Add-ons (riders)<\/td> What does each add-on cover, what does it cost, and what are its limits?<\/td> Add-ons are optional extras, so they carry their own terms.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n<\/p>\n\n\n\n
Illustrative example (for explanation only):<\/em> Suppose a policy limits room rent to \u20b95,000 a day with proportionate deduction, and you stay in a room that costs \u20b910,000 a day. In that structure, the insurer may pay only half of certain other charges linked to the room category, such as some doctor and procedure fees, because the room cost is double the allowed limit. The exact items affected depend on the policy wording.<\/p>\n\n\n\nIRDAI has standardised the definitions of common terms, such as “hospital” and “day care procedure”, so that they mean the same thing across policies. Even so, always check how a specific policy words them.<\/p>\n\n\n\n
Next on the health insurance checklist:<\/strong> Coverage on paper matters only if you can use it at the hospital you choose.<\/p>\n\n\n\nStep 5: Check the hospital network and cashless process<\/strong><\/h2>\n\n\n\nIn a cashless claim, the insurer settles the eligible bill directly with the hospital, so you pay only the items the policy does not cover. This works at network hospitals. For others, you would pay and claim later.<\/p>\n\n\n\n
Check these before buying:<\/p>\n\n\n\n
\nNetwork near you.<\/strong> Look for the hospitals your family would genuinely choose, in the areas where you live and where your parents live. Ask the insurer for the current list, because networks change.<\/li>\n\n\n\nPlanned and emergency admissions.<\/strong> For a planned admission, you usually ask for approval in advance. For an emergency, you inform the insurer within the time stated in the policy. Know the process and keep the helpline number saved.<\/li>\n\n\n\nWhat cashless does not mean.<\/strong> Approval does not make every rupee payable. Co-payments, deductibles, sub-limits and non-payable items can still leave a balance to pay.<\/li>\n<\/ul>\n\n\n\nIRDAI’s Master Circular sets time limits for insurers on cashless requests. An insurer must decide on a cashless authorisation request within one hour of receiving it, and must give the final authorisation within three hours of receiving the discharge request from the hospital. If the process drags beyond this, note the times and raise it with the insurer in writing.<\/p>\n\n\n\n
Next on the health insurance checklist:<\/strong> The network gets you admitted, and the claim process decides what happens after.<\/p>\n\n\n\nStep 6: Understand how claims work<\/strong><\/h2>\n\n\n\nA good health insurance checklist covers the claim route too, because you should know it before you ever need it.<\/p>\n\n\n\n
Cashless claim, in short<\/strong><\/p>\n\n\n\n\nTell the hospital’s insurance desk you want to use cashless and show your policy details and ID.<\/li>\n\n\n\n The hospital sends a pre-authorisation request to the insurer.<\/li>\n\n\n\n The insurer decides within the IRDAI time limit.<\/li>\n\n\n\n At discharge, you pay any non-payable items or shares, such as co-payment.<\/li>\n<\/ol>\n\n\n\nReimbursement claim, in short<\/strong><\/p>\n\n\n\n\nPay the hospital yourself.<\/li>\n\n\n\n Inform the insurer within the time stated in your policy.<\/li>\n\n\n\n Submit the claim form and documents.<\/li>\n\n\n\n The insurer assesses the claim and pays the eligible amount to you.<\/li>\n<\/ol>\n\n\n\nDocuments commonly asked for<\/strong> (the policy lists exactly what applies):<\/p>\n\n\n\n\nCompleted claim form<\/li>\n\n\n\n Original hospital bills and payment receipts<\/li>\n\n\n\n Discharge summary<\/li>\n\n\n\n Investigation and test reports<\/li>\n\n\n\n Doctor’s prescriptions and treatment notes<\/li>\n\n\n\n Photo ID and a copy of the policy<\/li>\n\n\n\n Bank account details for payment<\/li>\n<\/ul>\n\n\n\nKeep copies of everything, and keep the originals safe until the claim closes.<\/p>\n\n\n\n
