Health Insurance FAQ's

While "best" depends on individual needs, the top-rated insurers in 2025 based on Claim Settlement Ratio (CSR), network hospitals, and customer service include HDFC ERGO, Care Health, Aditya Birla, and Star Health. Experts recommend looking for a CSR above 95% and a large network of hospitals in your specific city. 

Most standard policies cover:

• Hospitalization: In-patient treatment (minimum 24 hours). 

• Pre & Post Hospitalization: Medical expenses incurred 30-60 days before and 60-180 days after hospital stay.

• Daycare Procedures: Treatments like dialysis or cataract surgery that take less than 24 hours.

• Ambulance Charges: Emergency transport to the hospital.

This is the duration you must wait before you can claim for specific conditions.

• Initial Waiting Period: Usually 30 days (except for accidents).

• Specific Illnesses: 2 years (for surgeries like hernia or stones).

• Pre-Existing Diseases (PED): Typically 2 to 4 years.

• Note: Many modern plans now offer "PED Waivers" to reduce this to Day 1 or 1 year. often called PED 

Yes. you as the proposer can have your children, spouse, parents and or parents In-Law in your policy. Generally only 6 people are allowed under one policy . Combinations could 6A, 5A+1C, 4A+2C, s so on and so forth. this depends of policy's elegibility criteria

Yes. There are specialized Senior Citizen Health Insurance plans for those above 60. Note that these often come with a "Co-payment" clause (where you pay a part of the bill) and might require a pre-policy medical check-up. 

Cashless: The insurer pays the hospital directly. This only works at Network Hospitals.

Reimbursement: You pay the bill first and then submit all documents (bills, discharge summary) to the insurer to get your money back. This is used at non-network hospitals.

 Family Floater: One sum insured covers the whole family. If the sum insured is ₹10 Lakh, any family member can use it until the ₹10 Lakh is exhausted. It is more cost-effective.

• Individual: Each person has their own separate sum insured (e.g., ₹5 Lakh each).

A sub-limit is a cap on how much the insurer will pay for a specific expense. For example, many older policies cap room rent at 1% of the Sum Insured. If you exceed this, the insurer applies a Proportionate Deduction, which can significantly reduce your total claim payout.

• Pro-tip: Always look for a policy with "No Room Rent Capping."

If you don't make a claim during a policy year, the insurer rewards you by increasing your Sum Insured for the next year at no extra cost. This increase can sometimes go up to 100% or 200% over a few years. 

Yes, under Section 80D of the Income Tax Act. You can claim a deduction of up to ₹25,000 for yourself/family and an additional ₹25,000 to ₹50,000 for your parents' insurance premiums. 

Yes, this is called Portability. Ideally need to be done within 60-45 Days from renewal. But you can switch your insurer at the time of renewal your new company will internally send a port request to you old company. The best part is that you don't lose the "Waiting Period" credit you have already earned with your old insurer. 

Yes, most comprehensive health insurance policies cover knee and hip replacement surgeries. However, because these are usually classified as age-related or pre-existing conditions, they almost always come with a "Specific Illness" waiting period. This waiting period is typically 24 months (2 years) from the start of your first policy. You should also check your policy for sub-limits, as some older plans cap the maximum payout allowed for joint replacements. 

Yes, emergency treatments for heart attacks, including ICU room rent, angioplasty, and the cost of cardiac stents, are covered. 

If the heart attack is a sudden, unexpected medical emergency with no prior history, it is covered immediately after the standard initial 30-day waiting period. 

However, if the procedure is required due to a pre-existing heart condition or severe hypertension declared at the time of buying the policy, the treatment is only covered after the Pre-Existing Disease (PED) waiting period is complete (usually 2 to 4 years). 

Yes. Modern health insurance policies cover standard in-patient hospitalization for cancer. More importantly, they cover chemotherapy and radiotherapy under "Daycare Procedures," meaning you do not need to be admitted to the hospital for 24 hours to claim the expenses. 

Note: When reviewing your policy brochure, look specifically for coverage under "Modern Treatments" or "Advanced Procedures," as this ensures newer, highly expensive treatments like immunotherapy and robotic surgeries are also covered. 

Yes, dialysis is universally covered under the "Daycare Procedures" section of standard health insurance policies. The insurer will pay for the ongoing dialysis sessions up to your total Sum Insured limit. Keep in mind that if the kidney failure is a result of a pre-existing disease (like chronic diabetes), the mandatory PED waiting period must be fully served before you can begin claiming dialysis expenses. 

No, basic standard health insurance policies usually do not cover maternity. 

To get coverage, you must specifically purchase a family floater plan that includes a "Maternity Benefit" or add it as a specific rider. These specialized plans cover normal deliveries, cesarean sections, and often include newborn baby cover from day one.

Note: Crucially, maternity coverage always comes with a strict waiting period ranging from 9 months to 4 years. If you want this coverage, you must purchase the policy well in advance of planning a family.