Read the cover before you need the care.
PRODUCT GUIDES · PROTECT · 3 MIN READ
A hospitalisation cover is more than its sum insured. What is covered, what you must pay and how the claim works determine its practical role.
How it works
Read the Customer Information Sheet alongside the policy wording. IRDAI’s health guidance explains that the CIS brings key features together, including coverage, exclusions, sublimits, deductibles, waiting periods and claims processes. It is a useful starting point; it does not replace the complete contract.
Compare individual and family arrangements against the people who need cover and any employer policy already available. Give careful attention to shared limits, continuity and a change of employment. Do not assume that the hospital nearest you is currently available for the cashless process under a particular policy.
Six things to compare
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Coverage and people
Who is insured and what events or treatments are covered? Read any shared family limit and how benefits are applied.
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Waiting and exclusions
Identify relevant waiting periods, excluded conditions and other restrictions. Disclose health information accurately rather than guessing what matters.
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Your share of costs
Read deductibles, co-payments and sublimits. Ask the insurer to explain a hypothetical bill using the actual policy conditions.
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Hospitals and process
Check the current network and pre-authorisation or reimbursement steps. Record the official emergency and claims contact information.
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Renewal and continuity
Understand renewal, migration or portability processes and the treatment of continuity. Read current conditions before making a switch.
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Documents and support
Keep the CIS, policy, proposal answers and claims instructions. Note the insurer’s grievance route for unresolved service issues.
Follow a bill through the policy
Choose a purely illustrative hospital bill and ask which items would be considered under the cover, which limits apply and what amount could remain payable by you. Do not accept the sum insured as the answer to every line. The purpose is to expose unclear conditions, not to predict approval of a real claim.
A cover amount does not describe the claim
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Deductible
A threshold or share applies under the contract before the relevant insurer payment.
Ask: Check the wording and whether the threshold is per claim or otherwise defined.
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Co-payment
The insured bears a stated share of the admissible amount under policy terms.
Ask: Check who it applies to and any conditions that change it.
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Limits and exclusions
A large headline sum does not remove sub-limits, waiting periods or exclusions.
Ask: Read the Customer Information Sheet together with the policy wording.
A decision to work through
In a deliberately simplified example, a ₹1,00,000 admissible claim with a 20% co-payment leaves ₹20,000 to the insured. If some billed items are not admissible, the personal payment can be higher. A deductible, sub-limit or combined condition can change the calculation again. Use the actual wording rather than adding percentages casually.
Keep a comparison record
Write the purpose, amount, time horizon and access date at the top. For each option, record the source document and date, costs in rupees where possible, what could go wrong and what remains uncertain. Compare on the same basis: a different payout, risk or restriction can explain an attractive headline.
Test the numbers in a planning calculator →
Before your next step
Build a comparison note from each product’s current CIS using the same headings. Check the actual hospitals and people involved, and keep questions about disclosure, exclusions or continuity in writing. Retain accessible cash for expenses that may not be settled by the policy.
Questions worth clearing up
Does cashless mean every expense is covered?
No. A payment process does not remove policy limits or exclusions. Read what is admissible and what you may need to pay.
Is employer cover always enough?
Examine who is covered, benefit limits and what happens if the job changes. Sufficiency depends on the household and actual arrangement.
Explore the numbers. Keep the limits in view.
Keep your cash buffer visible ↗
Read the related full money guide ↗
Continue exploring
Sources and scope
IRDAI: health insurance and the Customer Information Sheet ↗
Prepared by SiP Money. Source check: 18 October 2026. Introductory financial education for India; no individual product recommendation, provider ranking or professional review is claimed. Read current scheme or policy documents, fees, eligibility and tax rules before acting. Calculator outputs are illustrative.
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