Timelines.<\/strong> IRDAI’s rules require insurers to settle or reject claims within set timelines, and if payment is delayed beyond them, interest at 2% above the bank rate applies. Ask the insurer which timelines apply to your policy.<\/p>\n\n\n\nWhy claims are rejected.<\/strong> The usual reasons are non-disclosure on the proposal form, a claim during a waiting period, treatment that falls under an exclusion, missing or late documents, and treatment that does not meet the policy’s definition of hospitalisation. <\/p>\n\n\n\nMost of these are visible in advance if you work through Step 3, Step 4 and Step 7.<\/p>\n\n\n\n
A note on claim data.<\/strong> Insurers publish claim-related figures, and these can be one input when you compare. They describe an insurer’s overall record. They do not tell you how your own claim will be treated, so use them alongside the policy wording and never in place of it.<\/p>\n\n\n\nNext:<\/strong> Claims depend on the policy’s exact wording, so the next step is learning how to read it without getting lost.<\/p>\n\n\n\nStep 7: Read the fine print before you pay<\/strong><\/h2>\n\n\n\nYou do not need to read every page twice. Read these parts carefully.<\/p>\n\n\n\n
\nCustomer Information Sheet.<\/strong> IRDAI requires insurers to provide a summary of a health policy’s key features, in simple language. Ask for it before you buy and read it first.<\/li>\n\n\n\nExclusions.<\/strong> List what the policy will never pay for. Compare this list across the plans you are considering.<\/li>\n\n\n\nDefinitions.<\/strong> Check how the policy defines hospitalisation, day-care procedure and pre-existing disease.<\/li>\n\n\n\nProposal form.<\/strong> Make sure every answer is accurate and complete, including past treatment and any medicines you take regularly.<\/li>\n\n\n\nPolicy schedule.<\/strong> When it arrives, check names, dates of birth, sum insured, add-ons and the policy period for errors. Errors are far easier to fix at the start than at claim time.<\/li>\n<\/ol>\n\n\n\nUse the free-look period<\/strong><\/h3>\n\n\n\nIf you are not satisfied, IRDAI’s Master Circular gives you a 30-day free-look period from the day you receive the policy document. You can cancel in that time and receive a refund of the premium, after deductions as the policy document lists, which can include a charge for the period the cover was in force, medical examination costs and stamp duty. Use these 30 days to read the whole policy once, with the Customer Information Sheet beside it.<\/p>\n\n\n\n
Next on the Health Insurance Checklist:<\/strong> With the policy understood, the last practical question is what it will cost you over time and how you can leave it.<\/p>\n\n\n\nStep 8: Look at cost, renewal, portability and tax<\/strong><\/h2>\n\n\n\nPremium over time<\/strong><\/h3>\n\n\n\nPremiums usually rise as you move into higher age bands, so ask for the premium table by age rather than only today’s quote. Also ask how the insurer revises premiums and what you will be told in advance.<\/p>\n\n\n\n
Renewal<\/strong><\/h3>\n\n\n\nHealth policies are meant to be renewed for as long as you wish. Under IRDAI’s rules, an insurer cannot refuse renewal because you made claims. It may decline only in specific situations such as fraud, misrepresentation or non-cooperation. Do not let renewal slip, because a break in cover can affect the waiting period and moratorium credit.<\/p>\n\n\n\n
Grace period.<\/strong> If you pay late, IRDAI’s rules provide a grace period of 15 days for monthly premium payment and 30 days for other modes. Renewing in this window protects continuity, but the policy does not cover you for the gap, so treat the grace period as a safety net for continuity and not as extra cover.<\/p>\n\n\n\nPortability and migration<\/strong><\/h3>\n\n\n\nPortability is your right to move your policy to another insurer at renewal while keeping credit for the waiting periods you have already served. Migration is the same idea for moving to another plan with the same insurer.<\/p>\n\n\n\n
