Advanced IRDAI Complaint Generator
(Against Aditya Birla Health Insurance)
Facing issues with an Aditya Birla Health Insurance policy? If your claim is rejected, delayed, or you have issues with benefits like HealthReturns™, you have the right to file a grievance. This tool from DailyTechTuts helps you generate a formal complaint letter to the IRDAI (Insurance Regulatory and Development Authority of India) after you have completed the first-level complaint with the company.
Important Prerequisite: Before complaining to the IRDAI, you must first file a written complaint with Aditya Birla's Grievance Redressal Officer. You can only escalate to the IRDAI if:
You have not received a response from Aditya Birla Health within 15 days.
You are dissatisfied with the response you received.
This tool helps you generate the letter for the escalation to IRDAI (Step 3).
Once you have generated your letter using the button above, you can copy the text from the box below and proceed with the following steps to file your complaint.
Your Generated Complaint Letter
Step 3: How to File Your Complaint with IRDAI
You can file your complaint with the IRDAI using one of these methods:
Online (Recommended): Go to the IRDAI Bima Bharosa portal (IGMS) at bima.irdai.gov.in. Register your complaint, and paste the generated letter into the grievance description field.
Email: Send an email to [email protected]. Use the "Subject" line from the letter as your email subject and paste the letter into the body.
Crucial: Remember to attach all supporting documents to your complaint (e.g., policy copy, denial letter from the insurer, correspondence, hospital bills).
Step 4: If Your Issue is Still Unresolved
The IRDAI (Bima Bharosa) portal is a grievance redressal system that compels the insurer to provide a final response. If you are still unsatisfied with the company's final decision (even after the IRDAI complaint), you have further options. Do not stop here.
Option 1 (Highly Recommended): The Insurance Ombudsman
This is your most powerful, cost-effective, and fastest option. The Ombudsman is a quasi-judicial authority who can pass a binding order (called an "Award") against the insurance company.
Power: Can pass an Award up to ₹30 Lakhs. If you accept the Award, the insurer *must* comply within 30 days.
When to Approach: You must approach the Ombudsman within one year of the insurer's final rejection letter.
How: You must file a written complaint with the Insurance Ombudsman in your jurisdiction. You do not need a lawyer for this.
Option 2: The Consumer Court (Consumer Fora)
If you are not satisfied with the Ombudsman's decision, or if your claim is very large, you can file a case in the Consumer Court for "deficiency in service."
The system is divided by the value of your claim (pecuniary jurisdiction) as per the Consumer Protection Act, 2019:
District Commission (DCDRC): For claims up to ₹50 Lakhs.
State Commission (SCDRC): For claims between ₹50 Lakhs and ₹2 Crores.
National Commission (NCDRC): For claims above ₹2 Crores.
Option 3 (Last Resort): Civil Court
You can also file a civil suit in a city civil court for breach of contract. However, this is almost always the last resort because it is extremely slow and expensive compared to the other options.
Understanding Your Grievance: A Detailed Guide with Examples
The following are hypothetical examples for illustrative purposes only, designed to help you identify the category that best fits your situation.
What it means: The insurer has denied your claim by unfairly applying a Pre-Existing Disease (PED) clause, a waiting period, or a policy exclusion that you believe is not applicable to your case.
EXAMPLES
A claim for a heart condition is rejected as a PED, even though your policy is 5 years old and the PED waiting period was only 3 years.
The claim for a knee surgery due to a recent fall is rejected by linking it to a minor joint pain you had years ago.
The insurer rejects a claim for a condition diagnosed for the first time, incorrectly stating that you "must have known" about it before buying the policy.
A maternity claim is rejected because the insurer calculates the waiting period from the policy issuance date, not the date the member was added to the policy.
A claim for cataract surgery is denied, citing a 2-year waiting period, a detail that was not highlighted during the sale.
The insurer rejects a claim for an accident by misclassifying it under an "adventure sports" exclusion, even though it was a simple trekking accident.
A claim is denied because the treatment was taken for a complication arising from a disclosed PED, but the policy should cover such complications after the waiting period.
The insurer uses a vague entry in a doctor's notes from your past to reject a claim, even without a confirmed diagnosis.
A claim for a day-care procedure is rejected because the hospital stay was less than 24 hours, ignoring the specific day-care benefits list.
