Case: A policy with ₹5L cover costs ₹7,000/year. Agent offers 20% co-pay to reduce premium by ₹1,800. After a hospital bill of ₹2L, the insurer pays ₹1.6L and you pay ₹40,000.

Lesson: Co-pay reduces premium but can lead to large out-of-pocket costs. Only accept co-pay if it's mandatory or when buying for elderly with pre-existing conditions where premiums would otherwise be unaffordable.

If a policy caps room rent at 1% of sum insured (₹5,000/day for ₹5L), choosing a ₹10,000/day room can cause proportional reduction of many billed items (surgeon fees, diagnostics) — not just room rent. Result: unexpectedly large unpaid amounts.

Tip: Avoid room rent caps. If unavoidable, choose rooms within the cap or increase your sum insured.

Some policies advertise high cover but place caps per disease (e.g., ₹2.5L for heart ailments). You may never get the full advertised amount.

Tip: Confirm absence of disease-wise sub-limits before purchase.

Pre-existing conditions can have a waiting period (2–4 years). If you develop a complication tied to a disclosed condition, claims can be denied during waiting period.

Tip: Choose the policy with the shortest waiting period you can find and always disclose medical history truthfully.

Many policies exclude or limit pre- and post-hospitalization costs. Diagnostic tests before admission and follow-ups after discharge can be quantitatively significant.

Tip: Prefer policies covering 30–60 days pre- and post-hospitalization expenses.

Restoration restores your sum insured after it's exhausted — crucial for combined family policies. Some policies have restrictions (e.g., not for same illness).

Tip: Prefer plans with restoration, or buy a top-up to avoid total exhaustion.

Treatments that require less than 24-hour hospitalization (e.g., some appendectomies, dialysis, certain chemo sessions) are sometimes excluded.

Tip: Ensure daycare procedures are covered.

Rare but useful — covers medical expenses incurred while treated at home when hospital beds are unavailable or treatment is possible at home.

No-Claim Bonus increases your sum insured for every claim-free year (often upto a limit). Check how the insurer reduces bonus after a claim.

Some policies offer periodic free health checkups (yearly or biennial). Helpful for preventive care — a nice-to-have benefit.

Coverage typically applies only for treatment at government-recognized AYUSH hospitals and facilities.

Maternity cover can be costly. If you opt for it, study waiting periods and specific limits (often offered only in family plans).

OPD cover reimburses consultations and minor procedures. It raises premiums and may be less cost-effective than paying out-of-pocket for infrequent visits.