Put the policy schedule, Customer Information Sheet and full policy wording side by side. Record who is covered, the sum insured, whether that limit is individual or shared, and the exclusions that matter to your household. Two policies with the same sum insured can leave very different out-of-pocket bills. Use the summary to locate the relevant clauses and read the wording for the conditions.
Identify each waiting period
Check the initial waiting period, any waiting period for pre-existing diseases and any separate waiting periods for listed treatments. Write down what is affected and when the restriction ends under the contract. When changing a policy or increasing the sum insured, ask the insurer in writing which parts of your previous continuity are recognised and which conditions apply to the increased cover.
Estimate what you might pay yourself
A co-pay is a share of the eligible claim you bear. For example, if an insurer determines that ₹80,000 is eligible and a 20% co-pay applies to that amount, your co-pay is ₹16,000. Excluded expenses may add to that amount. Separately check any deductible, procedure sub-limit and room category restriction. Ask whether choosing a higher room category affects other charges under the particular policy.
Verify the hospital and claims process
Check whether the exact branch you use is in the insurer’s current network and ask how cashless authorisation works for planned and emergency admissions. Cashless processing can still leave eligible co-pays and non-covered charges to be paid by the patient. Ask how reimbursement works if cashless processing is unavailable, which records you should retain and how to contact the insurer or administrator after hours.
Official reference and further reading: IRDAI health insurance master circular and the TaxNexus Insurance hub. This guide is educational. Last updated 4 November 2026.
