Reference : My HDFC ERGO Family Mediclaim Policy No.50204032 PA.No.5651/1
I got a call from hdfc credit card dept for having a cashless health card insurace from bajaj allianz. They told me that they will taked money from my credit card and pay to bajaj allianz and latter every month they will debit my credit card and i use to pay the money to my credit card a/c. All they told me over phone. I accepted and i have also paid the premium amount Rs.5464/- to my Bajaj Health policy no.OG-08-9999-9960-00000031 in June 2009.
Then when for the 2nd year renewal they called me over phone and told that "Bajaj tieup is over and we are giving our HDFC Ergo Health insurance and the same policy will be continued and you have paid for the one full year and there is no claim for that we will are availing bonus amount also". Even i asked them now you are changing the company later you sholud not tell me that you are not eligible for the claim. For that they answered me that "the claim will be accepted becuase you have already paid one year in bajaj policy".
Last month August'2010 i was examined by the eye surgent and he told me that my right Eye has got catract and have undergo for surgery.
Then through Ananya Hospital the Pre Authorisation request is faxed to HDFC Ergo Insurance. Then reply fax of denial of cashless service report sent to the hospital. For that the reason given is "Cashless facility is denied as Exclussions are applicable". Then I have enquired the Greviance cell they answered me that after 2 years only i am eligible for the claim. The Terms and conditions which i have received with my policy there is no years mentioned for any of the cliams It is said that after 30 days.
Kindly let me know when we are eligible for the catract surgery claim. It is not my mistake for changing the company. They only forced me and changed it HEFC Ergo.
I have lost my money nearly Rs.10,000/-. Now hospital have coated me around Rs.15,000/- will incured for the catract surgery. Any how every year we are going renew the policy and continue this. My policy Insured value is 1lac.
Kindly clarify me what is the period of eligibility for claim and also help me to come out of this expenses.
Expecting a good result from your side.
Thanks & Regards,