Individual health insurance
An individual policy covers one person with a sum insured that belongs to that person alone. Several family members can each hold their own policy, or be listed as separate members with individual limits under one document.
- The full sum insured stays available to that person for the policy year.
- Premium reflects that person's age and health profile.
- Often the better structure for older members whose claims are more likely.
Family floater insurance
A family floater covers several members under one shared sum insured. Any covered member can use it, but the total available in the year is shared. If a ₹10 lakh floater pays ₹7 lakh for one member, ₹3 lakh remains for everyone else until renewal, unless the plan restores the cover.
See the explainer: what is a family floater.
Sum insured
The sum insured is the annual ceiling on what the insurer will pay. Choose it against realistic hospital costs in your city for a serious event, rather than against the premium. Top-up and super top-up plans can extend cover above a threshold at a lower cost than raising the base sum insured.
Waiting periods
- Initial waiting period — a short period at the start of a new policy when only accidental emergencies are usually payable.
- Specific illness waiting period — applied to listed conditions and procedures.
- Pre-existing disease waiting period — applied to conditions you already had.
- Maternity waiting period — where the benefit is offered at all.
Detail here: what is a waiting period in health insurance.
Pre-existing diseases
A pre-existing disease is generally a condition diagnosed or treated before the policy began. Insurers usually cover these only after a waiting period. Declare your medical history accurately at the proposal stage — non-disclosure is a common reason for a claim to be declined later, and it can put the whole policy at risk.
Co-pay
A co-pay is a fixed percentage of every admissible claim that you pay yourself. On a 20% co-pay, a ₹1,00,000 claim leaves ₹20,000 with you. Plans for senior citizens, and some cheaper plans, use co-pay to keep premiums down.
Deductibles
A health deductible is an amount that must be crossed before the policy pays. Top-up plans work this way: cover starts only above the threshold, which is why they are cheaper than an equivalent base policy.
Room-rent limits
Many policies cap the daily room rent, either as a rupee amount or as a percentage of the sum insured. This matters more than it looks: where a cap applies, exceeding it can lead to proportionate deductions across other hospital charges, not just the room bill. Check this clause carefully before you compare premiums.
Cashless treatment
At a network hospital, the insurer or its administrator can settle eligible charges directly, so you fund only your share. Planned admissions can be pre-authorised in advance; emergencies are authorised after admission. Deductibles, co-pay, room-rent deductions and excluded items remain payable by you.
More detail: what is cashless health insurance.
Reimbursement claims
- Inform the insurer within the notice period stated in the policy.
- Pay the hospital and collect original bills, discharge summary and reports.
- Submit the claim form with all documents and bank details.
- Respond promptly to any query raised during assessment.
- Receive the settlement or a written explanation of deductions.
How to compare health policies
- Compare on the same sum insured and the same family composition.
- Line up waiting periods, co-pay, deductibles, sub-limits and room-rent caps.
- Check whether restoration, day-care and pre- and post-hospitalisation cover are included.
- Look at the hospital network near where you live.
- Read the exclusions list and the official policy wording.
This information is educational. Health policies differ significantly between insurers, and only your own policy document is binding — see our disclaimer.