app/kbdocs/NITDAA_Medical_Insurance_FAQ.txt

NITDAA SUPER TOP-UP (STUP) AND BASE HEALTH INSURANCE
FREQUENTLY ASKED QUESTIONS

Compiled from the NITDAA Policyholder WhatsApp Group
Source: Responses by Debasis Basu and Anand Gaggar

Note: This document reflects Q&A exchanges from September 2024 through April 2026.
Where policy terms changed between Year 1 (2024-25) and Year 2 (2025-26), both are noted.

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SECTION 1: POLICY OVERVIEW AND ELIGIBILITY
================================================================================

Q1. What are the two NITDAA medical insurance policies?

A. There are two separate and independent policies:

   (1) NITDAA Super Top-Up (STUP) Policy — insured by Care Health Insurance
   (2) NITDAA Base Health Insurance Policy — insured by The Oriental Insurance
       Company Ltd (a public sector company)

   The two policies are with different insurers and their coverage and hospital
   networks may differ. There is no automatic seamless migration of a claim from
   the Base policy to the STUP. [Debasis Basu, June 2025]


Q2. Who is eligible to buy these policies?

A. NITDAA Life Members — Alumni, Faculty, and Staff of NIT Durgapur. Life
   membership of NITDAA is mandatory before purchasing any policy. Non-life
   members who purchased the STUP in Year 1 were required to obtain Life
   Membership before the Year 2 renewal. [Debasis Basu, May-June 2025]


Q3. What is the entry age limit?

A. Up to 85 years for both policies. [Debasis Basu, September 2024]


Q4. Who can be covered under the policy as family members?

A. Self, spouse, dependent children, parents, and parents-in-law.
   [Debasis Basu, September 2024]


Q5. Can children above 24 years be included?

A. Under the Base Policy: No. Maximum age for children is 24 years.

   Under the STUP:
   — Year 1 (2024-25): Maximum age was 24 years.
   — Year 2 (2025-26): The age limit for children was increased to 30 years.
     Children can be added free of additional premium up to age 30.

   Children above 30 are not included in the scheme. Adult children above the
   specified age are considered independent individuals. Including them was
   discussed and not pursued because it would have made the group heterogeneous
   with different professions, affecting premium calculation.
   [Debasis Basu, January 2025 and June-July 2025]


Q6. Can a separately abled / differently abled child above the age limit be included?

A. Age limit is the primary eligibility criterion. If the child is within the age
   limit, there is no special acceptance or rejection criteria unless the condition
   falls in the STUP negative list. For the Base Policy, which has no negative
   list, the proposal goes to the Medical Board. If accepted, coverage proceeds;
   if not, nothing further can be done. [Debasis Basu, May 2025]


Q7. Are parents and parents-in-law covered under the same policy or separate?

A. Parents (and parents-in-law) are covered under a separate, additional policy
   under the same programme. They are not part of the family floater for the
   primary member. [Debasis Basu, September 2024]


Q8. If an alumnus passes away, can the family continue the policy?

A. Yes. For the current policy year, the family remains covered until renewal.
   For subsequent years, NITDAA has agreed to allow the family to continue
   the policy. [Debasis Basu / FAQ Q.47 reference, July 2025]


Q9. Is this a voluntary policy or a compulsory one?

A. It is a voluntary group policy, not a compulsory one. It is a B2B2C policy
   — NITDAA as the group administrator, Zopper/Solvytech as the technology and
   placement partner, and the insurer. [Debasis Basu, January 2025]


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SECTION 2: SUPER TOP-UP (STUP) POLICY — FEATURES
================================================================================

Q10. What are the key features of the STUP policy?

A. — Entry age: Up to 85 years
   — Sum Insured options: Up to 1 Crore
   — Deductible options: 3, 5, 7, 10 lakhs (and higher options introduced in
     Year 2: 15, 20, 25 lakhs)
   — No medical checkup required at entry
   — Room: Any kind of room except suite (no per-day limit)
   — No sublimits on treatment
   — No co-payment
   — Pre-Existing Disease (PED) waiting period: 1 year only (vs 3-4 years in
     retail/individual policies)
   — People with chronic ailments such as heart disorders, blood disorders,
     insulin-dependent diabetes, and recovered cancer can also enrol, subject to
     the negative list
   — Modern Treatment: Covered up to 50% of Sum Insured
   — GPA (Group Personal Accident) rider: Optional, introduced in Year 2,
     available only for alumni and spouse, age limit 65 years maximum
   — Consumables coverage: Optional in Year 2, at 5% additional premium
   [Debasis Basu, September 2024 and July 2025]


Q11. What is the negative list under the STUP?

