5 Minute Checklist for Buying Health Insurance

Health insurance is the firewall that protects your life's savings from the flames of medical emergencies. However, buying the wrong health insurance policy can be almost as damaging as having none at all. It gives you a false sense of security, only to let you down when you need it the most.

Here’s a simple, 5‑minute checklist to review before you buy or renew health insurance in India. It keeps the focus on coverage you can actually use, not just glossy features or tax deductions.

Start Here - How much cover do I really need?

Illustrative thumb rules (adjust for city, hospital preferences, family size):

• Metros (Tier‑1): Consider ₹10–₹20 lakh base cover per adult. You may add a ₹20–₹50 lakh super top‑up for major events, or take higher base cover if premium cost suits your pocket.

• Non‑metros (Tier‑2 and 3): ₹7–₹15 lakh base cover per adult, plus super top‑up as budgets allow.

• Parents/seniors: Take separate policy for seniors. Prioritize adequate base + high super top‑up; expect co‑pays or higher premium costs in senior plans.

Remember: this is a starting point, not a guarantee. Medical inflation, lifestyle and hospital choice matter.

Your 5-Minute Checklist for a Wise Choice

Take time to evaluate any health insurance policy against these five critical parameters.

1. The Company itself

   - Don't just get allured by policy features or low costs, the most important part is choosing a good company to cover your health risk.

   - Check the company history, settlement ratio, complaints ratios

2. Sum Insured

   - Is the base cover adequate for your city/hospital preference?

   - Consider a super top‑up to cheaply lift protection for big bills.

3. No Room‑Rent Capping

   - Is there a room‑rent cap (₹5,000/day or 1% of SI)? Prefer “no cap” or “single private room” eligibility.

   - Most insurers apply a ‘proportionate deduction’ clause. If your room rent eligibility is 40% lower than your actual room rent, the insurer may reduce the payout for the entire hospital bill (including doctor’s fees, medicines, tests) by 40%.

4. No Sub‑Limits On Treatments

   - Look for disease‑wise caps (e.g., cataract), modern treatment limits, domiciliary, AYUSH caps

   - Fewer sub‑limits = fewer surprises.

5. No Co‑Pay & Deductibles

   - Co‑pay is the share you must pay (e.g., 10–20%), common in senior/zone‑based plans

   - Deductible is the fixed amount you pay before insurer pays.

6. Waiting Periods

   - Initial waiting (often 30 days), specified diseases (commonly 1–2 years), pre‑existing diseases (PED, often 2–4 years), maternity (often 9–36 months).

   - Check restoration/NCB behavior during these periods.

7. Network Hospitals & Cashless

   - Shortlist 3–5 nearby hospitals you actually prefer; ensure they’re in‑network.

   - Understand cashless steps and TPA/app flow in advance.

8. Bonus, Inflation Protection & Restoration

   - Bonus and Inflation Protection can increase cover each year. Checking conditions attached to use of these add-ons is crucial.

   - Restoration refills cover after a claim; check triggers (same illness or different? once per year or unlimited?).

   - Order in which Sum Insured, Bonus, Restoration are applicable is important. Generally it's SI > Bonus > Restoration benefits.

9. Medical History Declarations

   Disclose all past conditions, investigations, and medications. Non‑disclosure can jeopardize claims.

10. Day‑Care, OPD, Consumables

    - Many procedures are day‑care now; ensure coverage.

    - Check OPD/consultation add‑ons, consumables cover (gloves, PPE, etc.), and ambulance limits.

11. Pre and Post Hospitalization

    - Your prescribed medicines and tests done pre- and post-hospitalization are covered in the health policy

    - Limits vary between 60-90 days for pre- and 120-180 days for post-hospitalization in general.

    - Generally these claims are not cashless, and are on reimbursement basis with appropriate availability of doctors' prescriptions

12. Bonus Tip: Check the Exclusions

    Your Insurer may put additional exclusions. Some are for a time being (like waiting period) but some could be there permanently, which you can never ever claim. When you get a policy copy, go through the same and check if there are any such exclusions. I you dont agree, you can return the policy and get a full refund in free-look period.

FAQs

1. "My employer's group policy is enough, right?"

   This is one of the biggest myths. Corporate cover is often inadequate (low sum insured), may have restrictions (like room rent caps), and most importantly, it ends the day you leave your job. Your personal policy is your only true lifelong safety net.

   
   

2. "I'm young and fit. Isn't this a waste of money?"

   No, it's the smartest time to buy. Your premiums will be at their lowest, you will get coverage without exclusions for pre-existing diseases, and you will painlessly serve out all waiting periods while you are healthy.

   
   

3. Will Bonus, Inflation Protection and Restoration replace a higher base cover?

   They help, but shouldn’t replace an adequate base. If you decide to port your policy for a better choice in future, only base sum insured is considered for exemption of waiting periods. Also, if you develop a health condition in between, the company may refuse to increase the base sum insured later.

Conclusion

Five focused minutes today can prevent five‑figure surprises later! Prioritize usable coverage - sum insured, room category, no caps, network fit and then weigh price and add‑ons. This 5-minute checklist empowers you to look beyond the premium and sales pitch and evaluate a policy on the terms that truly matter. Choosing the right health insurance policy is not an expense; it is a critical investment in your financial well-being.

Happy Investing!