Rules of health insurance

Important rules of health insurance that everyone should know. 

1. Understand Your Policy

Always read and understand your policy document carefully before signing—know inclusions, exclusions, waiting periods, and claim limits.

2. Disclose Honestly

Never hide pre-existing diseases or medical history; false information can lead to claim rejection.

3. Pre-Existing Diseases Waiting Period

Most policies cover pre-existing illnesses only after a waiting period (usually 2–4 years).

4. Waiting Period for New Policies

Generally, there is an initial waiting period of 30 days (except for accidents) before you can make claims.

5. Cashless Network Hospitals

Check if your preferred hospitals are in the insurer’s network list for cashless treatment.

6. Room Rent Limit

Many policies have restrictions on room rent; exceeding the limit can reduce claim reimbursement.

7. Sub-Limits on Diseases

Some policies put cost caps on certain treatments (like cataract, hernia, etc.).

8. Day-Care Procedures

Modern health insurance covers treatments that don’t need 24-hour hospitalization (like cataract surgery, dialysis).

9. AYUSH Coverage

Some policies cover Ayurveda, Yoga, Unani, Siddha, and Homeopathy treatments.

10. Maternity & Newborn Cover

Usually comes with a long waiting period (2–4 years); check if your policy includes it.

11. No-Claim Bonus (NCB)

If you don’t make a claim, your sum insured often increases (10–50% yearly) at no extra cost.

12. Restoration of Sum Insured

Some policies restore 100% of your insured amount if it gets exhausted in a year.

13. Free Health Check-ups

Many insurers provide free annual health check-ups as part of the policy.

14. Co-Payment Clause

Some policies require you to share a percentage of the claim cost (common in senior citizen plans).

15. Exclusions

Cosmetic surgery, dental procedures, self-inflicted injuries, and certain conditions are not covered.

16. Portability Option

You can switch insurers without losing benefits like waiting periods (if you’re unhappy with your insurer).

17. Claim Intimation

Always inform the insurer within 24 hours (emergency) or 48–72 hours (planned hospitalization).

18. Pre & Post-Hospitalization Expenses

Policies usually cover medical expenses 30–60 days before and 60–90 days after hospitalization.

19. Lifetime Renewability

Choose a policy that allows renewal for life, as medical needs increase with age.

20. Tax Benefits (India Specific)

Premiums paid are eligible for tax deduction under Section 80D of the Income Tax Act.

---

👉 Do you want me to make this into a well-structured infographic (with icons and visuals) so it’s easier to remember, or keep it as a simple text guide?