A. The negative list contains specific diseases that disqualify a person from
   buying the STUP policy. Approximately 5-6 conditions are named in Year 2
   (the Year 2 list is smaller than Year 1). A person having a disease from the
   negative list at the time of buying cannot be covered; their premium will be
   refunded.

   If any of the specifically named diseases are contracted AFTER buying the
   policy (i.e., they were not pre-existing), they will still have a one-year
   waiting period.

   Only the specific individual with a disqualifying condition is denied coverage;
   other family members can still be covered. [Debasis Basu, July 2025]


Q12. Is there any loading or additional premium for having a pre-existing disease?

A. No. Pre-existing diseases do not attract additional premium and do not impose
   any restriction or limitation on coverage. They are simply subject to the one-
   year waiting period. [Debasis Basu, July 2025]


Q13. Is there any increase (loading) in premium if a claim is made?

A. No. Being a group policy, there is no loading on premium for individual claims
   even if they go to 500% or beyond for any individual. This is unlike individual
   retail policies. [Debasis Basu, September 2024]


Q14. Can the Sum Insured be increased in subsequent renewals?

A. Year 1 policy: The Sum Insured could not be increased in subsequent renewals;
   it could only be reduced. However, this condition was revised:

   Year 2 one-time option: Alumni were given a one-time option to reduce the
   deductible and increase the Sum Insured at the Year 2 renewal. The PED
   exclusion of one more year applies to the difference between the old and new
   Sum Insured and the difference between old and new deductible.

   This change in SI and deductible is not possible if a disease from the
   negative list has been contracted during the year, or if a claim was made.

   After this one-time option, it is unlikely the increase in SI will be available
   in further renewals. Reduction in SI and increase in deductible are always
   possible. [Debasis Basu, July 2025]


Q15. What is the deductible and how does it work?

A. The deductible is the amount the policyholder must pay (or has already paid
   through a base policy or out-of-pocket) before the STUP policy is triggered.
   Once the cumulative hospital bill for the entire family during the year exceeds
   the chosen deductible, the STUP pays the excess.

   The deductible applies on an aggregate family basis for the policy year, not
   per incident. Whether paid by the policyholder themselves or recovered from
   any other base policy, the STUP pays the excess over the deductible.
   [Debasis Basu, March 2025]


Q16. Is this policy connected to or dependent on another base policy?

A. No. The Super Top-Up policy has no requirement for a base policy. It is
   different from a normal top-up policy that requires topping up on another
   specific policy. [Debasis Basu, September 2024]


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SECTION 3: BASE HEALTH INSURANCE POLICY — FEATURES
================================================================================

Q17. What are the key features of the NITDAA Base Health Insurance Policy?

A. — Insurer: The Oriental Insurance Company Ltd (public sector)
   — Entry age: Up to 85 years
   — Sum Insured options: 3 lakhs or 5 lakhs
   — Covers self, spouse, children (up to 24 years), parents, and parents-in-law
   — No medical checkup required
   — Room: Single private AC room
   — Modern Treatment: Covered up to 100% of Sum Insured
   — No sublimits on treatment
   — No co-payment
   — 1 year waiting period on Pre-Existing Diseases (PED)
   — No negative list
   — No requirement to declare PEDs at enrollment
   — Dental treatment (e.g., root canal) is NOT covered
   — OPD (Out-Patient Department) treatments are NOT covered
   — Day care treatments: Covered
   [Debasis Basu, May-June 2025]


Q18. Why is the Base Policy Sum Insured limited to 3 or 5 lakhs?

A. The Base Policy was brought as a surprise offer from Oriental Insurance at
   a very good premium. It was intentionally kept at a small level because:
   (1) The objective of the NITDAA programme is the STUP for protection against
   something really going wrong (major illness/accident), not for routine medical
   cost management. (2) Base policies are vulnerable to attritional claims, which
   can make premium consistency challenging. [Debasis Basu, June 2025]


Q19. Under the Base Policy, can the Sum Insured be different for the alumni's
family versus parents/in-laws?

