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Care Health Insurance rejects post-hospitalisation claim without item-wise explanation

Care Health InsurancePC-2026-02939Insurance ClaimsAnonymous ·
*12 Years of Paying Premiums. One Year of Fighting for Fair Claim Settlement. And Another Rejection.* I have been a Care Health Insurance policyholder for 12 years. Over the past year, while dealing with kidney disease, I have been going from pillar to post to get my genuine medical claims assessed in accordance with my policy. Now, Care has rejected my post-hospitalisation reimbursement claim by stating: "Benefit Not Covered in Policy." Claim No.: ****** Policy No.: 95855172 Rejection Letter: 25 October 2026 The letter provides a general explanation of the "Benefit Not Covered" clause, with examples such as dental treatment, cosmetic treatment and preventive health check-ups. But my question is straightforward: Which specific expense in my post-hospitalisation claim is not covered, and under which exact policy clause? Post-hospitalisation benefits exist to cover eligible expenses after discharge, subject to the policy terms. A generic explanation does not clarify why my particular claim has been rejected. This comes while my earlier claim remains disputed: - Original claim: ₹2,80,000 - Amount paid: ₹1,82,590 - Balance disputed: ₹97,410 I appreciate that Care has withdrawn the separate recovery demand of ₹18,653 following the Insurance Ombudsman's award. However, the unresolved short settlement and this new rejection remain serious concerns. After 12 years of paying premiums, I am not asking for special treatment or anything beyond my policy. I am asking for specific reasons, the applicable policy clauses and a fair assessment of my eligible medical expenses. Care Health Insurance, please provide an item-wise explanation for this rejection and reconsider the claim in accordance with the actual policy terms. A policyholder should not have to spend a year repeatedly pursuing answers while managing a health condition. I hope this matter can still be resolved fairly and transparently. Care Insurance Suresh Kolla Manish Dodeja Ajay Shah Insurance Regulatory and Development Authority of India Aditya Shah Bima samadhan HDFC ERGO General Insurance Niva Bupa Health Insurance X Department of Consumer Affairs #CareHealthInsurance #HealthInsurance #PostHospitalisation #InsuranceClaim #ClaimRejection #ConsumerRights #InsuranceOmbudsman

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  1. Case filed

    System · 25 Oct 2026, 6:37 pm

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