The claim is rejected based on the "first 30-day" exclusion for an illness that was clearly a medical emergency.
Your claim for dental treatment following an accident is rejected based on a general "dental exclusion" clause.
A claim is rejected because your hospitalization was primarily for diagnostic purposes, even though it led to an immediate surgery.
The insurer rejects a claim for mental health treatment, citing a specific exclusion for "behavioral disorders" that was not clearly defined.
A claim for bariatric surgery is denied because the co-morbid condition (like sleep apnea) was not deemed severe enough by their panel doctor.
Your claim is denied because the hospital was not on their "approved list," even though it was an emergency admission in a remote area.
A claim is rejected because you did not take a "second opinion" from their network doctor before a planned surgery, a clause hidden in the fine print.
The insurer rejects a claim for a modern treatment (like robotic surgery), stating it's "experimental," even though it's a standard procedure now.
Your claim is denied because you were traveling abroad and the "international coverage" was an add-on you were not told about.
A claim is rejected because the policyholder's age was entered incorrectly by the agent, placing them in a different waiting period bracket.
The insurer rejects a claim for a chronic condition, stating you did not enroll in their "Chronic Management Program," even though it was never offered to you.
Excessive Delay in Claim Reimbursement
What it means: After you have paid the hospital bill from your pocket and submitted all necessary documents for a reimbursement claim, the insurer is taking an unreasonably long time to process and pay you back.
EXAMPLES
It has been over 45 days since you submitted your last document, and your reimbursement claim is still showing as "In Process."
The insurer raises one minor query after another, each time taking weeks to review your reply, just to prolong the settlement process.
You receive an email confirming your claim is approved, but the payment is not credited to your bank account for several weeks.
The claims team keeps giving vague excuses like "system audit" or "heavy workload" for the delay.
Your claim was settled after 60 days, but the insurer refuses to pay the mandatory interest for the delay as per IRDAI regulations.
A query is raised just a day before the 30-day deadline, resetting the clock, and this pattern continues.
The customer support team is unable to provide a clear timeline or reason for the hold-up in your payment.
The insurer claims they have made the payment, but it has not been credited, and they are slow to provide proof of transfer or a UTR number.
The reimbursement for pre-hospitalization and post-hospitalization expenses is delayed for months after the main claim is settled.
The insurer's TPA approved the claim, but the final payment from the company is stuck for weeks due to internal processes.
Your claim is being delayed because they are conducting an unnecessary "hospital verification" for a well-known, large hospital.
The company claims a "technical glitch" in their payment system has been causing a delay for over a month.
The insurer's physical cheque for the reimbursement amount is sent to an old address, and the re-issuance process takes another month.
The claims team is not responding to emails from you or the hospital regarding the status of your payment.
A delay is caused because the claim documents were lost in transit between the TPA and the insurer's main office.
The reimbursement is delayed because they are asking for the original pharmacy bills, which were already submitted with the main file.
The payment is delayed because your servicing branch has changed and the records have not been transferred properly.
The insurer has approved the claim but is holding back the payment, asking you to first renew your policy for the next year.
A claim for a small amount (e.g., Rs 10,000) is being delayed for months with the same intensity as a high-value claim.
The company is delaying the claim because they are disputing a minor charge (e.g., Rs 500) on a large hospital bill.
Unjustified Deductions from Claim Amount
What it means: Your claim is approved, but the final amount is significantly reduced due to deductions for items or services that you believe should have been covered under your policy.
EXAMPLES
A large sum is deducted for "non-payable items" like gloves, masks, and syringes, even though these are essential for treatment.
The insurer applies a "proportionate deduction" on the entire bill because you stayed in a room with a rent higher than your eligibility, a clause that was not clearly explained.
A 20% co-payment is applied on your claim, but your policy document states that co-payment is only applicable for treatment in a non-network hospital.
The cost of an essential implant (like a lens for cataract surgery or a stent for angioplasty) is disallowed from the claim.
The insurer claims the hospital's charges are "not reasonable and customary" and pays a much lower amount without providing any official rate list.
The cost of medicines is partially paid, with the insurer claiming that cheaper generic alternatives should have been used.
A co-payment is applied to a claim for an accident, even though your policy explicitly waives co-payment for accident-related hospitalizations.
