[ontheway]

Originally Posted by whitesquall

I am hesitant to move from existing insurer to a new insurer as the waiting period clause will come into play afresh.

IRDA introduced health insurance portability for these kind of situations. Just google about it and you will get the details. Explore your preferred insurers with portability of existing policy and compare premiums quoted by them. With portability, you get waiver of waiting periods upto the coverage amount in current policies.

[whitesquall]

Originally Posted by ontheway

IRDA introduced health insurance portability for these kind of situations. Just google about it and you will get the details. Explore your preferred insurers with portability of existing policy and compare premiums quoted by them. With portability, you get waiver of waiting periods upto the coverage amount in current policies.

That's a relief! I will explore and let you know how it goes. Thanks!

[whitesquall]

I couldn't switch! Switching is allowed only if the policy expiry date is between 45 to 60 days and I am left with just 30 days

[JMaruru]

Recently, got to know 'Apollo Munich' has been merged into 'HDFC Ergo'. I have been with 'Apollo Munich' for more than 10+ years now. Had once claimed for 'Dengue' treatment and claim reimbursement was hassle free.

I do NOT know much about 'HDFC' insurance company. Somehow, I did NOT like them when I took the current health policy. I have NEVER considered them for Banking OR Auto Insurance. Now, have been forcibly moved into them, coz of this merger.

How are they as a 'Health Insurance' company? Does anyone here have first hand experience with their 'claim processing' behavior?

[ontheway]

Originally Posted by whitesquall

I couldn't switch! Switching is allowed only if the policy expiry date is between 45 to 60 days and I am left with just 30 days

Yes 45 days is the 'ideal' time. But as per comments by fellow members, people were able to port with only 14 days in hand. As per IRDA, the current insurer has to provide the details to the new insurer within 7 days. After that its upto the efficiency of the new insurer to issue the policy in time. Just FYI new insurer can reject the issue of policy if it has reasons.

Originally Posted by JMaruru

I have NEVER considered them for Banking OR Auto Insurance. Now, have been forcibly moved into them, coz of this merger.

How are they as a 'Health Insurance' company? Does anyone here have first hand experience with their 'claim processing' behavior?

I am also in the same boat. Never liked HDFC, and avoid using it for insurance or banking needs. As per my uderstanding and some search on policybazaar, Apollo Munich has been renamed 'HDFC Ergo Health' and HDFC Ergo's existing business still goes as just HDFC Ergo. Claim settlement ratio is given as 92% for HDFC Ergo Health and 97% for HDFC Ergo (Source: Policybazaar).

No personal experience with them.

[ach1lles]

Hi. I want to get my mother insured. She's bordering on 60. Her insurance was rejected by Apollo Munich last year due to a pre-existing condition.
Has IRDA updated or mandated a policy change about pre-existing conditions in any way? She's a tax payer so it would be better if she carried an independent policy.

If I try any other company, are they privy to this information of rejection? How much weightage would this information carry in their decision to cover my mother?

Thanks.

[ontheway]

Hello fellow members. I need some good advice as how to proceed forward in the below case:

I have a family floater policy with National Insurance Company since 2006 and my current TPA is MDIndia. Recently my younger brother got fever and after multiple visits to 2 family doctors and oral medicines given by them, his situation did not improve. He developed severe constipation and underwent sigmidoscopy procedure (kind of high end anema) after 15 days of suffering with fever and resultant constipation. The gastro doctor gave written advice to get him admitted to hospital as he showed symptoms of typhoid but test reports were normal. Our family doctor also finally adviced hospitalisation as given the long suffering of my brother, she adviced medication for typhoid through IV for fast recovery.

We finally got him admitted to hospital after 15 days of running around and on written advice of 2 doctors. Immediately intimated the TPA through email. The hospital was not network hospital, so its a case of reimbursement.

The TPA MDIndia was lethargic from the starting. Took 9 days just to issue claim ID as acknowledgement of my intimation, insurance company took 50 days to process my claim and finally rejected in on grounds: Admission to hospital which is not medically necessary.

I first submitted my grievance against claim repudiation to insurance company itself. When they did not change their decision, I filed a complaint with Insurance Ombudsman, Delhi. Few days back, I had a hearing at the Ombudsman, where the TPA used some medical terms and insisted that the doctors prescribed hospitalisation unnecessarily. My argument was that I had decided to get the patient admitted to hospital based on written advice of 2 reputed doctors and after running around for 15 days. Why am I made to suffer financially if I acted on faith in the professional advice and the medical condition of my brother was also such that any rational person would agree to hospitalisation. But the Ombudsman was inclined towards the insurance company, given their medical jargon and decided the complaint in their favor.

