Your health cover, explained.
What ₹10,00,000 really means
5 conditions decide what's paidOne sum insured shared by You (36), Spouse (34), Daughter (6): a big claim for one person leaves less for the others that year. What decides the amount paid: room rent up to 1% of the sum insured a day (₹10,000), and other charges cut in proportion above it; co-pay of 10% if treated in a costlier city zone than the policy is priced for; 2 treatments with a cap below the sum insured; consumables (gloves, PPE kits…) not paid; 4 waiting periods still running. On an example bill of ₹2,68,000 (4 days in a ₹20,000-a-day room), the policy would pay about ₹1,60,000 and you ₹1,08,000; 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 ₹20,000 room, ₹1,20,000 doctors and OT, ₹40,000 medicines, ₹20,000 tests, ₹8,000 consumables | — | ₹2,68,000 |
| Consumables not paid | −₹8,000 | ₹2,60,000 |
| Room rent above the limit | −₹40,000 | ₹2,20,000 |
| Proportionate cut on room-linked charges | −₹60,000 | ₹1,60,000 |
| The policy would pay | ₹1,60,000 |
Exclusions
- Dental treatment unless from an accident
- external congenital anomalies
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 ₹25,000 of the premium deductible (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%.