The insurer deducts a flat "administrative fee" from your claim amount, a charge that is not mentioned anywhere in your policy.
The cost of diagnostic tests that were crucial for your diagnosis is deducted, stating they were "not related to the treatment."
They deduct charges for a specialist doctor's consultation, claiming it was not justified.
A "zonal co-payment" is applied even though you took treatment in a hospital in your own city zone.
The insurer disallows the cost of physiotherapy sessions that were part of the post-operative recovery process inside the hospital.
A deduction is made for a "companion pass" or "attendant charges" which is a standard hospital practice.
The insurer disallows the cost of a specific high-end drug, stating it's "not part of the standard treatment protocol."
A deduction is made because you did not use a pharmacy from their "preferred network" for post-hospitalization medicines.
The insurer deducts an amount claiming the hospital stay was "prolonged" by a day, against your doctor's advice.
A deduction is made for the cost of blood transfusion processing charges.
The insurer applies a sub-limit for a specific treatment that is not mentioned in your policy schedule.
They disallow the cost of "Room Disinfection" and "Bio-Medical Waste" charges levied by the hospital.
The final settled amount is less than the initial pre-authorization amount, and the difference is not explained.
Denial or Delay of Cashless Authorization
What it means: The insurer either rejects your request for cashless treatment at a network hospital or takes an unreasonably long time to provide approval, causing distress and delays.
EXAMPLES
Your planned surgery at a network hospital is denied cashless facility with the vague reason "requires further review," forcing you to pay upfront.
You are medically fit for discharge, but the final cashless approval takes more than 8 hours, forcing you to pay for another day's room rent.
The insurer's approval team is unresponsive during a medical emergency at night or on a weekend.
The pre-authorization request is rejected because of a minor clerical error in the form submitted by the hospital, and the insurer refuses to allow a quick correction.
The insurer denies cashless, claiming the treatment can be done as an OPD procedure, contradicting your doctor's advice for admission.
The initial approval is for a very small amount (e.g., Rs 20,000 for a surgery estimated at Rs 2 Lakhs), and the request for enhancement is delayed for hours.
Cashless is denied because your physical card was not available at the time of admission, even though you provided the policy number and e-card.
The insurer's TPA keeps raising one small query after another, deliberately delaying the approval process for a planned admission.
You are told the hospital's agreement with the insurer has expired, even though the hospital still shows on the insurer's official website.
The approval is delayed because the insurer wants to conduct a preliminary investigation into your medical history before a standard procedure.
Cashless is denied for a newborn baby, even though the mother's policy includes a newborn baby cover.
The insurer is taking too long to approve an emergency cardiac procedure, putting the patient at risk.
Cashless is denied because the diagnosis is not "finalized," even in a clear case of an accident.
The insurer's portal for cashless requests is down, and there is no alternative mechanism for approval.
A request for cashless enhancement is rejected, with the insurer stating the additional expenses are "not justified."
The insurer is not responding to the hospital's calls or emails for authorization.
Cashless is denied for a senior citizen, with the insurer asking for a long list of past medical records in the middle of an emergency.
The approval is delayed because the case has to be reviewed by a "senior medical officer" who is unavailable.
Cashless is denied because the hospital is in a different state from your residence, even for a planned treatment.
The insurer provides a verbal approval to the hospital but does not send the official authorization letter for hours.
Issues with Hospital Network (List Accuracy, Service Quality)
What it means: The list of network hospitals provided by the insurer is inaccurate, or the service provided by the hospital's insurance desk for your insurer is poor, causing problems during admission or discharge.
EXAMPLES
You chose a hospital because it was listed as a "cashless network hospital" on the insurer's website, but upon arrival, the hospital denies having a tie-up.
The hospital's insurance desk is uncooperative and slow in sending the pre-authorization request, leading to long delays.
A hospital is on the network, but they demand a large "refundable" deposit from you, claiming that your insurer is slow with payments.
The network hospital list on the insurer's app is outdated and shows hospitals that have been removed from the network months ago.
The hospital staff seem unfamiliar with the insurer's cashless procedures, causing confusion and errors in paperwork.
You are told the hospital is on the network, but only for certain procedures, not for the one you require, a detail not mentioned on the insurer's website.
The hospital overcharges for services, and the insurer does not intervene, leaving you to bear the brunt of the deductions.