A. For parents and parents-in-law: Yes, a different Sum Insured is possible.
   For the alumni, spouse, and children: The Sum Insured will be the same.
   [Goutam Majumder, June 2025]


Q20. Can the Base Policy Sum Insured be increased from 3 to 5 lakhs in the
next year's renewal?

A. This has not been confirmed. If allowed, the PED waiting period will apply
   again for the additional 2 lakhs (i.e., the difference of 5-3 = 2 lakhs will
   have a further one-year PED exclusion). [Debasis Basu, June 2025]


Q21. Is there a premium difference between 1 adult, 2 adults, and 2 adults +
children?

A. The premium for 1 adult (1A), 2 adults (2A), and 2 adults + children
   (2A+2C) is the same. Group policy pricing is done on the basis of average
   exposure, not on individual risk assessment. Children's exposure is almost
   negligible, so it is offered as a marketing incentive without separate premium.
   [Debasis Basu, May 2025]


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SECTION 4: PRE-EXISTING DISEASES (PED) — DECLARATION AND COVERAGE
================================================================================

Q22. What pre-existing diseases must be declared in the STUP?

A. Year 1 Policy: All PEDs without exception must be declared — including
   controlled conditions like blood pressure, diabetes, thyroid, etc. There is
   no published list of PEDs. Every condition for which the person is taking
   medication or has received treatment must be declared. Past surgeries and
   procedures (e.g., hernia operation, leg fracture with plate insertion) must
   also be declared. Non-declaration can potentially be used to void a policy.
   [Debasis Basu, July 2025]

   Year 2 Update (Revised CIS, August 2025): The PED declaration requirement
   was removed. At policy purchase/renewal, the alumni only need to answer
   specific mandatory questions related to the negative list (i.e., confirm
   whether they have any of the approximately 5-6 disqualifying conditions).
   All other PEDs will simply have a one-year waiting period without
   any declaration requirement.

   This change was a significant improvement secured through negotiation with
   Care Health Insurance. Anand Gaggar's detailed personal PED disclosure
   (going back 35 years) was presented as a case study to make the argument.
   [Debasis Basu, July 2025]


Q23. Anand Gaggar shared his personal PED list for guidance. What was it?

A. When Anand Gaggar (REC Durgapur, 1965-70) enquired with Zopper about
   whether past surgeries also needed declaration, he was advised to declare all
   PEDs in detail, even if applying afresh. His own list included:

   — Past TURP surgery for BPH (Benign Prostatic Hyperplasia)
   — Cholesterol
   — Cataract surgery (one eye)
   — Hypertension
   — Type 2 Diabetes
   — Hypothyroidism
   — Dyslipidemia
   — Acid Reflux
   — Vertigo
   — Cervical Spondylitis
   — BPH (Benign Prostatic Hyperplasia)

   He shared this example publicly to caution other members about the
   importance of thorough PED disclosure. Debasis Basu confirmed the advice
   and pursued the matter with Care Healthcare, ultimately achieving the
   removal of the PED declaration requirement. [Anand Gaggar and Debasis Basu,
   July 2025]


Q24. How should a PED that is medically controlled (e.g., cholesterol medication
taken as a precaution with no elevated levels) be declared?

A. Always write "medically controlled [condition name]." For past ailments,
   write the name of the condition and the approximate period. Example: "Hernia
   operation in March 2018." If in doubt about whether to declare something, the
   answer is yes — declare it. Non-declaration has no benefit since there is no
   loading on premium and no restriction imposed. [Debasis Basu, July 2025]


Q25. Do PEDs of family members also need to be declared?

A. Yes. All family members' PEDs should be declared. The insurer will ask if
   they have questions. [Debasis Basu, July 2025]


Q26. Are PEDs covered after the one-year waiting period?

A. Yes. After the one-year waiting period, all pre-existing diseases are
   covered without restriction, limitation, or additional premium.
   [Debasis Basu, multiple dates]


Q27. For the Base Policy, do I need to declare PEDs?

A. No. The Base Policy does not require any PED declaration. All PEDs are
   covered after one year of waiting from the policy start date. All other
   conditions (not PEDs) are covered after 30 days.
   [Debasis Basu, July 2025]


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SECTION 5: HOSPITAL NETWORK AND CASHLESS FACILITY
================================================================================

Q28. How do I find network hospitals for cashless treatment?

