Room eligibility
Prefer clear room-category wording. Ask whether choosing a higher room can cause proportionate deductions elsewhere in the bill.
Waiting periods
Record separately:
- initial waiting period
- pre-existing-disease waiting period
- specified disease or procedure waiting period
- maternity or newborn conditions if relevant
Do not rely on a salesperson’s verbal description.
Co-pay and deductible
A co-pay makes you bear a percentage of eligible claims. A deductible must be crossed before the policy or top-up pays according to its terms. Check whether these apply by age, city, hospital, treatment, or claim type.
Sub-limits
Look for limits on procedures, disease categories, ambulance, consumables, modern treatments, maternity, domiciliary care, and other benefits.
Restoration or recharge
Check when the sum insured restores, whether it can be used for the same illness or person, and whether it activates once or multiple times. Marketing names differ.
Exclusions
Read permanent exclusions, non-medical items, waiting-related exclusions, and any individual underwriting exclusion or loading.