Health insurance: choosing a policy you can claim on

One hospital bill can undo years of saving. Health insurance pays for hospital treatment under the policy's terms, either cashless at a network hospital or by reimbursement.

Policies look alike in brochures and differ a lot in the fine print. This page covers what to compare.

Individual cover or family floater

A family floater shares one sum insured across the family. When everyone is young it is cheaper than separate policies. The catch is that one large claim leaves less cover for everyone else for the rest of that year.

Parents above 60 are usually better off on a separate policy. Their age pushes up the floater premium for the whole family.

How much cover

Choose cover with the hospital you would actually use in mind. If you might travel to a bigger city for major treatment, plan for that city's costs.

A base policy plus a super top-up is often a cheaper way to get high cover than one large base policy. A super top-up starts paying once your total hospital bills in a year cross its deductible.

Fine print that decides claims

Rules that changed in 2024

IRDAI's 2024 product regulations and its health insurance master circular made several changes in buyers' favour. Check the IRDAI website for the current circulars.

Disclosure, portability and claims

Declare every existing condition. Under-declaring may lower the premium, but it risks a rejected claim.

If you are unhappy with your insurer, you can port to another one at renewal and keep the waiting-period credit you have built up. Apply well before the renewal date.

Renew on time. A policy that lapses can lose the waiting-period credit you have built up.

Keep every bill, report and discharge summary. For reimbursement claims, insurers ask for the papers within a set number of days.

If a claim is rejected unfairly, complain to the insurer's grievance cell first. If that does not resolve it, use IRDAI's Bima Bharosa portal, and then the Insurance Ombudsman.

Tax

Under the old tax regime, health insurance premiums for yourself, your spouse and children qualify for a deduction (Section 80D in the old Act) of up to ₹25,000 a year, or ₹50,000 if the insured person is a senior citizen. A separate deduction is allowed for premiums you pay for your parents. The new regime does not allow these deductions.

How we help

We go through policy wordings with you in Hindi or English and put the features that matter side by side: room-rent rules, co-pay, sub-limits, waiting periods and the hospital network near you. If you already have a policy, we read it with you before renewal so you know what it does and doesn't cover.

Claims are decided by the insurer or its TPA. We help you understand which documents are needed and how to escalate if a claim is stuck.

Group cover from your employer usually ends when you leave the job or retire. A personal policy keeps your waiting periods running, so we look at both together.

What to bring to the office

The office is at Khatri House, Behind S.B.I. Bank, O/s Jalori Gate, Jodhpur. You can walk in Mon–Sat, 10 am – 7 pm, or call first so we can keep the forms ready.

Frequently asked questions

Is my employer's group health cover enough?

It helps, but it usually ends when you leave or retire, and the sum insured may be low. A personal policy keeps your waiting periods running regardless of your job.

What is the waiting period for pre-existing diseases?

It depends on the policy, but IRDAI's 2024 rules cap it at three years.

Can senior citizens buy a new health insurance policy?

Yes. Since 2024 there is no upper age limit for buying. Expect higher premiums, medical tests and often a co-payment.

What is a super top-up?

A policy that pays hospital bills above a set deductible, counted across the whole year. Paired with a base policy, it is often a cheaper way to get high cover.

Do you settle health insurance claims?

No. Claims are decided by the insurer or its TPA. We help you understand the documents needed and how to escalate if something goes wrong.

Sources

Nick Investment, Khatri House, Behind S.B.I. Bank, O/s Jalori Gate, Jodhpur, Rajasthan 342001. Mon–Sat, 10 am – 7 pm. Call +91 94141 28970 or WhatsApp. Call +91 94141 28970 · WhatsApp us

Nick Investment is an AMFI-registered Mutual Fund Distributor (ARN-112296). We are not a SEBI Registered Investment Adviser. We distribute regular plans and receive trail commission from the asset management companies, which is included in the scheme's expense ratio.