A. Use the Care Insurance hospital network search link:
   https://www.careinsurance.com/health-plan-network-hospitals.html

   When searching, type the location and select "general" for category instead
   of a speciality. This list is auto-updated by Care Insurance from time to
   time. Members should stay updated as hospitals can be de-listed.
   [Debasis Basu, September 2024]


Q29. Are there cashless facilities at non-network hospitals?

A. There is an "Anywhere Cashless" provision for emergencies, but it requires
   informing the insurer within 48 hours of admission. In practice, the process
   is not straightforward. Best practice is to always use network hospitals for
   cashless treatment. [Goutam Majumder, January 2025]


Q30. What happens if treatment is taken at a non-network hospital?

A. The reimbursement process must be followed. Reimbursement from non-network
   hospitals is generally not paid in full because non-network hospitals charge
   more than the pre-agreed rates between the insurer and network hospitals. The
   insurer settles reimbursement at their "rack rate" (the rate they have agreed
   with network hospitals), not the actual bill charged. [Debasis Basu, February
   2025 and March 2025]


Q31. A member experienced that their network hospital refused to raise dual
cashless claims (one for base policy with Star Health and one for STUP with Care).
What is the resolution?

A. This was identified as a teething issue in Year 1. The member (Anirban) had
   to discharge the patient and use the reimbursement route. Debasis Basu
   acknowledged this as a known concern and committed to taking it up with the
   insurers for a seamless cashless process in network hospitals.
   [Debasis Basu, February 2025]


Q32. Should I inform Care Insurance before hospitalisation?

A. Any hospitalisation where the bill is likely to exceed the deductible should
   be informed to the insurer in advance.

   During a second hospitalisation in the same year where the cumulative bill
   will cross the deductible: Submit the first hospitalisation bill and payment
   receipt to the hospital's insurance desk and ask them to communicate with Care
   for cashless processing of the STUP.
   [Debasis Basu, January 2025]


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SECTION 6: POLICY DOCUMENT AND CASHLESS CARD
================================================================================

Q33. How do I receive my policy and cashless card?

A. All policy documents are digital. The policy certificate and the cashless
   card are sent to the registered email address. There is no physical policy
   document or physical card; nothing comes by post. [Debasis Basu,
   November 2024]


Q34. Where is the cashless card?

A. The cashless card is a digital card on the last page of the digital policy
   PDF. Members should keep it saved and handy. [Debasis Basu, December 2024]


Q35. How can I retrieve my policy if I have lost or deleted the email?

A. Two options:
   (1) Install the Care Health Insurance app and retrieve the policy using the
       policy number. The app also has an "Emergency Login for Family Member"
       feature.
   (2) Use the self-service link:
       https://selfcare.careinsurance.com/self-help-policy-verification?
       subCategory=policyDetails-showPolicyDetails
       Enter the policy number and the certificate and cashless card will be
       generated within a minute.
   [Debasis Basu, December 2024 and March 2025]


Q36. Can I log in to NITDAA portal to access my STUP policy?

A. Yes. Log in to www.nitdaa.org. Under the Health Insurance tab, the STUP
   policy is accessible. The Base Policy (Oriental) may not be directly
   accessible through the NITDAA portal as Oriental's infrastructure integration
   is different. [Goutam Majumder, November 2025]


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SECTION 7: CLAIMS PROCESS
================================================================================

Q37. Who do I contact first when I need to make a claim?

A. Zopper is the single window contact for the insured. All documents and claims
   are submitted via email to Zopper (nitdaahealthplan@zopper.com). There is no
   direct contact with Care Insurance as part of the standard claim process.
   Zopper also assists in assembling documents, advising on their nature and
   source, and provides advance information on claim status.
   [Goutam Majumder, January 2025]


Q38. Does Care Health Insurance have a TPA?

A. No. Care does not use a TPA. It has its own claims team. Zopper, as the
   servicing intermediary, provides support for claims.
   [Debasis Basu, September 2024]


Q39. What documents are needed for a reimbursement claim?

A. Based on the Bivas claim case (December 2024-January 2025), the following
   were submitted:
   — Filled reimbursement claim form
   — Scan copy of discharge summary
   — Scan copies of all bill payment receipts
   — Scan copy of final bill
   — Aadhaar and PAN cards
   — Cashless final approval letter from base insurer (if applicable)
   — Cancelled cheque

   Care subsequently asked for:
   — First consultation prescription of the doctor who attended on the day of
     admission
   — MLC report (if applicable)
   — Investigation reports supporting the diagnosis
   — Indoor case papers

   Recommendation: Keep every piece of paper issued by the hospital, even if
   it seems insignificant. [Goutam Majumder, January 2025]


Q40. Should I submit original bills or photocopies?

