Insurance companies are not charities. They are highly optimized financial risk engines. If you don't read the fine print, your claim will be rejected. Here is what to explicitly look for before signing.
1. Room Rent Capping
This is the biggest trap in the industry. Many cheap policies cap hospital room rent at 1% of the Sum Insured (e.g., βΉ5,000/day). If you accidentally pick a room costing βΉ8,000/day, the insurer won't just refuse to pay the extra βΉ3,000βthey will proportionally reduce the payout for the *entire* surgery, doctor visits, and ICU costs. Always buy policies with "No Room Rent Limit".
2. Co-Payment Clauses
A 10% co-payment clause means you agree to pay 10% of every massive bill from your own pocket. Avoid policies with co-pay clauses at all costs, even if the premium looks heavily discounted.
3. Restoration Benefits and Consumables
Look for policies with 100% Restoration. This means if you exhaust your βΉ10 Lakh cover treating dengue in June, the insurer immediately refills the βΉ10 Lakhs for free to cover a completely unrelated surgery like appendicitis in December. Also, ensure you purchase a rider that covers "Consumables" (PPE kits, gloves, syringes), which make up 15% of modern hospital bills and are normally out-of-pocket expenses.
\n