\nThe credit applies to the sum insured of your earlier policy. Any additional sum insured is treated as new, with fresh waiting periods.<\/li>\n\n\n\n The new insurer reviews your proposal afresh and can accept or decline it, so keep your current policy active until you have written acceptance.<\/li>\n\n\n\n IRDAI’s Master Circular sets short timelines for the process: the existing insurer must share your details within 72 hours of the request, and the new insurer must respond within five days of receiving them.<\/li>\n\n\n\n Start well before the renewal date, because you need time for documents and decisions.<\/li>\n<\/ul>\n\n\n\nGST on premiums<\/strong><\/h3>\n\n\n\nPremiums for individual health policies, including family floater and senior citizen plans, are currently exempt from GST. Group policies are not. Tax rules can change, so check your premium receipt.<\/p>\n\n\n\n
Tax deduction under Section 126<\/strong><\/h3>\n\n\n\nSection 126 of the Income-tax Act, which replaces the earlier Section 80D, allows a deduction for health insurance premiums and certain medical expenses. These are the main limits as currently set:<\/p>\n\n\n\nWho is covered<\/strong><\/th>Deduction limit<\/strong><\/th><\/tr><\/thead>You, your spouse and children (below 60)<\/td> \u20b925,000<\/td><\/tr> You, your spouse and children (you are 60 or above)<\/td> \u20b950,000<\/td><\/tr> Your parents (below 60)<\/td> \u20b925,000<\/td><\/tr> Your parents (60 or above)<\/td> \u20b950,000<\/td><\/tr> Overall maximum when both limits are at their highest<\/td> \u20b91,00,000<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\n\nA preventive health check-up of up to \u20b95,000 is included within these limits. It is not an additional amount.<\/li>\n\n\n\n The premium must be paid through a non-cash mode to qualify. The preventive check-up is the exception.<\/li>\n\n\n\n The deduction is available only if you file under the old tax regime. It is not available under the new regime.<\/li>\n<\/ul>\n\n\n\nYour own circumstances may change the amount you can claim, so speak to a tax professional before you file.<\/p>\n\n\n\n
Next on the health insurance checklist:<\/strong> Price and tax are settled, and the final check is knowing what to do if the insurer says no.<\/p>\n\n\n\nStep 9: Know where to go if something goes wrong<\/strong><\/h2>\n\n\n\nMost claims proceed smoothly. If yours does not, work through these in order.<\/p>\n\n\n\n
\nWrite to the insurer.<\/strong> Send your complaint in writing to the insurer’s grievance officer or customer care, and keep the reference number and a copy.<\/li>\n\n\n\nEscalate to IRDAI.<\/strong> If the insurer’s reply does not resolve the matter, you can register the complaint on IRDAI’s Bima Bharosa portal.<\/li>\n\n\n\nApproach the Insurance Ombudsman.<\/strong> If the insurer rejects your complaint, or does not reply within 30 days, you can take it to the Insurance Ombudsman for your area. An insurer must comply with an Ombudsman’s award within 30 days of receiving it.<\/li>\n\n\n\nConsumer Commission.<\/strong> You can also approach a consumer forum, which is a separate legal route.<\/li>\n<\/ol>\n\n\n\nKeep every email, letter, bill and call reference in one folder. A clear paper trail is the most useful thing you can bring to any of these steps.<\/p>\n\n\n\n
Next on the health insurance checklist:<\/strong> You now have the full sequence. Before you finish, see the mistakes that undo it.<\/p>\n\n\n\nCommon mistakes that undo a health insurance checklist<\/strong><\/h2>\n\n\n\nMistake<\/th> What to do instead<\/th><\/tr><\/thead> Choosing only the lowest premium<\/td> Compare the limits in Step 4, not only the price.<\/td><\/tr> Leaving out a condition on the proposal form<\/td> Disclose every condition and treatment, even if it seems minor.<\/td><\/tr> Ignoring the room rent limit<\/td> Check the cap and whether a \/proportionate deduction applies.<\/td><\/tr> Assuming cashless pays everything<\/td> Expect co-payments, sub-limits and non-payable items.<\/td><\/tr> Letting the policy lapse<\/td> Renew on time and keep cover continuous.<\/td><\/tr> Relying only on employer cover<\/td> Keep a personal policy that continues when the job ends.<\/td><\/tr> Cancelling the old policy before the new one is accepted<\/td> Wait for written acceptance before you leave the old policy.<\/td><\/tr> Not saving claim documents<\/td> Keep copies of every bill, report and message.