Checklist When Buying a Health Insurance Policy: What Every Indian Must Review Before Buying

Buying a health insurance policy is one of the most important financial decisions you will make. With medical inflation rising at 12–14% annually, even a short hospitalisation can exhaust savings. Yet, most claim disputes and rejections happen because policyholders buy plans without understanding key terms.

To protect yourself and your family, here is a complete, practical checklist you MUST go through before buying any health insurance plan — whether it’s for individuals, families, parents, or senior citizens.

Your sum insured must match today’s medical costs.

1. For metros: At least ₹10–25 lakh
   
2. For families: Consider a family floater with ₹20–30 lakh
   
3. For parents/seniors: Minimum ₹10–15 lakh + Super Top-Up

Tip: Always combine a base policy with a super top-up for higher coverage at a lower premium.

Waiting periods cause a large share of claim rejections.
Check for:

1. Initial waiting period: 30 days
   
2. Pre-existing diseases (PED): 2–3 years
   
3. Specific conditions: Hernia, joint replacement, cataract, etc.

Choose insurers offering reduced PED waiting period options (with extra premium).

This is a major hidden cost. If your policy has a cap like 1% of SI for room rent, you may end up paying proportionately for everything — doctor fees, diagnostics, nursing charges.

Best: Choose “No Room Rent Capping” or “Any Room Category (except suite)”.

Many policies silently add caps on:

1. Cataract surgery
   
2. Modern treatments like robotics
   
3. AYUSH
   
4. Ambulance
   
5. Daily cash
   
6. Maternity

Go for plans with minimal or zero sub-limits, unless you are aware and comfortable.

A co-pay means you pay a percentage of every claim.
Example: 20% co-pay → You pay ₹20,000 on a ₹1,00,000 bill.Avoid co-pay clauses unless buying for senior citizens or high-risk age bands.

Before buying:

1. Verify your preferred hospitals are in-network
   
2. Check if cashless is available
   
3. Ensure the insurer has a strong presence in your city/locality
   

Look for:

1. At least 60–90 days pre-hospitalisation
   
2. At least 90–180 days post-hospitalisation
   This matters for conditions requiring long follow-ups like cancer, cardiac issues, or surgeries.

Ensure the policy covers all modern day-care procedures without listing limitations.

This automatically restores your sum insured if it gets exhausted.
Choose:

1. Unlimited restoration
   
2. Applicable for same illness (most insurers restrict this)
   

Good to have:

1. OPD doctor consults
   
2. Diagnostics
   
3. Dental
   
4. Annual health check-ups

As preventive care becomes important, these benefits add real value.

High claim settlement ratio is not enough — look for:

1. Speed of settlement
   
2. Transparency
   
3. Reviews
   
4. Ease of documentation
   
5. Support during hospitalisation

Pick insurers known for quick and fair claims.

Common exclusions include:

1. Cosmetic surgery
   
2. Non-allopathic treatments beyond limits
   
3. Unproven therapies
   
4. War/riot-related injuries
   
5. Unregistered hospitals

Always read the policy wording before paying.

Most consumers don’t know this — you get up to 30 days as a free-look period  If you find the policy unsuitable, you can cancel and get a refund.

A well-chosen health insurance policy protects your savings, provides peace of mind, and ensures timely treatment. A poorly chosen one leads to disputes, rejection, and financial stress.

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