Property & IRDAI Licensed Insurance Agent in Indore. Expert in Health Gap Analysis. Travel Insurance. Insurance is the subject matter of solicitation.

Health Insurance Gap Analysis

Is Your Health Insurance a "Paper Tiger" or a Real Shield?

Most people in Indore buy health insurance the same way they buy a grocery item: they look at the price (premium) and the "Cover Amount." However, at Diversified Solutions, we’ve seen families with a ₹10 Lakh policy still end up paying ₹3 Lakh out of their own pockets during a claim.

Indore is typically considered tier 2 or lower in almost all of the policies currently in india. This mostly triggers Co-payment even in no co-payment policy if someone goes for treatment in tier 1 cities like (Surat, Pune, Delhi or Mumbai etc). Feature and traps like these are buried in fine print of policy, we discover them and based on those we provide you report letting you know how not to be blind-sided at the time of claim.

Why? Because their policy was a "Paper Tiger." It looked strong on paper but had no teeth when it came to the actual hospital bill.

Major Traps in Health Insurance Policy

The "Proportionate Deduction" Trap (The Silent Killer)

Most people think if they pick a room that costs ₹2,000 more than their limit, they just pay the extra ₹2,000.

The Trap: If you exceed your room rent limit, the insurer can reduce every other charge (Surgeon fees, OT charges, Nursing, etc.) in the same proportion.
The Result: A ₹5,000 room upgrade could lead to you paying 40% of a ₹5 Lakh bill out of your own pocket.

Learn how Proportionate Deduction Trap Work with Example

2. The "Zonal Pricing" Trap

As you know, all cities in Madhya Pradesh including Indore is often treated as Tier 2 or lower.

The Trap: If you bought your policy in tier 2 city like Indore but get treated in Mumbai or Delhi or Surat or Pune, your insurer may apply a 10%–20% "co-payment" because the treatment costs are higher in Tier 1 cities.
The Result: You are penalized for wanting the best treatment available in India.

3. Disease-Specific "Sub-Limits

Your policy might say ₹10 Lakhs, but the fine print says otherwise for common surgeries.

The Trap: Limits like "Cataract capped at ₹30k" or "Knee Replacement capped at ₹80k" are common.
The Result: Modern robotic surgeries can cost ₹2-3 Lakhs, but your "₹10 Lakh" policy will only pay the small capped amount.

4. The "Consumables" Hole

In a typical hospital bill, 10%–15% of the cost is for items like gloves, masks, PPE kits, and syringes.

The Trap: Most standard policies do not cover "Non-Medical Items" (Consumables).
The Result: Even with "Full Coverage," you could be handed a ₹40,000 bill just for these "extras" upon discharge

5. The "Standardization" Clause

Post-2020, IRDAI introduced new guidelines, but many old policies haven't updated their definitions.

The Trap: Old policies may not cover "Modern Treatments" like Immunotherapy, Robotic Surgeries, or Oral Chemotherapy.
The Result: If your policy is older than 4 years and hasn't been audited, you might be paying for 1990s-level medical coverage in 2026.

How Our Free "Health Insurance Gap Analysis" Works

We don't just "check" your policy; we audit it. Our Indore-based team performs a 20-point inspection of your current plan to identify:

Hidden Co-payments: Are you forced to pay 20% of every claim?
Waiting Period Overlaps: Are your pre-existing diseases actually covered yet?
Restoration Benefits: Will your cover refill if you have a second hospitalization in the same year?

Straight Talk: No Sugarcoating

If your current policy is excellent, we will tell you to keep it. We aren't here to flip policies for commissions; we are here to ensure that when you are at a hospital in Vijay Nagar or Palasia, your focus is on recovery, not the billing counter.

Sample Report