a. Almost all health policies provide a common cover: Hospitalization or Inpatient expenses that
include Room Rent, Nursing expenses, Anesthetist expenses, medicines and like.
b. Check if there are any sub-limits or not for specific treatments / diseases. Also for room rent.
c. If there are limits on room rent be careful. Why? Because, if the policyholder takes a room that is
charged at Rs. 2000 per day, when the eligibility is Rs. 1,000/- then the claim payable for cost
incurred for treatment (excluding medicines) will be reduced in proportion. In this case, as the
eligibility is Rs. 1000/- but the Insured took a Rs. 2000/- room (even though the balance was being
paid by the policyholder), and if the overall payable cost excluding medicines, comes to Rs. 50,000/-,
then the policyholder will be given only Rs. 25,000/-.
d. Pre and post hospitalization expenses - provided by almost all companies varying from 30 days
to 120 days.
e. Restoration / Recharge / Reinstatement of Sum Insured: There are some finer points
surrounding this. Some companies restore the sum insured to its base amount once the sum insures
is exhausted; Some others, after the payment of a claim, bring back the sum Insured to its original
base levels (Policy is of Rs. 5.00 Lakhs; Claim is Rs. 2:00 Lakhs. They automatically enhance the
sum insured to 5.00 Lakhs - all this automatically done with payment of additional premium); But then
there are conditions: Some companies will effect the reinstatement once the original sum insured is
exhausted or is about to get exhausted. There are companies which tell that if the recharged sum
insured can not be used for the same treatment, should that happen, within the same year.
f. Ambulance Charges: Starts from Rs. 1500 onwards.
g. Health check up: Most of the companies provide it every claim free 4 years. Some give it every
year regardless of claims.
h. Second opinion - Whether it will be paid or not.
i. No Claim Bonus: Many companies provide a 20% enhancement of sum insured in the following
year provided there is no claim in the previous year. This is done at no extra cost. TATA AIG in their
Medicare and Medicare Premier provide 50% NCB. So, in the 4th year of the policy, a policy that was
taken for Rs. 5.00 Lakhs will have a sum insured of Rs. 10.00 Lakhs for the same premium (provided
the insured has not moved between age bands) in the 4th year of renewal. Religare Health Insurance
provides for SUPER NCB, where in on payment of additional premium, the sum insured is enhanced
by 50% each in the 1st and 2nd year of renewal and in the subsequent 3 years sum insured is
enhanced by 10%. Sum Insured enhancement is always on the base sum insured on all policies.
j. Compassionate Travel: Whether it will be paid or not.
k. Consumables: Whether it will be paid or not.
l. Waiting Period: 3 types of waiting periods are applicable:
1. First month - no hospitalization expenses are payable except when it is caused due to
accident.
2. 12 / 24 months - Specific medical conditions are excluded
3. Pre Existing Diseases - 24 / 36 / 48 months exclusion for pre existing diseases.