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Health insurance · Comparing plans
Compare the terms that decide a claim, not just the premium.
Two policies with the same sum insured can pay very different amounts for the same hospital stay. These are the lines in a policy that make the difference, and a worksheet to set two side by side.
Reviewed
In short
- Start with each policy’s Customer Information Sheet: the key terms on a page or two.
- Room rent limits, co-payments and sub-limits reduce what a claim pays, whatever the sum insured.
- Waiting periods decide when cover for existing and specific illnesses actually begins.
Start with the Customer Information Sheet
Every health policy comes with a Customer Information Sheet: a short summary of what is covered and what is not, the waiting periods and the limits, with references to the full policy wording. Two of them side by side are the quickest honest comparison there is.
Where the sheet and the policy wording seem to differ, the policy wording decides.
The terms that change what a claim pays
Room rent: a cap on the room charge for each day. Choose a room above it and many policies reduce some other charges in proportion too, not just the room rent.
Co-payment: a share of every claim you pay yourself, sometimes only for older members or for treatment in certain cities. Sub-limits: caps on particular treatments, such as cataract surgery, whatever the sum insured. Deductible: an amount you pay before the policy pays, usual in top-up plans.
The terms that decide when cover starts
Most policies do not pay for illness in the first 30 days, though accidents are covered from the start. Pre-existing diseases are covered after a waiting period stated in the policy, which IRDAI’s rules cap at three years; some conditions and procedures, such as joint replacement, carry a waiting period of their own.
What adds value over the years
A no-claim bonus raises the sum insured after a claim-free year, up to a limit. Restoration tops the sum insured up again once it has been used within a policy year. And a network hospital near you means treatment without paying first.
Compare two policies
What to check
These decide whether cover is real when you claim. Read them before the premium.
Like for like
Compare the same members and the same sum insured, or the premiums tell you nothing.
Room rent in rupees
Turn “1% of the sum insured” into a rupee figure and set it against the room you would choose at your nearest hospital.
Who pays a co-payment
Check whether it applies to every member, only older members, or only some cities.
The sub-limits list
Caps on common procedures can matter more than the headline cover.
Your nearest hospitals
Check that the hospitals you would actually use are on each insurer’s cashless network.
Questions people ask
General guidance. Your policy wording decides the specifics.
Is a lower premium always better value?
Not necessarily. A lower premium often comes with a room rent cap, a co-payment or longer waiting periods. Compare what each would pay on a likely claim.
Where do I find these terms?
In the Customer Information Sheet and the policy wording, which the insurer publishes for every policy and gives you before you buy.
Will you tell me which policy to buy?
We explain the terms and the options that fit your needs, with what each costs. We do not rate or rank insurers, and the choice is yours.
Insurance is the subject matter of solicitation. Benefits depend on the policy terms and the insurer’s decision; read the policy wording before buying.