Star Health Insurance - Renew or Port ?

[sjmajumder]

It was RBIO all till date. Its gonna be a new person to my life from next month. Insurance Ombudsman 🤣🤣

I have 3 (out of 3) success stories with Insurance Ombudsman in 2011-2012. Since then UIIC & Heritage didn't dare to deduct anything illegitimately. In fact, since then they have paid some items which are non-payable, like sample collection charge 🙂

The only issue I face now is my claims take longer to settle as I have become so famous they don't release any of my claims without an audit.

P.S. I did away with my 20 year old UIIC policy and moved to ICICI this year as their policies lacked modern features and was very expensive at the same time.

 

[sjmajumder]

Which one should I consider to port to?

In my view HDFC is best closely followed by ICICI. You should check IRDA website for claim settlement ratio before porting.

 

[drvirag]

Which one should I consider to port to?

Hdfc or tata

 

[drvirag]

Icici hs less network hospitals plus dere claim settlement is also less bt its cheaper dan both hdfc n tata. Hdfc being best n costliest. Few things depend on personal choice u want or nt so download policy wordings or u cn ask dem dey will mail u. read policy documents urself n decide urself.

 

[Tonymathew]

Icici hs less network hospitals plus dere claim settlement is also less bt its cheaper dan both hdfc n tata. Hdfc being best n costliest

Understood.. hdfc optima secure is now the consensus. Though double the premium of star. Will consider seriously ✌️✌️

 

[drvirag]

Yes hdfc is costly. More costly dan u think. Compare price at 50 yr 55yr 60 yr. Den u ll come to know difference. Coz at dat age u wont b able to port. Bt hs gud review n dere settlement is also very gud.

 

[Tonymathew]

@drvirag .. any idea on psu like new India assurance? My mom has it.. at 60y. Settled almost 90-95% of the amt all the time.. I overlooked it always.. any idea on New India Assurance

 

[hender]

I have 3 (out of 3) success stories with Insurance Ombudsman in 2011-2012. Since then UIIC & Heritage didn't dare to deduct anything illegitimately. In fact, since then they have paid some items which are non-payable, like sample collection charge 🙂

The only issue I face now is my claims take longer to settle as I have become so famous they don't release any of my claims without an audit.

P.S. I did away with my 20 year old UIIC policy and moved to ICICI this year as their policies lacked modern features and was very expensive at the same time.

Sir - What's the Class Time.
👏🙏

 

[drvirag]

@drvirag .. any idea on psu like new India assurance? My mom has it.. at 60y. Settled almost 90-95% of the amt all the time.. I overlooked it always.. any idea on New India Assurance

If u dont have problm in visiting dere office or tpa office. Coz cashless hospitals r less. So u hv to pay n den dey will pass n pay u. Dey r very gud if u r ok wid it.

 

[Tonymathew]

If u dont have problm in visiting dere office or tpa office. Coz cashless hospitals r less. So u hv to pay n den dey will pass n pay u. Dey r very gud if u r ok wid it.

I think I will visit. As my family have a good track with them...

 

[sjmajumder]

If u dont have problm in visiting dere office or tpa office. Coz cashless hospitals r less. So u hv to pay n den dey will pass n pay u. Dey r very gud if u r ok wid it.

Don't worry if you are living in a metro. All major hospitals are part of PPN network.

 

[Tonymathew]

Don't worry if you are living in a metro. All major hospitals are part of PPN network.

Nop. Not in metro. Tier 3 city

 

[Tonymathew]

Got the mail from grievance team of star health.

As expected, rejected on account of 'T&C'.

Now will go the Ombudsman way.

 

[sjmajumder]

Got the mail from grievance team of star health.

As expected, rejected on account of 'T&C'.

Can you share the details?

 

[Tonymathew]

Can you share the details?

@sjmajumder

I have a Young star policy of 10L
I took it when I was 28 y old. Now 30.

3 w back, I had to undergo a surgery for my shoulder labrum rupture repair, bicipetal tenodesis and corrective surgery for severe AC joint arthritis. All on right shoulder.

I opted for cashless claim. The entire bill came to 2.495 lakhs. Star sanctioned 2.13 lakh. Had to pay 36500 from hand. Under the remark section they noted 20600 was deducted from ortho implants due to lack of invoice provided by the hospital.

Hence, after the discharge, I got the implant invoice from the hospital store, and submitted at the Star health office for reimbursement, along with prehospital, post hospital and hospital wellness benefit.

