Your health cover, explained.
What ₹5,00,000 really means
4 conditions decide what's paidOne sum insured shared by You (41), Spouse (39): a big claim for one person leaves less for the others that year. What decides the amount paid: room rent up to ₹5,000 a day, and other charges cut in proportion above it; 2 treatments with a cap below the sum insured; consumables (gloves, PPE kits…) not paid; 2 waiting periods still running. On an example bill of ₹2,28,000 (4 days in a ₹10,000-a-day room), the policy would pay about ₹1,40,000 and you ₹88,000; the Hospital bill studio lets you change every line. The insurer decides what's admissible on a real claim.
An example bill, step by step
Example| Step | Taken off | Left |
|---|---|---|
| Bill: 4 days in a ₹10,000 room, ₹1,20,000 doctors and OT, ₹40,000 medicines, ₹20,000 tests, ₹8,000 consumables | — | ₹2,28,000 |
| Consumables not paid | −₹8,000 | ₹2,20,000 |
| Room rent above the limit | −₹20,000 | ₹2,00,000 |
| Proportionate cut on room-linked charges | −₹60,000 | ₹1,40,000 |
| The policy would pay | ₹1,40,000 |
Exclusions
- Treatment of mental illness
- cosmetic dentistry
Your rights
- Free look30 days from receiving the policy
- Grace period15 days monthly, 30 days otherwise
- RenewalNot refused because you claimed
- Claim-free yearMore cover, a lower premium, or both: your choice
- PortingCredits move; decision in 5 days
- More than one policyYou choose which pays first
- MoratoriumAfter 60 continuous months
Claims: the time limits
- Cashless approvalWithin 1 hour
- Final approval at dischargeWithin 3 hours
- Reimbursement15 days from submitting
- If lateInterest at bank rate + 2%
A claim can be rejected only with the insurer's claims review committee's approval; a part rejection has to cite the clause.
Tax
About ₹21,800 of the premium deductible: ₹6,802 less tax (old regime)
Under section 126 of the Income-tax Act, 2025 (formerly 80D), premiums for yourself, spouse and children are deductible up to ₹25,000 a year (₹50,000 if one of you is a senior citizen), and for your parents up to another ₹25,000 (₹50,000 if a parent is a senior); a preventive check-up up to ₹5,000 counts within these. Only in the old tax regime, and not for premiums paid in cash. GST on this premium: 0%.