| 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. |
|
|
| ================================================================================ |
| 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] |
|
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|
|
| Q3. What is the entry age limit? |
|
|
| A. Up to 85 years for both policies. [Debasis Basu, September 2024] |
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|
|
| 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] |
|
|
|
|
| ================================================================================ |
| 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] |
|
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|
|
| 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] |
|
|
|
|
| ================================================================================ |
| 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] |
|
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|
|
| 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] |
|
|
|
|
| ================================================================================ |
| 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] |
|
|
|
|
| ================================================================================ |
| 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] |
|
|
|
|
| ================================================================================ |
| 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] |
|
|
|
|
| ================================================================================ |
| 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 |
|
|
| ================================================================================ |
| END OF DOCUMENT |
| ================================================================================ |
|
|
