Simplest Guide for Health Insurance in India

Sir/Madam,

This is to inform you that Karvy had offered a mediclaim policy under the renowed name of National India Insurance. They had given us a pamphlet stating
*from the very first day of policy login all the disease except AIDS, Heart Transplant, Knee Transplant, will be covered.
*pregnancy cover after nine months will be covered.
*there will be no capping
*emergency situation will be covered.
apart from these other few promises were given

we bought the policy, we got the cards but received no policy bond details or any conditions etc. We asked for the policy but they said its available on the net.. We just relied on there pamphlet and their representative’s word. We kept on asking for the policy but got no response.
Now in an emergency, I got my wife admitted in Metro, informed the agency, and when again contacted the agency they replied, there is a waiting period of three months. They asked me to look for the conditions on net, there is a login password, which I havent recieved yet. So how can i know about condition,. Karvy people are not replying. I am feeling very cheated and frustrated.
I want to know few things,
How can a company sell their plans giving wrong information on their pamphelets?
Can a company say no for the policy hard paper and ask their clients to rely on internet?.
If this will happen, how can an internet unfriendly people will come to know about the policy?
Isnt this a proper case of cheating and fraud?
Please look into the matter, so that these people wont cheat anyone again.

Kavindra Sachan
Sahara Samay News Channel,
9811946797
Noida

My mother took Senior Citizen Red Carpet Policy (Coverage: 2 Lac; P/161119/01/2009/000073) from Star Health. In 2008, when she took policy, she declared that she has Blood Pressure. In March,2010, multiple blocks in her heart was detected and accordingly she underwent open heart surgery. She spent around Rs. 260,000/- in this process. She submitted all the papers to Star Health. Today, I came to know that they have rejected the claim (#8713) and mentioned the reason “patient was symptomatic prior to inception of star policy”.

My mother felt cheated now as she paid hefty amount to these people in last 2 years and they rejected the claim when she really needs it. It looks like Star health Insurance is “only” interested in collecting the insurance (May be, this is the reason for selling it Cheap)?

What is the legal way to handle this issue ? Can anybody guide me ?

Ajay Goel
09840563293

General insurance companies offer health policies which are mainly short term in nature. This means, that the health insurance policies can be renewed year after year and the premium amount varies with age.

Health insurance covers offered under general insurance, include mainly hospitalization covers either on reimbursement or cashless basis. The Third Party Administrators (TPAs) mainly offer cashless service as they have arrangements with various hospitals, who are the service providers. The TPAs also help in reimbursement claims.

To read more see Health Insurance by Life and General Insurance Cos

There are various life insurance companies that offer health benefits and packages. Firstly, the health related policies under life insurance companies cover certain critical illnesses. For example, certain private companies that offer life insurance to customers cover about 36 critical illnesses which include heart attacks, stroke, cancer, paralysis etc. Now this in turn means that once a person visits a doctor for treatment, and if the doctor then after diagnosis confirms a serious illness, then on the basis of the doctor’s report, the insured will get a lump sum amount from the company.

Health Insurance policies by life insurance companies are long term plans (over 10, 20 years and above)

One of the prime ways in which life insurance companies tend to sell health policies are mostly in the form of investment plans. These are essentially known as Health ULIP plans. However the difference in these plans and others lies with regard to:

• the hidden charges which are high ,
• a waiting period of three years before which you cannot claim,
• High premium rates.

To read more see Health Insurance by Life and General Insurance Cos

I have total submitted of total amounting to Claim of Rs.44837/-, but they have disallowed amounting to Rs.24085/- Kindly look into this matter and try to repayment above disallowed amount.

To,

The Hon’ble Magistrate ,
Consumer court,
New Delhi

Sub :Non Receipt of Policy inspite of regular followup

Respected Sir/Madam ,

My name is Ganesh Mal Joshi , Age 56 years is suffering from kidney problem has given to payment Rs. 12468 /- to M/s, Rapid Health care Pvt. Ltd. New Delhi through DD no. 003023 dt 19.04.2010 as premium for making Mediclaim Policy. I am the regular customer of Rapid health care (P) Ltd., Inspite of 18 – 20 times follow up till date they are not giving my policy , on every followup they say that your policy will come within 2 or 3 days.
I have deposite premium amount on 21 april 2010 & my previous policy has to be expired on 01 may 2010 ,I have paid my premium amount well in advance time .