The insurer removes a major hospital from its network in your city without any prior intimation to its policyholders.
The network hospital's staff advise you to pay directly and claim reimbursement because the insurer's approval process is "too slow."
A hospital is on the network, but they refuse to provide cashless services for any policies sold by agents, only for policies bought directly online.
The contact number or address for a network hospital listed on the website is incorrect.
The hospital insurance desk tries to dissuade you from using your cashless card, favoring patients who pay directly.
You are charged higher "corporate" rates by the hospital because you are using insurance, compared to their rates for walk-in patients.
The hospital refuses to provide a detailed breakdown of the bill, which is required by the insurer, leading to a deadlock.
The insurer's "preferred provider network" (PPN) offers discounts, but the hospital refuses to honor them.
The hospital's pharmacy is not part of the cashless network, forcing you to pay for all medicines out of pocket.
A hospital is listed on the network, but they do not have a functional insurance desk on weekends.
The hospital makes you sign a "self-pay" declaration form even after cashless approval, as a security measure against insurer delays.
The hospital does not follow the package rates agreed upon with the insurer, leading to claim disputes.
You are forced to use the hospital's in-house diagnostic center, which is more expensive, as they don't accept reports from outside labs that are part of the network.
Issues with HealthReturns™ Program (Points, Redemption)
What it means: A key feature that rewards you for staying active by giving you a monetary equivalent (HealthReturns™) is not working correctly, or you are facing issues in redeeming the earned amount.
EXAMPLES
You have completed the required number of "Active Dayz™" in a month, but the HealthReturns™ are not credited to your account.
The insurer's "Activ Health" app is not syncing with your fitness tracker or mobile's health app, so your physical activity is not being counted.
You have a significant balance in your HealthReturns™ account, but you are unable to use it to pay for your renewal premium.
The value of your HealthReturns™ has been incorrectly calculated and is much lower than what it should be based on your activity.
You are trying to redeem your HealthReturns™ for an OPD consultation, but the claim is being rejected.
The insurer changes the rules for earning HealthReturns™ mid-year, making it much harder to achieve the targets.
Your accumulated HealthReturns™ balance disappeared from your account without any explanation.
The process to redeem HealthReturns™ is extremely complicated and requires you to submit multiple forms and follow up repeatedly.
The insurer claims that HealthReturns™ cannot be used to pay for non-payable items during a claim, which contradicts the policy's marketing material.
Customer support is not trained on the HealthReturns™ program and provides incorrect information about how to earn or redeem them.
The app shows you have earned rewards, but they are not reflected in your main policy account.
You are a senior citizen, and the activity targets to earn HealthReturns™ are unrealistically high.
The insurer has forfeited your entire HealthReturns™ balance because your policy lapsed for a few days due to a payment issue.
The redemption of HealthReturns™ is only allowed through a very limited set of vendors or platforms.
The app's "Health Assessment" questionnaire, which is required to earn points, is not working.
The insurer has put a cap on the maximum HealthReturns™ you can earn in a month, which was not there when you bought the policy.
You are not being awarded bonus points for participating in official marathons or fitness events as promised.
The app frequently logs you out, leading to loss of activity data for that day.
The HealthReturns™ feature is suddenly discontinued or changed in your plan at the time of renewal without your consent.
The monetary value per point for redemption is lower than what was advertised.
Problems with Chronic Management Program
What it means: If you have a chronic condition like Diabetes or Asthma, the specialized program designed to help you manage it and offer benefits (like Day 1 coverage) is not being provided effectively.
EXAMPLES
You declared a chronic condition and were promised Day 1 coverage under the program, but your first claim for that condition is rejected citing a waiting period.
You were enrolled in the Chronic Management Program, but you are not receiving the promised consultations with medical experts or health coaches.
The cost of diagnostic tests required under the program is not being fully reimbursed as promised.
The insurer is not covering the cost of medicines for your chronic condition from Day 1.
The process to get a "Health Check-up" done under the program is extremely difficult, with no available slots at network labs.
The insurer's health coach provides generic, unhelpful advice that does not cater to your specific medical condition.
A claim for hospitalization due to a complication of your chronic condition is rejected.
The insurer increases your premium at renewal because you are enrolled in the Chronic Management Program, which is counterintuitive.