After 1 week, they approved the prehopital and post hospital expenses amount of 2.3k against actual of 3.9k, again citing several deductions, and wellness benefit of 1000 per day for 3 days= 3000.

However they did not consider the reimbursement of the implant, despite attaching it's invoice, stating that I did not fill that particular part of the claim form.

Hence, raised a request to grievance redressal. Let's see how they reply.

Today recieved the mail from grievance dept, as follows.

"On review of your grievance, our medical panel has observed that the net claim amount was settled after deducting the charges towards non-payable items and consumables, as per the policy terms and conditions.
Please be assured that our decision is based on the terms and conditions of the policy and our claim settlement is in order.

In case you are not satisfied with this decision, please click here to refer your grievance to Insurance Ombudsman -
https://www.cioins.co.in/ombudsman".

That is the status as of now..

 

[drvirag]

@sjmajumder

I have a Young star policy of 10L
I took it when I was 28 y old. Now 30.

3 w back, I had to undergo a surgery for my shoulder labrum rupture repair, bicipetal tenodesis and corrective surgery for severe AC joint arthritis. All on right shoulder.

I opted for cashless claim. The entire bill came to 2.495 lakhs. Star sanctioned 2.13 lakh. Had to pay 36500 from hand. Under the remark section they noted 20600 was deducted from ortho implants due to lack of invoice provided by the hospital.

Hence, after the discharge, I got the implant invoice from the hospital store, and submitted at the Star health office for reimbursement, along with prehospital, post hospital and hospital wellness benefit.

After 1 week, they approved the prehopital and post hospital expenses amount of 2.3k against actual of 3.9k, again citing several deductions, and wellness benefit of 1000 per day for 3 days= 3000.

However they did not consider the reimbursement of the implant, despite attaching it's invoice, stating that I did not fill that particular part of the claim form.

Hence, raised a request to grievance redressal. Let's see how they reply.

Today recieved the mail from grievance dept, as follows.

"On review of your grievance, our medical panel has observed that the net claim amount was settled after deducting the charges towards non-payable items and consumables, as per the policy terms and conditions.
Please be assured that our decision is based on the terms and conditions of the policy and our claim settlement is in order.

In case you are not satisfied with this decision, please click here to refer your grievance to Insurance Ombudsman -
https://www.cioins.co.in/ombudsman".

That is the status as of now..

If they hv deducted for non payable item n consumables n it is not included in ur policy u wont get anything more. Even if u go to Ombudsman or consumer court.

 

[Tonymathew]

If they hv deducted for non payable item n consumables n it is not included in ur policy u wont get anything more. Even if u go to Ombudsman or consumer court.

Out of the deduction of 36k, 20600 was for implant, citing maximum limit reached' citing no invoice attached. Once I had submitted the invoice, how can they categorise the implant under consumables or non-payable? No such clause under my policy.

 

[sjmajumder]

Out of the deduction of 36k, 20600 was for implant, citing maximum limit reached' citing no invoice attached. Once I had submitted the invoice, how can they categorise the implant under consumables or non-payable? No such clause under my policy.

Implants are generally payable. Hospital/you need to provide invoice and sticker with serial number and in some cases box too. Check if there is a sub limit on the category/implant. If not, go ahead and complaint to Ombudsman online.

Assuming the response is from insurance company and not TPA. In case it is from TPA you first need to complaint to grievance redressal of insurance company before reaching out to Insurance Ombudsman.

 

[Tonymathew]

Implants are generally payable. Hospital/you need to provide invoice and sticker with serial number and in some cases box too. Check if there is a sub limit on the category/implant. If not, go ahead and complaint to Ombudsman online.

Assuming the response is from insurance company and not TPA. In case it is from TPA you first need to complaint to grievance redressal of insurance company before reaching out to Insurance Ombudsman.

The reply that I recieved today is from the grievance redressal officer of STAR.

I had replied them again to reconsider. However, will be approaching Ombudsman simultaneously

 

[anujdit]

@drvirag .. any idea on psu like new India assurance? My mom has it.. at 60y. Settled almost 90-95% of the amt all the time.. I overlooked it always.. any idea on New India Assurance

New India insurance has room rent limit (1-1.5%) and sub-limit of different operation/surgery (Cataract etc). Please go through the policy carefully. I would recommend to port to HDFC Optima secure as chances of health issues are high at this age and better to pay higher premium to get claims.

Take a example: If you pay 60-70k premium every year and in 5 yrs you get claim of 4-5 lakhs then also it is saving.