This has shook my faith in the whole medical insurance scheme, as we pay hefty premiums for these kind of medical expenses only. I still can't understand what I did wrong so as to suffer financially in the current case.

Anyhow, now I am contemplating whether to move for consumer court as now it has become more about justice than money.

If any of you have any experience with consumer courts in these scenarios, or whether it would be worth my time and effort, please comment and advice.

[vDragon3]

Originally Posted by ontheway

If any of you have any experience with consumer courts in these scenarios, or whether it would be worth my time and effort, please comment and advice.

Before I put in my views, Disclaimer: I do not have any personal experience in the situation stated above. I happen to hear a similar situation so thought below points might help you.

You already have a written advice from 2 of your doctors that hospitalization is necessary. That is the first piece of evidence against admission not required. Suggest to review the discharge summary as well that may provide the conditions, evidences of the patient before hospitalization. 1st option, if you could find anything to support your argument such as body temperature during admission etc. try to have a discussion with the Insurance ombudsman one more time, as their decision is final and binding. 2nd option is to register a complaint with IRDAI, but again they will redirect only to the company and ombudsman. Give a try if you feel so. 3rd option, some Google reviews shows https://www.insurancesamadhan.com is successful in such situations. Again, do research about them if they are good enough and proceed.

If you still feel cheated by the company then try to port your policy with other company.

[ontheway]

Originally Posted by vDragon3

You already have a written advice from 2 of your doctors that hospitalization is necessary. That is the first piece of evidence against admission not required. 3rd option, some Google reviews shows https://www.insurancesamadhan.com is successful in such situations. Again, do research about them if they are good enough and proceed.

Thank you for your views. Option 1 and 2 are no longer feasible, because as per the decision letter received from the Ombudsman, they have specifically stated that 'no further communication will be entertained or responded to'. IRDA complaint portal is also rarely effective, as all they do is just forward the complaint to the insurer.

My basic belief is that I acted on the written advice of 2 doctors. Then why should I prove to the insurance company that hospitalisation was necessary. If they have any doubts, they should directly contact the doctors, so that they can have proper conversation in purely medical terms.

In the profit oriented business approach of hospitals and unprofessional insurance companies, it is the premium paying policyholders who most suffer.

Insurancesamadhaan website seems promising and would surely investigate further. Thanks for suggesting the same.

[laluks]

I got a shocker today on receiving our Health insurance premium renewal notice. It was 38K last year, no claims at all so far. The renewal premium sent to me without any additional noteworthy benefits or increased coverage is 58K. That is at least a 50% hike in premium. I made a soft call to their customer care to know what is going on. I am being informed about some IRDAI changes and such things. I raised a dispute and asked some senior to contact me to talk and understand what is going on.

Did something happen at the IRDAI front? This is a health policy from Max Bupa, running since some 10 years, with every year a premium increase under 10% so far

[vinit.merchant]

Originally Posted by laluks

I got a shocker today

A trick resorted to by the service providers.
Did the same with my parents policy. Since they do not want to continue with the customer, they increased the premium to 2.5 times and made it unfeasible. Happened when my father crossed the age of 70.

Makes me wonder whether I should really continue with the health policy, since there are high chances they will do the same thing when I age and need the policy the most.

[vDragon3]

Originally Posted by laluks

Did something happen at the IRDAI front?

IRDAI is trying to standardise the exclusions that will be common across all insurers. So that means Max can no longer deny claims for such cases. So the risk and the premium increases as well. This circular was issued last year and 1 year time was given for all to make those changes.Deadline for implementation is only during September I suppose. 50% increase is pretty high. There are certain age slabs like when you cross 45/ 60 years then premium rise considerably. If you feel it is high then try to port out to another insurer. In case you continue make sure those exclusions are promptly updated.

[slicvic]

Originally Posted by vinit.merchant

A trick resorted to by the service providers.
Did the same with my parents policy. Since they do not want to continue with the customer, they increased the premium to 2.5 times and made it unfeasible. Happened when my father crossed the age of 70.

Sorry for being such a noob, but aren't the policy premiuim's frozen at an amount until the end of the policy term ?

[laluks]

Originally Posted by slicvic

Sorry for being such a noob, but aren't the policy premiuim's frozen at an amount until the end of the policy term ?

This is health insurance premium, which increases every year as you age. Life insurance premiums mostly stay the same as per the initial commitments.

[The Rationalist]

Originally Posted by laluks

I got a shocker today on receiving our Health insurance premium renewal notice. That is at least a 50% hike in premium.Did something happen at the IRDAI front?

Yep, IRDA has suggested some changes and premium was expected to increase by upto 25%. But your’s is way too high. Did you jump into higher age bracket, for example from 36-40 to 41-46 or so?