A. Submit self-attested photocopies, not originals. The NITDAA team has
   negotiated with the insurer to accept self-attested photocopies. If they
   request originals, offer to send them to the nearest office for verification
   and return. [Debasis Basu, November 2025]


Q41. What is the experience with claim settlement in the first year?

A. Case 1 (Bivas, Durgapur, December 2024):
   — Soma (spouse) was admitted to a non-network hospital with burn injuries.
   — Base insurer (National Insurance / Medi Assist) paid Rs 81,386 cashless.
   — Bivas paid Rs 5,58,599 out-of-pocket. Total bill: Rs 6,39,985.
   — Deductible under STUP: Rs 5,00,000. Claim filed: Rs 1,39,985.
   — Care paid in two tranches: Rs 55,928 and Rs 81,386. Total: Rs 1,37,314.
   — Settled at approximately 98.1% of the claimed amount.
   — Complications: Non-network hospital, "Anywhere Cashless" denied,
     investigator harassment; all resolved on NITDAA intervention.

   Case 2 (Anirban, Navi Mumbai, December 2024-January 2025):
   — Both parents hospitalised at MGM Vashi (network hospital), total bill Rs 8.5L.
   — Base policy with Star Health (not Care); hospital refused dual cashless.
   — Discharged after paying balance; reimbursement route followed.
   — Claim processed within approximately 30 days.
   — Certain deductions made for consumables etc.
   — Zopper was very helpful throughout the process.

   General observation from IIM Bangalore programme (same STUP policy):
   — A single claim of Rs 39 lakhs was paid for a 45-year-old member.
   — NIT Warangal had a single claim paid of Rs 13 lakhs.
   [Goutam Majumder, January 2025; Debasis Basu, multiple dates]


Q42. What is the claim settlement ratio of Care Health Insurance?

A. The data shared was the 2022-23 industry report showing Care's loss ratio by
   policy count at approximately 67-70%, meaning 70 out of 100 policies had
   claims. Debasis Basu cautioned this is not the "percentage of claims paid"
   but the "cost of claims relative to premium" (loss ratio).
   He noted Care's loss ratio had increased in 2023-24 and this was a concern.
   [Debasis Basu, November 2024]


Q43. Can I go to Ombudsman if a claim is denied?

A. Yes. The Insurance Ombudsman route is available if Zopper/Care does not
   resolve the issue. The complaint link is:
   https://www.cioins.co.in/
   The NITDAA team does not expect members to need this route given the group
   policy's commercial leverage, but it is available. Medical claim disputes
   generally do not go to the legal route; the Ombudsman level is the most
   extreme recourse. [Debasis Basu, December 2024]


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SECTION 8: ENROLLMENT AND RENEWAL
================================================================================

Q44. When does enrollment open for new members?

A. Year 1 (STUP only): Window opened around August 2024, closed September 15,
   2024. No further extension was given.
   Year 2 (STUP new enrollment): Around July 15, 2025 (with possible few days
   delay for system readiness). Window remained open for approximately one month.
   Year 2 (Base Policy): Enrollment opened June 5, 2025 and closed June 25, 2025.
   Year 3 (both policies): Renewal and new enrollment expected in June/July 2026.
   [Debasis Basu, multiple dates]


Q45. Can the policy be bought outside the enrollment window?

A. No. New enrollment is only possible during the announced enrollment window.
   For STUP Year 1 policy holders who missed the renewal, a short extension window
   in Feb-March was explored for Base Policy but not confirmed for STUP.
   [Debasis Basu, November 2025 and December 2025]


Q46. How does renewal work for the STUP?

A. Renewal notices come by email from Care Insurance and by SMS. The renewal is
   done through the NITDAA portal (www.nitdaa.org > External Insurance tab) using
   the same process as the initial purchase. Renewals go live from respective
   policy anniversary dates. Members should renew at least 7-10 days before the
   renewal date.
   [Debasis Basu, June 2025 and July 2025]


Q47. Can I port my existing individual health insurance policy to the NITDAA
group policy?

