Health insurance pays for hospital treatment that the policy covers, up to the sum insured for the policy year. The insurer either settles the bill directly with a network hospital (cashless) or pays you back after you have paid (reimbursement).
Two policies with the same sum insured can pay very different amounts. Room-rent limits, co-payment, sub-limits, waiting periods and exclusions decide what you actually receive, and they are written in the policy wording.
Products
No products are listed in this category yet. Products appear here only after Finobazaar has reviewed them against the insurer's documents; we do not show invented products or prices.
What policies usually cover
- In-patient treatment when you are admitted to hospital
- Day-care procedures that do not need a 24-hour stay, as listed in the policy
- Expenses for a set number of days before and after the hospital stay
- Ambulance charges, usually up to a limit
Your policy wording lists exactly what is covered, the limits and the exclusions.
What to check before you buy
- Sum insured, and whether it is for each person (individual) or shared by the family (floater)
- Room-rent limit and what happens to other charges if you choose a costlier room
- Co-payment: the share of each claim you pay yourself
- Waiting periods: the first days of the policy, pre-existing diseases and listed illnesses
- Sub-limits on particular treatments or illnesses
- Network hospitals near your home for cashless treatment
- Exclusions, and the renewal terms as you grow older
Key terms
- Sum insured
- The most the policy pays in a policy year, for one person or for the whole family on a floater.
- Family floater
- One sum insured shared by the family members on the policy. A large claim for one person reduces what is left for the others that year.
- Waiting period
- A time after the policy starts during which certain claims are not paid. The policy lists each waiting period.
- Pre-existing disease
- An illness or condition you had, as defined in the policy, before the cover started. Claims for it are paid only after its waiting period.
- Co-payment
- A fixed percentage of each admissible claim that you pay; the insurer pays the rest.
- Deductible
- An amount of the claim, or of the year's claims, that you or another policy must pay before this policy starts paying. Top-up and super top-up policies work this way.
- Moratorium period
- After 60 months of continuous cover, the insurer cannot contest a claim on grounds of non-disclosure or misrepresentation, except for established fraud.
- Cashless
- The insurer or its TPA pays a network hospital directly after approving your treatment.
- Reimbursement
- You pay the hospital and then claim the money back with the bills and reports.
Rules that apply
- For health policies issued or renewed after 30 September 2024, the waiting period for pre-existing diseases can be at most 36 months. Older policies may show a longer period until they are renewed. [1]
- You get 30 days from receiving the policy document (free-look period) to review it and cancel if it does not suit you, for policies of one year or more. [2]
- The grace period for paying the renewal premium is 15 days for monthly instalments and 30 days for others; renewing within it keeps the benefits you have built up. [2]
Rules referred to
- IRDAI (Insurance Products) Regulations, 2024 (F. No. IRDAI/Reg/8/202/2024, 20 March 2024)
Product rules, including the limit on the waiting period for pre-existing diseases. - IRDAI Master Circular on Health Insurance Business (Insurance Products Regulations, 2024) (IRDAI/HLT/CIR/PRO/84/5/2024, 29 May 2024)
Free-look period, grace period, moratorium period, cashless and discharge timelines.
Finobazaar read published copies of these rules on 19 October 2026. Rules change: check the current text on irdai.gov.in or with your insurer.
Calculators
- Health insurance cover calculatorCompare the health cover you want with the cover you already have, and see the gap.
- Insurance coverage gap calculatorEnter the cover you need and the cover you have; see the gap and the shortfall in percent.
- Compare premiums you were quotedPut up to four quotes side by side, with the premium for each ₹1 lakh of cover. Your figures are not stored.
Guides and checklists
- How to make a health insurance claimCashless or reimbursement: which route to take and what happens at each step.
- Cashless health claimsHow cashless treatment is approved at a network hospital, and the time limits.
- Reimbursement health claimsPaying the hospital first and claiming the money back: documents and time limits.
- Waiting periods in health insuranceInitial, pre-existing disease and specific illness waiting periods, and how continuity helps.
- Policy exclusions: what insurance does not coverWhere to find exclusions in a policy and how to read them.
- Renewing an insurance policyGrace periods, keeping your benefits and what to check before you renew.
- Health insurance claim: document checklistDocuments commonly asked for in a health claim. For cashless claims the hospital and the insurer or TPA exchange most of them.
- Policy details review checklistWhat to check in a new policy, ideally within the free-look period.
- Policy renewal checklistWhat to have ready and to check before you renew a policy.
Official resources
- IRDAI – Insurance Regulatory and Development Authority of India (opens in a new tab)The insurance regulator: regulations, circulars and the lists of registered insurers and intermediaries.
- IRDAI policyholder website (opens in a new tab)IRDAI's site for policyholders: consumer education and how to complain.
- Bima Bharosa – IRDAI grievance portal (opens in a new tab)Register and track a complaint against an insurer after you have complained to the insurer.Toll-free 155255 or 1800 4254 732; email complaints@irdai.gov.in. IRDAI accepts complaints from the policyholder or claimant, not from agents or other people writing for them.
Addresses checked on 19 October 2026.