Health Insurance: 5 Things Nobody Tells You Before You Buy

Health insurance is one of those things everyone knows they need but few actually understand. Most people buy a policy based on premium and sum insured, and assume they're covered. Here are five things that could surprise you when you actually file a claim.

First, the waiting period. Most policies have a 2-4 year waiting period for pre-existing conditions. That means if you have diabetes and buy a policy today, your diabetes-related hospitalizations won't be covered for the next few years. Always check the waiting periods before buying.

Second, co-payment clauses. Some policies require you to pay 10-20% of the claim amount yourself. This is common in policies for senior citizens. A ₹5 lakh hospital bill with a 20% co-pay means you're still paying ₹1 lakh out of pocket.

Third, room rent limits. If your policy has a room rent cap of ₹5,000/day and your hospital room costs ₹8,000/day, the insurer will proportionally reduce your entire claim — not just the room rent difference. This is the single biggest source of claim disputes.

Fourth, restoration benefits. A good policy restores your sum insured if it gets exhausted during the year. Without this, a major hospitalization early in the year could leave you uninsured for the remaining months.

Fifth, network hospitals matter more than you think. Cashless treatment is only available at network hospitals. Before buying, check how many quality hospitals near you are in the insurer's network. A policy with a great premium but poor network is practically useless.