Health insurance,without the fine print.

Health insurance pays for your medical treatment when you are admitted to hospital. You pay a yearly premium; if you fall ill or are injured, the insurer pays the hospital directly or repays you afterwards, up to the cover amount you chose — say ₹10 lakh a year.

A single hospital stay for a heart procedure or cancer treatment can cost ₹5–20 lakh in a private hospital today. Health insurance turns that unpredictable shock into a small, predictable yearly cost.

• Hospital room, nursing and ICU charges
• Doctor and surgeon fees
• Operations and procedures
• Medicines, tests and scans during the stay
• Tests and visits 30–60 days before admission
• Follow-up care 60–180 days after discharge
• Day-care treatments that need no overnight stay
• Ambulance charges
• Treatment at home when advised by a doctor
• Ayurveda and other traditional treatments

• Illnesses in the first 30 days of a new policy (accidents are covered from day one)
• Existing illnesses such as diabetes or blood pressure — until a waiting period of up to 3 years is over
• Certain planned treatments like cataract, hernia or joint replacement — usually after 1–2 years
• Cosmetic surgery, dental work and spectacles, unless due to an accident
• Outpatient doctor visits and routine medicines, unless your plan includes them

• 01

  Cashless treatment

  At a network hospital, the insurer pays the hospital directly. You only pay for items not covered.

• 02

  Reimbursement

  You pay the hospital first, then send the bills to the insurer to be repaid.

• 03

  Waiting period

  A period after buying during which certain illnesses are not yet covered.

• 04

  Room rent limit

  A cap on the room you can choose. Pick a bigger room and the insurer may cut the whole bill proportionately — avoid plans with this limit.

• 05

  Co-payment

  A fixed share of every bill — say 10–20% — that you pay yourself. Common in policies for senior citizens.

• 06

  No-claim bonus

  Your cover grows — often by 10–50% a year — for every year you make no claim, at no extra cost.

• 07

  Restoration

  If you use up your cover in a year, it is refilled for another illness or another family member.

• 08

  Top-up / super top-up

  A low-cost extra policy that pays once your bills cross a set amount — a cheap way to add large cover.

• 01

  Individual

  Who it covers

  One person, with their own cover amount

  Good for

  Single people, or older parents

• 02

  Family floater

  Who it covers

  Whole family shares one cover amount

  Good for

  Young families — lower cost

• 03

  Senior citizen

  Who it covers

  People over 60

  Good for

  Parents; often with co-payment

• 04

  Critical illness

  Who it covers

  A lump sum on diagnosis of a serious illness

  Good for

  Adding to a regular policy

• 05

  Super top-up

  Who it covers

  Bills above a set amount, for the year

  Good for

  Raising cover cheaply

In a metro city, ₹10–15 lakh for a family of four is a sensible minimum today; ₹25 lakh or more if you want comfort for serious illnesses. A cost-effective way is a ₹10 lakh base policy plus a ₹25–50 lakh super top-up.

Your employer’s health cover ends when you leave the job. Keep a personal policy too — it builds waiting-period credit and no-claim bonus that you never lose.

1. 1

   Check that your preferred hospitals are in the insurer’s cashless network

2. 2

   Choose a policy with no room-rent limit and no co-payment

3. 3

   Prefer shorter waiting periods for existing illnesses

4. 4

   Look for a good no-claim bonus and restoration benefit

5. 5

   Declare every existing illness honestly

• 01

  For you and your family

  Premiums up to ₹25,000 a year (₹50,000 if you are over 60) reduce your taxable income under Section 80D, in the old tax regime.

• 02

  For your parents

  A further ₹25,000 a year — or ₹50,000 if they are senior citizens.

• 03

  Health check-ups

  Up to ₹5,000 a year for preventive check-ups, within the limits above.

Cashless — at a network hospital

1. 1

   Show your health card at the hospital’s insurance desk

2. 2

   The hospital sends an approval request to the insurer

3. 3

   The insurer approves; the bill is settled directly at discharge

Reimbursement — at any hospital

1. 1

   Inform the insurer within 24–48 hours of admission

2. 2

   Pay the hospital and keep every bill, report and prescription

3. 3

   Submit the claim within the time limit; the money is paid to your bank