Indemnity health plans reimburse eligible hospital bills (cashless or reimbursement) up to the sum insured. Some products are defined benefit (e.g. fixed payout per surgery)— read which structure you are buying. Family floater shares one sum insured across members; individual plans allocate separate limits.
Sum insured and sub-limits
- Choose a sum insured that can cover serious illness in your preferred hospital tier—metro costs differ from smaller cities.
- Room rent caps or category limits can reduce payable amount if you choose a room above eligibility.
- Co-pay and deductibles shift part of each claim to you in return for lower premium.
Waiting periods and disclosures
Initial waiting periods (often 30 days except accident), disease-specific waits, and pre-existing condition (PED) declarations are central to claims. Non-disclosure of known conditions can lead to repudiation—answer proposal forms accurately and keep medical records consistent.
Cashless network and claims
Cashless needs pre-authorisation for planned admission where possible; emergencies follow insurer TATs. Reimbursement claims need bills, discharge summary, and prescriptions in order. Know your TPA/insurer app workflow before admission.
Common add-ons
- Maternity, OPD, or wellness riders where offered
- Restoration of sum insured after a claim
- No-claim bonus protection or annual health check benefits
Add-ons increase premium—buy only what you will use and understand exclusions.
Renewal and portability
Lifetime renewability wording matters as you age. Portability lets you switch insurers with accrued continuity benefits subject to underwriting—plan before lapsing old cover.
Tax (general)
Premiums may qualify for deductions under applicable sections for eligible taxpayers—limits and rules change. Consult a tax professional; we do not give tax advice.
Disclaimer
Aroundu Wealth Capital provides educational information and advisory support. We are not an insurer. Benefits, exclusions, and premiums are defined only in the insurer's policy document. Nothing here is an insurance offer.