A. No. NITDAA group policies have no porting-in or porting-out facility. If you
   wish to switch from your existing policy to NITDAA policies, it is advisable
   to maintain overlap between the two policies for one year (to cover the NITDAA
   PED waiting period) and then discontinue the old policy. [Debasis Basu,
   January 2026]


Q48. Is there a no-claim bonus (NCB) in the STUP policy?

A. No. There is no no-claim bonus in a group policy. [Debasis Basu, June 2025]


Q49. Will the premium remain the same on renewal?

A. The premium on renewal is likely to remain the same. However, the premium is
   on an age-band basis and is subject to the overall loss ratio of the group
   portfolio. If the loss ratio remains manageable, the premium should be stable.
   The group leverage across multiple NITs (NIT Warangal, Nagpur, Hamirpur,
   Rourkela, Surathkal, Calicut, Jamshedpur, and NIT Durgapur, with others
   joining) provides additional stability. [Debasis Basu, June 2025]


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SECTION 9: RELATIONSHIP WITH OTHER POLICIES AND SCHEMES
================================================================================

Q50. If I have a government scheme (CGHS / ESI / company group insurance /
Sasthya Sathi), do I still need this policy?

A. These schemes have fixed limits that do not increase with medical cost
   inflation (currently 13-15% per year). The NITDAA programme is considering
   higher deductible options (15, 20, 25 lakhs) for those with employer or
   government coverage at those levels. Taking the STUP with a high deductible
   as a backup over an existing scheme provides high-limit protection at an
   affordable premium.

   For CGHS users specifically: CGHS hospitals are limited, and treatment is
   restricted to government hospitals. The NITDAA policy allows treatment at
   private network hospitals including single room facility.
   [Debasis Basu, multiple dates]


Q51. My cataract operation cost Rs 1.25 lakhs. My base policy reimbursed
Rs 75,000. Can I claim the balance from the STUP?

A. No. The STUP will not pay below the chosen deductible (3 lakhs or 5 lakhs).
   If the total cumulative family bill for the year has not crossed the
   deductible, the STUP does not trigger. [Debasis Basu, March 2025]


================================================================================
SECTION 10: POLICY AND INSURANCE CONCEPTS
================================================================================

Q52. Can an error in my name (e.g., middle name missing) affect my claim?

A. A minor clerical error in the name that is not material to the loss would
   not affect a claim. In a group policy, small deviations are generally not
   an issue unlike individual policies. However, key fields like date of birth
   and address should be correct. The advantage of group policy is that minor
   individual deviations cannot be used as grounds for denial.
   [Debasis Basu, December 2024]


Q53. Why does the hospital network keep changing?

A. Hospitals are de-listed when they do not comply with the pre-agreed rates
   between the insurer and the network hospital. Hospitals sometimes increase
   charges beyond what the insurer has agreed. If an agreement is reached, the
   hospital is re-listed. This is a commercial negotiation that is ongoing.
   Apollo Kolkata (on EM Bypass) was delisted and subsequently came back into
   the Care network. [Debasis Basu, March 2025 and January 2025]


Q54. Why does the insurer pay less on reimbursement claims compared to cashless?

A. For cashless in network hospitals, the insurer pays according to pre-agreed
   rates. For reimbursement from non-network hospitals, the insurer settles
   based on the same pre-agreed "rack rate" it uses for network hospitals. Since
   non-network hospitals typically charge higher rates, the insurer will not pay
   the full bill. [Debasis Basu, multiple dates]


Q55. What is the Principle of Utmost Good Faith in insurance?

A. Insurance is based on the principle of Utmost Good Faith. The policyholder is
   expected to be fully transparent at the time of buying the policy. Hiding a
   pre-existing condition and later having a claim rejected for non-disclosure
   is worse than declaring the condition and waiting out the one-year exclusion
   period. [Debasis Basu, September 2024]


================================================================================
SECTION 11: ANAND GAGGAR — ADVISORY POSTS
================================================================================

Q56. What was Anand Gaggar's assessment of India's healthcare costs and the
need for the NITDAA STUP?

A. In a July 2025 article, Anand Gaggar wrote:

   India's healthcare crisis unfolds through the relentless erosion of financial
   security. Medical emergencies routinely wipe out years of savings. India
   spends barely 1.4% of its GDP on public healthcare. Over 66% of India's total
   health expenditure comes directly from people's pockets — one of the highest
   proportions globally.