My last Policy Detail are as under -:

Insurance Company – United India Insurance co. Ltd.
Policy No - 222700/48/09/41/00000481
Certificate no. - 3381
Advisor Code - RAP/0048
Covered w.e.f - 01/05/2009 to 30/04/2010

I have pending claim of approx Rs.150000/- , one of my claim I have submitted in Rapid Health care (P) Ltd. office on 28.06.2010 whose acknowledgement has kept in my records.
I have very disappointed to observe the service of M/s, Rapid Health care (P) Ltd. & feel difficult to do cure myself both mentally & financially.

Respected sir/madam you are requested to look into that matter & favour us my rights and justice.

Thanking you Addressof M/s Rapid Health (P) Ltd.
Yours failthfully Contact person -
Ganesh mal Joshi Mr. T.C. Chopra /Savita
410 Padma Tower – I ,
Rajendra Place,
My Address – New Delhi – 110008.
House no. 917 , (Ph.) 011 – 32222252
Sector – 21C , (M) 9811754804 .
Housing Board Colony ,
Faridabad ,
(Ph) 0129 2411227 ,
(M) 09811216884 , 09868855899
Email – snwvmpl@yahoo.co.in , vishvamktg@gmail.com

I have taken an health insurance policy from TATA AIG in june 2010 and on 29 june i have admitted in an 100 bed hospital due food poisoining and after discharge from hospital i am trying to contact those peopel for lodge of my claim but they are nither picking up my phone nor responding my sms and nor responding information given on their website, these people are just harrashing us at the time of booking of policy and force us for that and at the time of genine claim when then a person is suffering from his desease he also suffer for them………. shame on those insurance provider.v9 TATA AIG). please dont take any one policy from this company these are onlt cheater.

Dear Sir,

I have taken One Family Care First Mediclaim Policy of Bajaj Allianz through Destimoney Company. My wife got major Intestinal Suregry in Jan 2010 and I have submitted claim for Reimbursement of Expenses against My Poliy No. 0121316756. My Claim No. is 03104021.

I have submitted all the documnets in original in the first file, Then I received a letter from TPA Mediacre to submit more documents which I have submitted. They are asking now the Original Recipt of Rs. 10,000/- from Jaipur Golden Hospiatl which is misplaced at their end only. However I went to Jaipur Golden Hiospital and requested them to issue me the Receipt once again. The Hospital has issued me the Duplicate Recipt of Rs. 10,000/- which is properly Stamped and Signed by the Hospial Authorities. I have submitted the Recipt to MEDICARe Patel Nagar Office. But now they have sent me a ltter that this Recipt is not Acceptable. They want original one otherwise they will close my claim.

Plrease let me know of once the original receipt got misplaced and even after submiiting the duplicate Receipt whioch is properly signed and stamped is submitted, then why they are not settling my Claim. This clearly indicates taht they are not willing toreimbure my claim.

Hello,

I was about to go through a laproscopy for endometriosis. The reason of the surgery was chronic pain in lower abdomen during menstrual cycles.
Earlier I was taking ayurvedic and homeopathy treatment as pain killers like meftal, meftal spas etc were in-effective for me.
In month of Feb-March 2010, I visited gynecologist in Deenanath Mangeshkar hospital and she advised me to go through laproscopy. For some personal reasons, I started the treatment with some other gynecologist from same department.
During month of June 2010, the endometriotic ceast size grew to 6 cm and it was urgent to do the surgery.
So I applied for my company’s insurance submitting all the required papers for cashless facility.
On the day when my surgery was going on, company/TPA sent rejection letter.
They gave the reason that they do not see any reason for admission.
I was admitted to hospital for 2 days and had 4 stitches. My surgery lasted for 2.5 hours and still the company says that there no reason for admission to the hospital.
Are there any doctors working in TPA? Do they really know anything about medical field?
We had to manage the money and pay the hospital bills of rs. 56000/-

I had similar incidence for my father’s treatment as well. He had hardaz disease, which affects your vision completely. By God’s grace, it was detected in earlier stage and he started with the treatment and recovering from it now.
He had to go through some expensive investigations and later on treatment costing around Rs.8000/-
He is retired from the service so Rs.8000/- is also a good enough amount for him.
He is also covered under my health insurance. So I claimed his medical expenses to same Oriental health insurance.
After 2 weeks, they rejected the claim saying “we cannot see any treatment given under admission. It looks to be mainly for investigation. All the medication is given after admission, which can be taken at home.”
I talked to my office agent and resubmitted the claim. But it got rejected again.

If in case of emergency, the insurance company is going to take us down then what is the use of paying so much premium every year?
We take help of medical insurance so our tension during hospitalization is only our dear and near one’s health and not money. But looks like these companies just find their way for not giving money, even though we pay premium regularly.