I honestly never thought I would be writing something like this, but I just want to share my experience so that maybe someone else can avoid going through the same frustration and disappointment.

A few weeks ago, I was hospitalized for 4 days due to Enteric Fever (Typhoid). It was not some minor fever that could be managed at home. I had a persistent high fever with chills, vomiting, extreme weakness, dehydration, and could barely eat or function properly. My reports showed positive blood culture for Salmonella Typhi, positive Typhoid IgM, enlarged spleen, and I was put on IV antibiotics and continuous monitoring by doctors.

During my hospitalization, Star Health’s own representative/doctor visited the hospital, checked my reports, spoke with the treating doctors, reviewed my condition, and at that time, there was absolutely no issue raised regarding the admission. Naturally, I felt relieved thinking that at least the insurance process was going smoothly during an already stressful situation.

But after discharge, they rejected my claim, saying my “vitals were normal” and that hospitalization was “not medically necessary”.

I genuinely cannot explain how upsetting and helpless this feels. When you are sick, scared, physically weak, and already dealing with hospital expenses, the last thing you expect is your insurance company trying to find reasons to deny support. What is the point of paying premiums regularly for years if, during an actual medical emergency, they simply look for excuses to reject claims?

What hurts even more is the contradiction. Their own representative saw my condition in the hospital and did not object to the treatment or admission. But now, suddenly, the company is saying hospitalization was unnecessary. It honestly feels unfair and extremely misleading.

This entire experience has seriously damaged my trust in health insurance companies, especially Star Health Insurance. I worked hard to pay for this policy, believing it would protect me during difficult times, but instead it added more stress when I needed support the most.

Just mentioning my experience here so that anyone planning to buy their insurance can think carefully and not waste their hard-earned money as I did. Please research properly before choosing Star Health Insurance.

I am planning to buy a comprehensive health insurance policy, preferably HDFC Ergo Optima Secure, but I am getting mixed inputs from advisors and wanted some clarity from people with real experience.

Background:

I had a hydatid cyst in the liver which was treated surgically in 2021

No ongoing issues since then and currently stable

No major health problems otherwise

One advisor mentioned that HDFC Ergo and Niva bupa will reject the application due to past liver related history and he had spoken with some underwriter somewhere, while another suggested they might still consider it with loading or exclusions

I have a few questions:

Has anyone with a similar past condition such as liver cyst or surgery been accepted by HDFC Ergo?

Do insurers usually reject outright or offer with exclusions waiting periods or higher premium?

Should I try applying to HDFC first or go with more flexible insurers like Care or Niva Bupa

Does a rejection from one insurer affect chances with others

I am okay with reasonable exclusions or loading, just trying to avoid unnecessary rejections and make a smart decision

Any real experiences or guidance would be really helpful. Thanks in advance