You are unable to log your medical readings (like blood sugar levels) in the app, which is a mandatory requirement of the program.
The insurer claims you are "not compliant" with the program's requirements and has withdrawn the benefits, even though you have been following all advice.
The program was a key reason you bought the policy, but it has now been discontinued or its benefits have been severely diluted.
The list of doctors or specialists available for consultation under the program is very limited and they are not available in your city.
You are being charged a separate fee for consultations under the program, which you were told would be free.
The app interface for the Chronic Management Program is confusing and difficult to use.
The insurer is not providing the promised renewal premium discount for successfully managing your condition under the program.
The reimbursement for medicines under the program is very slow.
The insurer is forcing you to consult only their panel of doctors and is not accepting reports from your long-time personal doctor.
The program requires you to follow a diet plan that is not suitable for your cultural or dietary preferences, and there is no flexibility.
The insurer is sharing your sensitive medical data from the program with third-party marketing companies.
The benefits of the program, like reduced waiting periods, are not being applied correctly when you try to port your policy.
Dispute over Sum Insured Restoration or Super Top Up
What it means: The benefit that restores your sum insured after it's exhausted is not being provided, or your Super Top Up plan is not activating correctly.
EXAMPLES
Your base sum insured of ₹5 Lakhs is exhausted. When a second claim arises in the same year, the insurer refuses to activate the "restoration" benefit.
The insurer restores the sum insured but states that it cannot be used for the same illness for which the first claim was made, a major restriction.
The restoration benefit is applied, but the insurer refuses to provide cashless service for the restored amount, asking you to pay first and claim later.
The insurer claims the restoration benefit is only available once per policy year, contradicting the "100% restoration" promise.
Your sum insured is ₹5 Lakhs. You make a claim of ₹5 Lakhs. The insurer refuses to restore the policy for a second claim of ₹1 Lakh for a different person in the same policy.
The insurer agrees to restore the sum insured but applies a 20% co-payment on the restored amount, which is not in the policy terms.
You are told the restoration benefit can only be used by another family member, not the person who exhausted the original sum insured.
The process to get approval for using the restored sum insured is extremely slow and difficult, defeating the purpose of the benefit.
The insurer claims the restoration benefit does not apply to a specific list of critical illnesses.
At renewal, the insurer adds a new clause limiting the restoration benefit without your consent.
Your hospital bill exceeded your base policy's sum insured, but the super top-up policy is not getting triggered automatically for cashless settlement.
The insurer is asking you to first pay the amount exceeding the base policy and then file a separate reimbursement claim for the super top-up.
A claim that was partially paid by your base policy is completely rejected by the super top-up policy citing a different interpretation of a policy clause.
The insurer is incorrectly calculating your deductible amount for the super top-up, asking you to pay a larger share from your pocket before it activates.
You have a base policy from another insurer, and you are facing extreme difficulty in coordinating the claim settlement with your super top-up insurer.
The super top-up claim is being delayed because the insurer is re-investigating the entire case from scratch, even though the base claim was already approved.
The insurer claims your super top-up policy has a waiting period for a condition that was already covered by your base policy for years.
The process to intimate a claim for a super top-up policy is different and more complicated than for a regular policy.
The insurer is not considering pre-hospitalization expenses paid under the base policy while calculating the aggregate deductible for the super top-up.
Your renewal notice for the super top-up policy has an exorbitant premium hike after one claim.
Exorbitant Premium Increase or Loading at Renewal
What it means: At the time of policy renewal, the premium has increased by an exorbitant amount that is not justified by your age change, medical history, or standard inflation.
EXAMPLES
Your renewal premium has increased by 70% in a single year, even though you made no claims.
After filing one small claim, your renewal premium is doubled.
The insurer justifies a massive premium hike by citing "high medical inflation," but the hike is much higher than the industry average.
You are moved to a different age bracket, and the premium increases by 50%, a much steeper jump than what was shown in the original product brochure.
The insurer adds a "loading" charge to your premium because you were diagnosed with a lifestyle disease, and this charge is excessively high.
Premiums for senior citizen policies are increased by a huge margin, making them unaffordable for retirees.
The base premium for your plan has been increased for all customers, but the hike is disproportionately high and was not communicated in advance.
The insurer claims the premium hike is due to the addition of "new features" to the policy, which you never asked for and do not need.
