₹10 Lakh Policy.
₹3 Lakh Payout.
The Room Rent Trap.

For a family of 4 in a metro city: minimum ₹10–15 lakh base cover + ₹50 lakh–₹1 crore super top-up. Medical inflation in India runs at 14% annually — a plan that feels adequate today is worth half in 5 years. In Tier 2 cities: ₹10–20 lakh base is sufficient. The optimal stack: ₹10L base plan (₹15–25K/year) + ₹1 Cr super top-up (₹3–5K extra/year) = ₹1 crore total cover for ~₹25K/year.

If your policy caps room rent at 1% of sum insured (₹1,000/day on a ₹10L plan) and you choose a ₹3,000/day room, the insurer doesn't just cut ₹2,000/day. They apply "proportionate deduction" — reducing ALL related charges (surgeon fees, anesthesia, nursing) by the same ratio (33% in this case). A ₹2 lakh surgery bill becomes ₹66,667 payout. You pay ₹1.33 lakh from pocket. Always buy plans WITHOUT room rent sub-limits.

A super top-up kicks in after your base plan is exhausted. Set the deductible equal to your base plan (e.g., ₹10L deductible on ₹1Cr super top-up). If a hospitalization crosses ₹10L, the super top-up covers the rest — up to ₹1 crore. Cost: just ₹3,000–8,000/year. It's the most cost-efficient way to get high cover. A ₹1 Cr base plan would cost ₹50K+/year; base + super top-up gets you there for ₹25K.

Pre-existing diseases (diabetes, hypertension, thyroid, etc.) are covered only after a waiting period — typically 24–36 months. IRDAI reduced the maximum from 48 to 36 months. Some plans offer 12-month PED waiting at a higher premium. This means if you're diagnosed with diabetes and buy insurance immediately, claims related to diabetes are rejected for the first 2-3 years. Buy insurance BEFORE you develop conditions.

Top reasons (IRDAI data, ₹30,000 crore rejected in FY24-25): non-disclosure of pre-existing conditions (30-40% of rejections), waiting period violations (25%), policy exclusions/coverage gaps (36%), non-network hospital (cashless denied), and room rent sub-limit triggering proportionate deduction. Prevention: disclose everything at purchase, understand waiting periods, check network hospitals before admission, and always verify room rent limits.

Cashless is always better. You pay nothing upfront — the insurer settles directly with the hospital. But it ONLY works at network hospitals. Non-network hospitals require you to pay ₹3–10 lakh from pocket, then file for reimbursement (15–30 days for payout). Before any planned hospitalization, always check your insurer's network hospital list. In emergencies, go to the nearest hospital and file for reimbursement later.

No. Company group cover (typically ₹3–10 lakh) ends the day you resign, are fired, or retire. Pre-existing diseases accumulated during employment won't have waiting periods on the group plan — but if you buy a personal plan at age 45 after leaving, you'll face fresh 2-3 year PED waiting periods and much higher premiums. Buy a personal plan NOW (while young and healthy) alongside your company cover. Use company cover for small claims; save personal cover for big ones.

Under Section 80D: ₹25,000 deduction for self, spouse, and children's premiums. Additional ₹25,000 for parents (₹50,000 if parents are senior citizens). Plus ₹5,000 for preventive health checkups (within limits, not additional). Maximum: ₹1 lakh/year. At 30% tax bracket, that's ₹31,200 in actual tax savings (including cess). Only available in old regime — 70%+ taxpayers on new regime get zero 80D benefit. Cash payment = zero deduction. From AY 2025-26, ITR mandates insurer name and policy number.