Hello Sir, None of the health insurance providers are offering health insurance cover to my spouse who is a breast cancer survivor. I have tried with 4 providers and they have all rejected it. She had the final surgery on dec 2018 and regular checks shows that she is normal. Wanted to check if there is any way out here? I could not take an insurance before as we were outside India and I had a local insurance on that country, now I am back in INDIA and I dont have a cover. Need your advise here.

Ans: Hello, as per the information I have gathered, the floater policy after the kid turns 25yrs will be split into 2 policies.
For eg : You have an existing policy of 10L covering you, your wife and your daughter. Once your daughter turns 25yrs, the company will have to issue 2 policies i.e one for you and wife for 10L and one for your daughter for 10L without any loading charges and without excluding cancer treatments.
If this is not done, you can go to ombudsman to solve your problems with the medical insurance company.

Ans: I'm truly sorry to hear about your husband's health complications and the subsequent challenges with your medical insurance. Facing such situations can be distressing, especially when dealing with unexpected denials and cancellations. It's important to take action to address this issue.

Firstly, gather all relevant documents, including policy details, correspondence with the insurance company, and any communication with the agent. This documentation will be crucial in understanding the reasons for the denial and in any potential appeals or legal actions.

Next, consider reaching out directly to the insurance company to request a review of the decision and clarification on why the claim was rejected. If you're unsatisfied with their response, you may escalate the matter through their grievance redressal mechanism or regulatory authorities.

Additionally, seeking legal advice from a lawyer who specializes in insurance matters could provide insight into your rights and options for recourse. They can help you navigate the complex legal landscape and pursue appropriate action to recover your hard-earned money.

While the situation is undoubtedly challenging, remember that you're not alone. Reach out to consumer rights organizations or advocacy groups that may offer support and guidance in dealing with insurance-related issues. Your perseverance and determination to seek justice are commendable, and I hope you find a resolution that provides the relief and security you deserve.

Ans: Hello;

Before signing up for a healthcare insurance cover you need to understand the permanent and time bound exclusions mentioned in the policy

Also check the black listed hospitals on insurers website and avoid them as far as possible.

Better is to select network hospital and go for cashless facility.

Also before signing up, you need to honestly disclose pre-existing diseases, hereditary history of you near blood relatives in good faith.

This will reduce chances of claim rejection.

For your reference I am sharing names of some health insurers whose incurred claims ratio(ICR) was above 80% in FY-24:

HDFC Ergo
ICICI Lombard
SBI General
Bajaj Allianz
National Insurance

Request you to do your due diligence and seek help from an investment advisor or insurance advisor for further help.

Best wishes;