The premium for your family floater plan is increased steeply because the insurer has changed its underwriting rules for including older members.
You are offered a renewal at a high premium, but a new customer can buy the same policy for a much lower price online.
A loading is applied because you are now in a "higher risk" location, even though you have not moved.
The insurer refuses to give you a reason or a calculation for the premium loading applied to your policy.
The premium is increased because of claims made by other people in your group policy, which is unfair.
Your "wellness discount" for being healthy is removed at renewal, leading to a de-facto premium hike.
The insurer increases the premium and also adds a new co-payment clause, a double penalty.
The renewal notice with the hiked premium arrives just a few days before the due date, giving you no time to port out.
The premium for your super top-up plan is increased drastically after you make a claim on your base policy from another insurer.
The insurer offers you a "discount" on the hiked premium, which is still much higher than last year's premium.
A premium loading is applied based on a medical check-up report that you believe is inaccurate.
The insurer forces you to move to a newer, more expensive version of your plan at renewal, discontinuing your old plan.
Mis-selling by Agent or Bank Partner (Bancassurance)
What it means: The agent, or a representative from a partner bank, used deceptive practices to sell you the policy, often by hiding crucial terms or misrepresenting benefits.
EXAMPLES
A bank employee sold the policy as a "mandatory" product required to get a loan or open an account.
The agent promised "100% coverage" and did not explain concepts like co-payments, sub-limits, or deductions for non-medical items.
The agent filled the proposal form for you and deliberately hid your pre-existing conditions, telling you it "doesn't matter," which later led to claim rejection.
You were sold a policy by being told its benefits are "the best in the industry," but the agent did not explain the critical limitations.
The agent convinced you to buy a more expensive policy by providing false information about the cheaper variants.
A bank relationship manager sold you the policy by presenting it as a "high-return investment plan" instead of a health insurance policy.
The agent promised "coverage from day one for all diseases" by hiding the concept of waiting periods for pre-existing diseases.
You were sold a policy with a "lifetime renewal guarantee," but the fine print allows the company to reject renewal under certain conditions.
You were shown a brochure with a list of 1000 hospitals, but the actual network list for your specific policy variant is much smaller.
The agent claimed the policy includes a unique feature that it does not actually have, just to close the sale.
The free-look period was not explained, so you could not cancel the policy in time after discovering the mis-selling.
The agent sold you a policy with a high deductible (super top-up) by representing it as a standard base policy.
You were told the HealthReturns™ benefit could be redeemed as cash, but it can only be used for specific purposes like premium payment.
The agent sold you a policy with a zonal co-payment without explaining that it would apply if you take treatment in a major city.
You were sold a critical illness policy and were told it covers "all major illnesses," but the actual list is very restrictive.
The agent assured you that OPD expenses were covered, but the policy only covers them through the limited Health Wallet.
A bank employee used your account details to automatically debit the premium for a policy you did not explicitly agree to buy.
The agent sold you a policy that is completely unsuitable for your age and medical condition (e.g., a basic plan for a senior citizen with chronic ailments).
You were told that the Chronic Management Program is "free," but it involves several paid services.
The agent used high-pressure tactics, claiming the "special offer" was ending that day, to prevent you from reading the terms and conditions.
Problems with Policy Portability (In or Out)
What it means: You are trying to switch your health insurance to or from the company, but the process is being delayed, or your continuity benefits are not being correctly transferred.
EXAMPLES
You applied to port your policy from another insurer 45 days before renewal, but the new insurer has not made a decision, jeopardizing your continuous coverage.
Your current insurer fails to provide your policy details and claims history to the new insurer in time for them to process your portability request.
Your portability request is accepted, but your continuity benefits for pre-existing diseases are not applied, and the new policy treats you as a fresh customer.
The company imposes a huge premium loading charge on your portability application, making it unaffordable.
Your portability request is rejected without a valid reason, or with a vague reason like "adverse claims history" when you have made no claims.
The company deliberately delays the portability process so that you miss the renewal deadline and your policy lapses.
You are told you can port your policy, but only to a much inferior plan with fewer benefits.
The agent advises you to cancel your old policy and buy a new one instead of porting, causing you to lose all your accumulated benefits.
The company refuses to port a family floater policy unless every single member undergoes a fresh medical check-up, including young children.
