Need Legal Advice: Star Health Insurance Denying Room Rent Coverage Despite Policy Terms

Hey everyone, I need some legal guidance regarding Star Health Insurance and potential misrepresentation of policy benefits.

The Issue

I purchased the Star Women Care Insurance (₹50L Sum Insured) (POLICY LINK) in September 2023 through PolicyBazaar. Their agent clearly told me that room rent is separate from the ₹75,000 maternity limit and that I could opt for any room with no sub-limits under the ₹50L plan. I have Whatsapp recordings of this conversation.

However, when I recently contacted Star Health customer care (31 Jan 2025) to confirm, they escalated me to one of the senior executive one Ms. Raji, who told me that room rent is INCLUDED in the ₹75,000 maternity limit—meaning if I take a ₹50K room, I’ll only have ₹25K left for delivery expenses.

This directly contradicts the policy document, which states:

  • "For Sum Insured ₹50,00,000/- and above: Any Room” (no sub-limits mentioned)
  • Maternity expenses up to ₹75,000 per delivery (but no clear mention that room rent is part of this cap)
  • Room rent is listed under "Room, Boarding, Nursing Expenses" as a separate benefit under hospitalization.

Possible Misrepresentation?

  1. PolicyBazaar agent gave me incorrect information at the time of purchase.
  2. Star Health's policy document does not explicitly mention room rent is deducted from the ₹75K maternity limit.
  3. If they enforce this limitation without disclosing it in the policy, could this be considered misrepresentation or an unfair trade practice under IRDAI regulations or the Consumer Protection Act?

My Next Steps & Legal Questions

  • Can I file a complaint with IRDAI or the Insurance Ombudsman regarding this discrepancy?
  • Does the Consumer Protection Act, 2019 apply here, since I was misled by both PolicyBazaar and Star Health?
  • Would this qualify as a breach of contract if the policy doesn’t explicitly state the room rent deduction?
  • What legal recourse do I have to ensure they honor the policy as written?

I am thinking of senting a formal complaint to Star Health, demanding a written response within 5 business days, failing which I plan to escalate.

Any insights on how to proceed legally would be greatly appreciated! Thanks in advance. 🙏