<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\nOne-page health insurance checklist<\/strong><\/h2>\n\n\n\nSave this or print it and take it with you when you compare policies.<\/p>\n\n\n\n#<\/strong><\/th>Check<\/strong><\/th>Look for<\/strong><\/th><\/tr><\/thead>1<\/td> Who is covered<\/td> Individual or floater; parents separately; employer cover as an addition<\/td><\/tr> 2<\/td> Sum insured<\/td> Based on local hospital costs, ages and family history; super top-up considered<\/td><\/tr> 3<\/td> Initial waiting period<\/td> Length and what it applies to<\/td><\/tr> 4<\/td> Pre-existing disease wait<\/td> Exact period, never above the 36-month ceiling<\/td><\/tr> 5<\/td> Specific waiting periods<\/td> The list of conditions and their periods<\/td><\/tr> 6<\/td> Maternity<\/td> Whether offered, wait and limits<\/td><\/tr> 7<\/td> Room rent<\/td> Cap and proportionate deduction<\/td><\/tr> 8<\/td> Co-payment and deductible<\/td> Percentage or amount and when it applies<\/td><\/tr> 9<\/td> Sub-limits<\/td> Any disease or procedure caps<\/td><\/tr> 10<\/td> Non-payable items<\/td> Which items you will pay yourself<\/td><\/tr> 11<\/td> Pre- and post-hospitalisation<\/td> Exact days<\/td><\/tr> 12<\/td> Day care, AYUSH, modern treatment<\/td> Cover and any limits<\/td><\/tr> 13<\/td> Restoration and bonus<\/td> Conditions and how they change after a claim<\/td><\/tr> 14<\/td> Network hospitals<\/td> Your preferred hospitals are listed<\/td><\/tr> 15<\/td> Claim process<\/td> Cashless steps, reimbursement steps, documents, time limits<\/td><\/tr> 16<\/td> Customer Information Sheet<\/td> Read before paying<\/td><\/tr> 17<\/td> Exclusions and definitions<\/td> Compared across plans<\/td><\/tr> 18<\/td> Proposal form<\/td> Every answer accurate and complete<\/td><\/tr> 19<\/td> Free-look period<\/td> 30 days; read the whole policy in this window<\/td><\/tr> 20<\/td> Premium by age<\/td> Table of future age bands<\/td><\/tr> 21<\/td> Renewal, grace period, portability<\/td> Dates, timelines and credit for waiting periods<\/td><\/tr> 22<\/td> Tax<\/td> Section 126 limits; old regime; non-cash payment<\/td><\/tr> 23<\/td> Grievance route<\/td> Insurer, Bima Bharosa, Insurance Ombudsman<\/td><\/tr><\/tbody><\/table><\/figure>\n\n\n\nConclusion<\/strong><\/h2>\n\n\n\nHealth insurance does its job only when the details match your needs, and those details are written in the policy, not in the advertisement. Work through the nine steps, use the one-page health insurance checklist whenever you compare plans, and keep a record of every document. A health insurance checklist works best when you repeat it at every renewal, because your family, your health and the policy terms can all change. Whichever plan you pick, read it fully during the free-look period.<\/p>\n\n\n\n
Disclaimer.<\/em><\/strong> This article is for general information and does not recommend any insurer or product. Policy features, regulations and tax rules vary and can change; please read the policy wording, the Customer Information Sheet and the sales brochure carefully before buying. Consult a qualified tax professional for your own tax position.<\/em><\/p>\n\n\n\nInsurance is the subject matter of solicitation.<\/p>\n\n\n\n
One Battalion Ventures Pvt Ltd (Pillow Insurance) is a corporate agent registered with IRDAI, Registration No. CA1145.<\/em><\/p>\n\n\n\nFAQs<\/strong><\/h2>\n\n\n\n
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What should I check first in a health insurance checklist?<\/h3>\n\n\n
Start with who needs cover and how much. Then read the waiting periods and the limits on room rent, co-payment and sub-limits, because these decide how much of a bill the policy pays.<\/p>\n\n<\/div>\n<\/div>\n
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Is a pre-existing disease always excluded?<\/h3>\n\n\n
No. Under IRDAI’s rules, the waiting period for pre-existing diseases cannot exceed 36 months, so cover can begin after that period if you have declared the condition. The insurer may still apply its own terms when it accepts your proposal, so check the details before you pay.<\/p>\n\n<\/div>\n<\/div>\n
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Does cashless mean the insurer pays the whole bill?<\/h3>\n