Before buying or renewing any health insurance plan, verify these 12 items. This checklist covers 90% of what differentiates a good plan from a bad one.
No room rent limit
Or at minimum, single private AC room allowed. Avoid % of sum insured caps.
Zero co-payment
For under-60 buyers, there is no reason to accept a co-pay clause.
No disease sub-limits
Cataract, joint replacement, hernia should be covered up to full sum insured.
High sum insured
Minimum ₹10 lakh in metros. ₹15–25 lakh is increasingly the realistic standard.
Restoration benefit
At least once per year. Ideally 'unlimited' or for any illness (not just unrelated).
Pre & post hospitalisation
At least 60 days pre, 90 days post. Some plans offer 90/180.
Day care procedures covered
Verify at least 300+ day care procedures are listed.
Lifetime renewability
Non-negotiable. Policy should not be cancellable due to age or claims.
No Claim Bonus structure
At least 10-20% bonus per claim-free year. Check if it accumulates reasonably.
Large network hospital list
Check hospitals in YOUR city specifically — not just total network size.
Claim settlement ratio
Check IRDAI's annual report. Look for retail individual CSR above 90%.
Check the exclusions list
Read Schedule II of the policy document. This is where the real risk hides.
How to verify each item
The policy wordings document (available for download on the insurer's website before purchase) is the ground truth. Marketing brochures can be misleading — always cross-check the actual policy document. Key sections to read: Schedule of Benefits, Exclusions (Schedule II), and Definitions.
Next step: Compare top plans
See how top 2026 plans score on these 12 parameters → Health plan comparison table
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