The terms to check
- Sum insured. The most the insurer pays in a year, and whether it is restored after a claim.
- Room-rent limit. The room you can take, such as a single private room or a percentage of the sum insured. Going above it can reduce the whole claim proportionately.
- Co-payment. The share of each claim you pay yourself.
- Sub-limits. Fixed maximums for treatments such as cataract surgery.
- Waiting periods. Usually 30 days for any illness, a fixed period for listed conditions, and up to 3 years for pre-existing diseases.
- Exclusions. Treatments the policy never pays for.
- Pre- and post-hospitalisation. How many days of expenses before admission and after discharge are covered.
- Claim deadlines. How soon you must inform the insurer and submit a claim.
- Network hospitals. Where you can get cashless treatment.
Your proposal form matters
The health details in your proposal form are the first thing an insurer checks when a claim comes in. Keep a copy, and make sure every condition and medicine was declared correctly.
After 5 years of continuous cover, called the moratorium period, a claim cannot be contested for non-disclosure unless there is proven fraud.
Renewing and porting
- Renew on time. A break in cover can restart waiting periods.
- Porting. When you move to another insurer, the waiting period you have already served carries over, up to your earlier sum insured.
How Mediclaimswala helps
Send us your policy and we will explain, in Hindi or English, what it covers, where claims usually go wrong, and what to keep ready before you need it.
Last reviewed: . This page is general information based on IRDAI rules as of the date above. It is not legal advice. Policy wordings differ, so we check what applies to your case.