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Health insurance commonly covers hospital room rent, surgery, medicines, and diagnostic tests. IC-38 stresses that only medically necessary and authorized expenses are reimbursed. Non-medical or cosmetic expenses are excluded to protect the insurer’s financial sustainability.

The Grievance Redressal Cell monitors how insurers handle complaints and ensures compliance with timelines. IC-38 highlights that it provides oversight and escalation for unresolved grievances. This system strengthens accountability and consumer protection.

Subrogation allows insurers to recover from third parties after compensating insureds. IC-38 notes this prevents unjust enrichment and ensures liability rests with the responsible party.

Policyholders may escalate unresolved grievances to IGMS or the Ombudsman. IC-38 highlights this multi-tiered system to ensure affordable and effective dispute resolution.

Cosmetic surgery for beautification is excluded. IC-38 clarifies that health insurance covers only medically necessary treatments, ensuring affordability and fairness for all policyholders.