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Steps to Follow while Filing a Complaint against Health Insurer

There are times when you might get unsatisfied with the services provided by your insurer. During this situation, you can approach the IRDAI for a solution. The insurance regulator can be approached in different ways to escalate an issue.
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IRDA has laid down a Turnaround Time (TAT) for the various services rendered by insurance providers to the insured. This rule has been stipulated under the IRDA Protection of Policyholders’ Interests (PPHI) Regulations, 2002. A maximum turnaround time has been set for life insurance companies as well as general insurance companies, based on the type of service or grievance redressal provided by the company.

In the event that the insurance provider does not provide a service or resolve a grievance within the stipulated date, the policyholder can approach the IRDA for a solution. The complaint can be escalated and the IRDA will help resolve the dispute with the insurance provider. In case an adjudication and/ or enquiry is required for the same, the policyholder will have to approach the Consumer Court or Consumer Forum.

Complaint Against Health Insurance Company

Process of Lodging a Complaint against a Health Insurance Company:

Before lodging a complaint against the health insurance provider, the policyholder has to approach the Grievance Redressal Office of the branch. The complaint has to be given in writing with associated documentation. A written acknowledgement will be given to you along with the date of submission of the complaint. Generally, the insurance provider has to resolve the grievance within 15 days. In case this does not happen, the issue can be escalated to the IRDA.

In order to lodge a complaint against a health insurance provider with the IRDA, the policyholder has to get in touch with the Grievance Redressal Cell of the Consumer Affairs Department of IRDA via email or customer care helpline. Once the complaint is lodged, you can use the Integrated Grievance Management System offered by the IRDA to monitor your complaint and its progress. The policyholder can also contact the Insurance Regulatory and Development Authority via letter or fax.

The maximum TAT (Turn Around Time) on complaints/ requests/ grievances related to some of the services offered by health insurance companies are as follows:

Service Rendered Maximum Turn Around Time
Processing the proposal, issue of policy or cancellation of policy 15 days
Obtaining a copy of the policy proposal 30 days
Service requests for errors or refund or NCB (No Claim Bonus) related service requests 10 days
Related to Annuity, Surrender value 10 days
Survival Benefit, Maturity Claim or penal interest not paid 15 days
Raising claim requirements after registering a claim 15 days
Death Claim settlement without investigation requirement 30 days
Death Claim repudiation or settlement with investigation requirement 6 months
Acknowledging a grievance 3 days
Resolving a grievance 15 days

First, contact the grievance cell or helpdesk of your health insurance company regarding your issue. If it’s not resolved within the TAT listed, you can escalate the issue to IRDA. Following are the contact details of some of the leading health insurance providers in India. .

Contact Details of Grievance Cell of Health Insurers:

Insurance Provider Email ID
Oriental Insurance Company csd@orientalinsurance.co.in
Cholamandalam MS General Insurance customercare@cholams.murugappa.com
Star Health Insurance complaints@starhealth.in
Bajaj Allianz Health Insurance customercare@bajajallianz.co.in
Religare Health Insurance customerfirst@religarehealthinsurance.com
Bharti AXA Health Insurance customer.service@bharti-axagi.co.in
Apollo Munich Health Insurance customerservice@apollomunichinsurance.com
Cigna TTK Health Insurance customercare@cignattk.in
HDFC Ergo Health Insurance care@hdfcergo.com
IFFCO Tokio Health Insurance websupport@iffcotokio.co.in
L & T Health Insurance help@ltinsurance.com
Max Bupa Health Insurance customerfirst@maxbupa.com
New India Health Insurance customercare.ho@newindia.co.in
Universal Sompo Health Insurance contactus@universalsompo.com
ICICI Lombard Health Insurance grievance@icicilombard.com
National Health Insurance 100000@nic.co.in
Oriental Health Insurance csd@orientalinsurance.co.in
Reliance Health Insurance rgicl.grievances@relianceada.com
Royal Sundaram Health Insurance customer.services@royalsundaram.in
SBI Health Insurance customer.care@sbigeneral.in
TATA AIG Health Insurance helpdesk@tata-aig.com
Future Generali Health Insurance care@futuregenerali.in
United India Health Insurance grievance@uiic.co.in
Agriculture Insurance Company of India Ltd. aicho@aicofindia.com
Raheja QBE Insurance complaint@rahejaqbe.com
Export Credit Guarantee Corporation Limited grievances@ecgc.in

Contact Details for Grievance Redressal Cell of the Consumer Affairs Department of IRDA:

Toll Free Number 1800 4254 732/ 155255
E-mail ID complaints@irda.gov.in
Postal Address Consumer Affairs Department Insurance Regulatory and Development Authority, 3-5-817/818, 9th Floor, United India Towers, Hyderguda, Basheerbagh Hyderabad – 500 029
Fax 040-66789768

Channels for Lodging a Complaint:

These are the main channels for lodging a complaint - the Insurance Ombudsman, the Integrated Grievance Management System and the Consumer Court. These are explained below:

Insurance Ombudsman:

You can seek the assistance of the Insurance Ombudsman in order to escalate an issue which has not been resolved by the insurance provider. You can file a complaint with the Insurance Ombudsman under the following conditions:

  • Your claim has been partially or wholly rejected.
  • You have not received your policy after payment of premium.
  • There is delay in claim settlement
  • There is a dispute regarding premium payable/ premium paid.
  • There is a dispute regarding the terms and conditions specified in the Policy Schedule.

