Health Insurance Legal & Claim Toolkits
Free, interactive calculators and legal utilities for Indian policyholders. Calculate waiting periods, enforce hospital cashless SLAs, track statutory deadlines, and find your Insurance Ombudsman.
Waiting Period & Portability Calculator
Check when your Pre-Existing Disease (PED) and slow-developing ailment waiting periods expire. Integrates ported policy continuity and the 36-month IRDAI cap.
- Pre-Existing Disease 36-Month Max Cap (2024 circular)
- Portability continuity credit calculator
- Moratorium period (60 months) validation
Statutory Claim Deadline Calculator
Calculate mandatory calendar deadlines for your Insurer GRO 30-day response, IRDAI Bima Bharosa escalation, and the 1-year Ombudsman limitation period.
- GRO 30-day mandatory resolution countdown
- Download .ics calendar reminders
- Rule 14(3)(b) 1-year Ombudsman limitation audit
Cashless Hospital Delay Stopwatch
Track hospital discharge delays against the statutory 3-hour limit (1 hour for pre-auth). If breached, insurers must bear the extra room stay charges.
- Live ticking SLA timer with breach detection
- IRDAI Clause 7.2 extra room charges protection
- One-click WhatsApp/Email escalation generator
IRDAI Grievance Letter Generator
Generate an instant, formal grievance letter addressed to your insurer’s Principal Grievance Officer citing IRDAI clauses and Supreme Court precedents.
- Pre-loaded Supreme Court precedents (Manmohan Nanda case)
- Specific counter-arguments for PED, room rent & consumables
- Copyable statutory 30-day notice
Claim Documents Checklist
Verify every single medical bill, signed discharge summary, implant sticker, and doctor note before submitting to prevent TPA query delays.
- Interactive readiness progress tracker
- Printable hospital audit checklist (window.print)
- 4 red flags that often lead to rejections
Insurance Ombudsman Office Finder
Find your official Insurance Ombudsman center having territorial jurisdiction over your state and district. Verified addresses, emails, and phone numbers.
- Covers all 28 States and 8 Union Territories
- Exact district splits for Maharashtra, UP & Puducherry
- Verified contacts from cioins.co.in
Why MediclaimSaathi Tools Are Legally Authoritative
In India, health insurance repudiations are strictly regulated by statutory bodies. Insurers and Third Party Administrators (TPAs) routinely cite internal guidelines or arbitrary policy exclusions that have already been declared void by the IRDAI or the Supreme Court of India.
IRDAI Master Circular 2024
Ref: IRDAI/HLT/REG/CIR/06/2024 (29 May 2024). Standardizes 100% cashless SLAs, caps PED waiting periods at 36 months, and bans proportionate deductions on non-room medical charges.
Insurance Ombudsman Rules 2017
Empowers 17 regional ombudsman benches under Rules 13 & 14 to settle disputes up to ₹50 Lakh with awards binding on the insurer and statutory penal interest.
Supreme Court Precedents
Landmark decisions in Manmohan Nanda (2022) and Om Prakash (2017) protect policyholders against technical repudiations and mechanical claim rejections.
Frequently Asked Questions
Do I need to create an account or pay to use these tools?
No. All 6 interactive tools on MediclaimSaathi are 100% free to use and do not require sign-in or payment. You can calculate deadlines, verify waiting periods, and generate letter previews instantly.
Are the calculations updated for the new IRDAI 2024 regulations?
Yes. Every tool is strictly grounded in the IRDAI Master Circular on Protection of Policyholders’ Interests issued on 29 May 2024, the Insurance Ombudsman Rules 2017 (amended 2021), and the Insurance Act 1938.
What is the difference between these free tools and the Claim Check (/check)?
These standalone tools help you calculate statutory benchmarks independently. The Claim Check tool (/check) uses AI optical character recognition (OCR) to read your actual rejection letter or hospital bill PDF/photo, extract every single disallowance line, and match it against our database of legal precedents.
How does IRDAI regulate waiting periods after May 2024?
Under the 29 May 2024 circular, IRDAI reduced the maximum waiting period for Pre-Existing Diseases (PED) from 48 months to 36 months, and reduced the moratorium period from 8 years to 5 continuous years (60 months). Insurers cannot enforce longer waiting periods even if older policy forms mention them.
Have a rejected health insurance claim letter?
Upload your rejection letter or deduction sheet. Our AI letter auditor conducts a 90-second statutory check against all IRDAI regulations and Supreme Court precedents.