Health Insurance Checklist — 10 Things to Verify Before You Buy
Written by
Avni Mittal
Insurance Writer
Choosing health insurance is not just about finding the cheapest plan. Many low-premium plans have hidden restrictions that dramatically reduce your actual coverage. Use this checklist to evaluate any health insurance plan before you commit.
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The TruPath Health Insurance Checklist
Verify all 10 factors before buying any health insurance plan.
Claim Settlement Ratio (CSR)
Check the insurer's CSR from the latest insurance industry annual report. Above 90% is excellent. Below 80% is a red flag. A high CSR means the insurer settles most claims without dispute.
Room Rent Limit
Check if the plan has a room rent cap (e.g., 1% of sum insured per day). Room rent limits drastically reduce your claim — all proportionate costs (doctor fees, ICU charges, etc.) are reduced pro-rata. Always prefer 'any room' or 'no room rent limit'.
Co-payment Clause
A co-pay of 10–20% means you pay that share of every claim. For a ₹5 lakh hospitalisation, you'd pay ₹50,000–₹1 lakh out of pocket. Avoid plans with mandatory co-payment unless the premium difference is significant.
Disease Sub-limits
Some plans cap payouts for specific conditions (e.g., ₹50,000 for cataract). These caps can leave you heavily under-compensated for expensive procedures. Prefer plans without sub-limits.
Pre-existing Disease Waiting Period
Most plans have a 2–4 year waiting period for pre-existing conditions. Check the exact period and what conditions are covered (and when). The shorter the waiting period, the better — especially if you have any existing health conditions.
Restoration Benefit
If your sum insured is exhausted mid-year, a restoration benefit reinstates it. Check if restoration applies to the same illness or only different illnesses — 'same illness restoration' is more valuable.
No Claim Bonus (NCB)
A good NCB increases your sum insured by 10–50% for each claim-free year. Check the maximum accumulation cap and whether NCB is in the form of a sum insured increase or premium discount.
Network Hospital Count
More network hospitals = better cashless access. Look for 8,000+ hospitals for metro cities and broader coverage for tier-2/3 cities where you may travel or have family.
Pre & Post Hospitalisation Coverage
Check how many days are covered before and after hospitalisation (30/60 days is minimum; 60/180 days is ideal). This covers diagnostics, consultations, and medications related to your hospitalisation.
Portability Option
Verify you can port this policy to another insurer later without losing waiting period credit. Portability is mandated by regulation, but check specific terms for smooth transfer.
TruPath's Buying Checklist Bottom Line
The best health insurance plan is one that protects you in a real hospitalisation scenario without hidden restrictions eroding your claim. Don't be seduced by low premiums — check room rent limits, co-pay, and sub-limits before anything else. HDFC Ergo Optima Restore passes all 10 checks for most buyers, which is why it's our top recommendation.
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