There is a long and unexplained silence from the company after you submit your portability application and documents.
The insurer to which you are porting is not giving you credit for the No Claim Bonus you accumulated with your previous insurer.
The new insurer applies a fresh set of waiting periods for specific illnesses that were already covered under your old policy.
The portability process is stuck because of a minor mismatch in your name or date of birth between the two insurers' records.
The insurer is not providing you with the necessary forms or information required to initiate the portability request.
Your portability application is rejected because of a medical condition that you developed while you were covered under the old policy.
The new insurer agrees to port the policy but excludes coverage for all your existing medical conditions, defeating the purpose of portability.
The agent who is handling your portability request is unresponsive and not providing any updates.
The insurer is not responding to the portability queries raised by your new insurance company.
The premium quoted for the ported policy is much higher than what was initially indicated.
The portability process has taken so long that your renewal date is approaching, and you are unsure which insurer to pay the premium to.
Unresponsive Customer Support or Grievance Team
What it means: Your attempts to get a resolution for your problem are met with silence, generic responses, or endless delays from the company's official support and grievance channels.
EXAMPLES
You sent a complaint to the designated Grievance Redressal Officer's email ID but have not received even an acknowledgment for over a week.
The customer support number is always busy, or the call is put on hold indefinitely until it disconnects.
You receive a generic, copy-pasted reply from the grievance cell that does not address the specific issues raised in your complaint.
Your complaint ticket is closed without your consent and with the status "Resolved," even though your problem still persists.
The Grievance Officer promises to look into the matter and get back to you, but you never receive a follow-up call or email.
You are repeatedly asked to submit the same documents to the grievance cell that you had already submitted to the claims team.
The company does not provide a clear timeline for the resolution of your grievance.
The response from the grievance cell simply repeats the initial decision of the claims team without any sign of a fresh review.
The Grievance Officer is never available to speak to, and you are always told that they are "in a meeting."
You are transferred between multiple departments, with no one taking ownership of your formal grievance.
The online chat support is always offline or is operated by a bot that cannot answer your questions.
The customer support email address bounces back as "undeliverable."
A representative promises a "call back within 24 hours," but you never receive one.
Different representatives give you conflicting information each time you call.
The social media support team asks you to DM your details but then never responds to your message.
The "escalation matrix" provided on the website is just a circular loop, with each level redirecting you back to the first one.
The company's toll-free number does not work from your mobile network.
There is no clear process to file a complaint against the unhelpful behavior of a customer support executive.
Your emails are being ignored, and you have no way of knowing if they have even been read.
The company's IVR system is a maze designed to prevent you from reaching a human representative.
App/Website Glitches (Activ Health app, document upload)
What it means: The company's digital platforms (website or mobile app) are unreliable, frequently down, or lack basic functionalities, making it difficult to manage your policy online.
EXAMPLES
The "Activ Health" app is not syncing with your fitness tracker, so your activity is not being counted towards your HealthReturns™.
You are trying to upload your reimbursement bills on the app before the deadline, but you keep getting a "File Size Too Large" error even for small files, or the app simply crashes.
The "Forgot Password" link does not work, so you are permanently locked out of your online account.
The website does not show your active policy, or shows incorrect details about it.
You are unable to download your policy document or health card from the digital portal.
The online premium payment page fails after you enter your card details, but the amount gets debited from your account without a receipt being generated.
The list of network hospitals on the app is outdated or inaccurate.
You submit a claim through the portal, but it does not reflect in their system, and there is no confirmation number provided.
The app keeps logging you out every few minutes, making it impossible to complete any task.
The document upload feature does not allow you to upload more than one file at a time, making the process tedious for multiple bills.
You cannot find the option to check your HealthReturns™ balance in the app.
The app's "Health Assessment" questionnaire, which is required to earn points, is not working.
You are unable to book a health check-up through the app as the feature is broken.
The app is not available for your specific smartphone model or operating system version.
You update your contact details on the portal, but the changes are not saved, and the system continues to use your old information.
The online portal for tracking claims is never updated and always shows the status as "In Process."
The app drains your phone's battery very quickly.
You receive notifications from the app that are irrelevant or are for a different policyholder.
The process of adding a new family member to your policy cannot be completed online due to a technical error.
The digital prescription upload feature for OPD claims does not work.