   For alumni of NIT Durgapur, the NITDAA-sponsored Super Top-Up Health Insurance
   Plan has been a lifesaver. He strongly urged all NIT Durgapur alumni to enroll
   when the window opens. While coverage up to Rs 1 crore is available, he
   recommended a minimum Rs 25 lakh Sum Insured with a deductible of Rs 3 to 5
   lakhs (depending on the base policy).
   [Anand Gaggar, July 2025]


Q57. What was Anand Gaggar's message in February 2026 to encourage alumni to
enroll?

A. He circulated a note to his batchmates that included the following key points:

   — Real experience: Alumni Atul Agarwal's father (above 75) had a hospital
     bill of Rs 6.85 lakhs. Rs 5 lakhs were approved under the base policy
     without hassle. The balance is to be claimed under the STUP. Atul's feedback:
     "The approval was smooth and the policy is especially valuable for the
     elderly."
   — A NITDAA Medical Emergency WhatsApp group exists for members who have
     enrolled.
   — A NITDAA Insurance Servicing Team WhatsApp group provides guidance on
     policy matters.
   — At the seniors' age, medical emergencies do not give prior notice.
     Financial preparedness gives peace of mind — not just to us, but to our
     families.
   — Let us not postpone this decision.
   [Anand Gaggar, February 2026]


Q58. What was Anand Gaggar's note to batchmates in April 2026 about the need
for health insurance at senior ages?

A. He wrote:

   As we move further into our seventies, one reality is becoming increasingly
   clear — healthcare in India is improving rapidly, but it is also becoming
   significantly more expensive. A short hospital stay for what was once
   considered a "minor issue" can easily run into Rs 5-7 lakhs. A surgery, ICU
   care, or a complication can push bills well beyond Rs 20-25 lakhs.

   Taking a Rs 30 lakh individual health cover at this age is almost impractical
   as premiums can run into several lakhs annually. This is where the NITDAA
   group health insurance scheme becomes extremely relevant. A Base Policy
   combined with a Super Top-Up Policy provides Rs 30 lakhs and beyond coverage,
   with premiums that are still manageable — typically under Rs 1 lakh per year.

   The annual premium for such a cover may be roughly equivalent to: the cost of
   smoking one packet of cigarettes a day, or just one family dinner outside per
   month.
   [Anand Gaggar, April 2026]


Q59. What alert did Anand Gaggar share about the Care Insurance excluded
providers list in March 2026?

A. Anand Gaggar (REC 1965-70) received a communication from Care Insurance
   titled "Excluded Providers Locator" containing a 181-page document. The
   communication stated: Providers who fall short of Care's quality assurance
   standards are excluded from the serviceable list for both cashless and
   reimbursement claims (except in emergencies).

   He shared this in the group so members could be aware and check the list
   before choosing a hospital. The Care Insurance excluded providers link:
   https://cms.careinsurance.com/cms/public/uploads/download_center/Excluded_List.pdf

   Debasis Basu confirmed he would check and revert. Members were advised not to
   panic and to wait for clarification. [Anand Gaggar, March 2026]


Q60. What is Anand Gaggar's suggestion on AI for healthcare bill auditing?

A. In April 2026, Anand Gaggar noted that advanced AI systems can analyse
   massive datasets — medical records, pharmacy logs, insurance claims, and
   hospital billing codes — to detect irregularities such as upcoding and
   unbundling of procedures. He asked whether there is a software developer
   within the NITDAA family who could develop a service to analyse hospital
   bills, medical records, and insurance claims to flag suspicious charges — a
   platform that could empower ordinary patients against opaque hospital billing.
   [Anand Gaggar, April 2026]


================================================================================
SECTION 12: CONTACT INFORMATION (AS APPEARING IN THE CHAT)
================================================================================

For Insurance-related queries:
   — Debasis Basu: 8420130756
   — Goutam Majumdar: 94344 75011
   — Sandip Roy: 98300 58101

For Membership and system-related issues:
   — Probal Chakraverty: 9831054954
   — Somnath Kar: 9836069058
   — Goutam Majumdar: 94344 75011

For Zopper (policy servicing):
   — Email: nitdaahealthplan@zopper.com
   — Rishab Katiyar: 93551 30621 / 98717 13662

NITDAA Portal: www.nitdaa.org
Enrollment Link: https://www.nitdaa.org/external_insurance
Care Health Network Hospitals: https://www.careinsurance.com/health-plan-network-hospitals.html

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