Integrated Grievance Management System:

IRDA had introduced the Integrated Grievance Management System as an online platform where the policyholders having a grievance or dispute with an insurance provider can escalate the same. You can register a complaint as well as track its progress using this system. This grievance redressal and monitoring tools helps the IRDA to provide a centralized access to the policyholder and to classify complaints based on predefined norms.

Under this system, complaints are assigned a unique complaint ID and is assigned to concerned departments for resolution. This helps to monitor market conduct issues as well. This also assigns Turnaround Times (TATs) for all complaints registered and sets up alerts for pending tasks. The system ensures efficient complaint resolution with rule based workflows and detailed reports.

Consumer Court:

If the complaint has still not been resolved, you can register the same with the consumer court. The consumer court has a separate department to handle health insurance grievances, especially those arising out of Unfair Trade Practice/ malpractice/ service issues.

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

How to Lodge a Complaint against Health Insurance Company? Reviews

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  • Royal Sundaram Health Insurance
    "Not happy with the service"
    0.5 2.5/5 "Just OK"
    I opened a health insurance policy in royal Sundaram in July 2017. 3 months over but till now I have not received my health policy documents. I gave complaint in customer care & they told they will send it again. I waited for one more month but I didn't receive it. I have given complaint almost 4 times. For calling customer care also they will charge Rs2 per minute.
    Was this review helpful? 0
    , bangalore
    Reviewed on Oct 11, 2017
  • Cigna TTK Health Insurance
    "Document and Claim Related query"
    0.5 1.5/5 "Bad"
    Hello, I bought a cigna ttk policy. on may 10 2016 . But my policy start date is may 30. 2016. Above is document and policy issue complaint. Again a file claim in july 16 but my claim statement in 75 days after mail from U.S head office. Because I many email and call in India office but no any one give me proper answer. so I send US head office a mail after send mail my claim settle in 10 days. Indian office worker is very poor service. Thanks Satyapal Yadav
    Was this review helpful? 1
    , mumbai
    Reviewed on Jan 12, 2017
  • Max Bupa Health Insurance
    "WORST SERVICE"
    0.5 0.5/5 "Unacceptable"
    I have taken 2 policies of Max Bupa through Ratnakar Bank. They told that the premium wont increase and it will remail the same life long irrespective of the age. I took the policy. Next year, i didnt receive any SMS, e-mail or Letter for renewal. I had to followup with ratnakar bank and call the customer care every now and then for the renewal. Further, on renewal they increased the Premium amount by Rs. 4000/- stating that all companies have increased the rates. This is the worst service i received from any insurance company. With no time left i had to renew the policy. I had lodged the complaint, but no solution of the same. Worst Company i have ever seen.
    Was this review helpful? 1
    , thane
    Reviewed on Jan 04, 2017
  • HDFC Ergo Health Insurance
    "Good but not the best"
    0.5 4.0/5 "Great!"
    Though HDFC ERGO is very good, they dont provide proper information. I did not get any ID card and they were not providing a proper response too. I had raised a complaint I was told that they would be debiting some EMI too. Finally, they confirmed that there is no EMI confirmation and I had to pay the full amount.
    Was this review helpful? 1
    , bangalore
    Reviewed on Dec 07, 2016
  • Religare Health Insurance
    "Delayed policy document "
    0.5 1.0/5 "Really Bad"
    Taken RELIGARESuper top up plan for my mother who has no health issues, through CoverFox portal. They have said in the posting that SUPER TOP UP is for Sum Assured-SA is for 6 Lacs. When I Made the payment SA came out only 3 Lacs (excluding the Basic Cover of 3 Lacs). Religare / CoverFox are misleading the customers by hiding the Actual Sum Assured of Super Top plans, on the Site. Also, they took the Premium online without proper receipt of payment, and delayed the Medical Examination and delivery of Policy Document. No document / invoice of payment was sent to me despite various call and mail reminders for 10+ days. Then I wrote the complain to IRDA. They sent the policy document the next day of my complaint. If Religare takes so long in giving a policy then what they will do in a Claim ? I think they have pathetic processes. The customer service is non responsive and have a Do-Not-Care Attitude. Horrible servicing and Customer Experience!! Please Avoid Religare Mediclaim Policies.
    Was this review helpful? 1
    , mumbai
    Reviewed on Jan 14, 2016
  • Apollo Munich Health Insurance
    "cashless claim rejected for dengue case, never buyapollo pol"
    0.5 0.5/5 "Unacceptable"
    The purpose behind buying health insurance is that if we need medical treatment, at least the need for immediate finances is met. Cashless settlement policies are aimed to go a step further. Unfortunately, for me who bought this Apollo Munich health policy in April 2014, the experience has not lived up to the promise. In simple case of dengue(certified by doctor with test report), Apollo Munich took more than 6 days for cashless request and finally rejected the claim based on possibility/guess of pre existing disease(without any evidence). I am very unhappy and harassed with the Apollo Munich and just wanted to raise a complaint on 9/9/2015 .
    Was this review helpful? 6
    , new delhi
    Reviewed on Sep 09, 2015
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