At a small monthly expense, you can be assured of quality medical services without any financial burden at the time of requirement. One should opt for health insurance early, when no severe diseases come into the picture, as the premium amounts are more affordable. But how do you know which is the best insurance policy for you? What to do if you face any health insurance policy rejection? In this article, we’ll take a closer look at the top hidden conditions of health insurance which you should know. Let’s have a closer look as we talk about them in detail below:
Table of Contents
What Is No Claim Bonus?
No claim bonus refers to the increase in your base cover amount by the insurance company if you do not make any claims for a particular time. Companies increase the cover amount over time if no claims are made to reward the customer. Thus, your health insurance policy, which has a cover amount of Rs 10 Lakhs in the first year, may increase to Rs 15 Lakhs in the second and so on till a specified limit.
In many cases, the company may increase the cover amount in exchange of no claims made. However, the room rent limit stays the same as the previous cover amount. This leads to only a fraction of cover amount being paid in place of the full amount.
For example, if the room rent limit in a five lakh cover insurance policy was Rs 5000, it is likely to be same even when the cover amount has been increased to ten lakh next year due to No Claim Bonus, thus causing a fraction of amount to be deducted in place of complete payment of hospital bill.
What Is AYUSH Claims Settlement?

AYUSH stands for Ayurveda, Yoga, Naturopathy, Unani, Siddha and Homeopathy. Different health insurance companies include AYUSH treatments which are a matter of few hours. However, health insurances have a 24 hour hospital admission condition. It is only after 24 hour hospitalisation that the claim amount is paid to the patient. Also, you’re expected to only visit government approved AYUSH hospitals for treatments to avail the AYUSH claims settlement.
Why Do Companies Refuse to Issue An Insurance Policy?
Companies may also reject your health insurance policy application considering you a high risk individual which is mainly in the case of multiple critical illnesses. Different sublimits imposed by the companies also add up the cons of health insurance policies.
Sublimits are boundaries in your insurance policy, which depend on the kind of treatment you are using your policy for. Different policies have different sub-limits based on diseases. If your base cover amount is Rs 10 Lakh and the insurance company has a sub-limit of Rs 3 Lakh on heart-related surgeries, you cannot claim your total base cover amount for such treatment.
The average cost of heart surgeries is much higher than this amount in metro cities. Thus, in this case, all the amount after Rs 3 Lakh is to be paid by the policyholder itself. Ideally, your insurance policy should not have any disease-specific sub-limits, which prevents you from using the entire claim amount and ultimately draining your savings.
It is important to note that policies with sub-limits usually have less premium than those without sub-limits. This makes them attractive but less practical in the long run.
Can You Club Health Insurance Policies?

You can buy more than one health insurance policies as well. You can also claim the cover amount from both of them without any hassle. All you need to do is analyze if there are any hidden conditions of health insurances.
You can choose the policies as per your criterias such as one policy can be of cashless type and other one can be of reimbursement type. This promotes ease in claims and solves the purpose of customer as well.
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Reimbursement or Cashless Method: Which Is Better And Why?
The concept of network hospitals has been introduced by Insurance companies to promote customer’s ease of claiming the cover amount.
It is possible that the insurance company may have not mentioned a particular sublimit for a disease in your policy document but they’ve fixed a certain disease specific sub limit with the hospital. This creates a discrepancy between the three parties involved namely, you, the insurance company and the hospital.
This whole scenario is solved by buying a reimbursement health insurance policy where you pay the amount to the hospital directly and then claim the same amount from the insurance company against your medical expenses.
Can You Modify Health Insurance Policies?

A routine checkup must be conducted once a year to determine whether the insurance policy needs to be modified. This includes adding or removing family members, adding a super top-up or top-up, buying a policy rider, or disclosing a new disease or health-related habit.
Also, in case of marriage, spouse can be added mid-year. However, you will have to inform to the insurance issuing company within 90 days of wedding. Furthermore, make sure that you thoroughly analyze the insurances for any hidden conditions of health insurance.
Should You Rely On Corporate Health Insurance?
You may argue on the fact that the company you work for has already provided a corporate health insurance policy however, buying a retail health insurance policy is still recommended as if you quit the particular job, the insurance policy is also cancelled simultaneously. You can also check your e-insurance account for any existing policies issued.
Retail health insurance policies are effective even when you lose your job. Also, you get higher sum assured and you can also include your family in the same plan.
The process of underwriting is conducted in case you opt for conversion of a corporate health insurance policy to a retail one, which involves examining the individual and is a complicated process.
Curious about when to buy a health insurance policy? Read about the right age to purchase health insurance.
Is It Possible To Change the Insurance Issuing Company?
Changing the policy issuing company may be a consequence of unsatisfactory service, poor experience or less features but you can port your existing policy to another company as it has several benefits. If you’ve passed the waiting periods of critical illnesses, porting the plan is beneficial than buying a new policy as your waiting periods have been crossed also you get to enjoy a number of benefits of the new insurer.
It is important to know that if you change the cover amount while porting a health insurance policy, the premium amount is subject to change. Furthermore, the extra cover amount can only be claimed after the waiting period of the company.
Also, if new diseases are disclosed while porting the policy, new terms and conditions can be added by the company.
Should I Buy Health Insurance as a Non-Resident Indian?
A simple answer to that question will be YES. As an NRI, you can opt for health insurance plans with international cover. This is offered by all major reputed health insurance companies.
However, you should check upon the terms and conditions of the health insurance policy to check if the company provides services in your resident country and has partnered with the major hospitals in the particular geographical region. Check out some global health insurance policies in this document.
While understanding the intricacies of health insurance policies, it’s equally crucial to know how to select the right one tailored to your needs. Our comprehensive guide on How to Find the Best Health Insurance Policy breaks down the selection process. This makes it easier for you to make an informed choice. From assessing your lifestyle and health needs to navigating through the maze of policy options, this guide is your go-to resource for demystifying health insurance. Ensure you’re not just covered but also getting the best value and protection for your unique situation.
In Conclusion: Hidden Conditions of Health Insurance

Summing up, we discussed about several factors which should be brought to notice while choosing a health insurance policy. This includes the hidden conditions of health insurance, truth of corporate health insurance, and the claims of AYUSH health insurance. To know more about health insurance in detail make sure to check out our complete guide to buying the perfect health insurance policy for your needs.
Lastly, you can avail tax benefits on buying health insurance. Thus, a small part of your insurance expense is compensated through a deduction in your Income Tax return. Claiming a deduction under Section 80D in your ITR is an essential step. Learn more about tax saving and planning in this article. This government policy encourages individuals to buy health insurance policies for a secure future.
Frequently Asked Questions: Hidden Conditions of Health Insurance
Choosing the best health insurance policy involves assessing your healthcare needs, financial capacity, and future requirements. Start by evaluating the coverage amount, understanding the terms of the policy, and checking for any hidden conditions such as sub-limits on specific treatments or room rent. Consider the insurer’s claim settlement ratio and customer service reviews. Additionally, comparing different policies and opting for a plan that offers comprehensive coverage without many exclusions is crucial. Don’t forget to look into additional benefits like No Claim Bonus, AYUSH treatment coverage, and cashless hospitalization options.
The ideal cover amount depends on factors like your age, health condition, family size, and the cost of healthcare in your region. Typically, a cover of at least ₹10 lakhs is recommended for urban areas due to higher medical costs. However, be mindful of hidden conditions such as sub-limits on certain diseases or room rent, which might restrict your ability to claim the entire cover amount during hospitalization. Understanding these limitations beforehand can help you choose a policy that meets your needs without unexpected out-of-pocket expenses.
Health insurance policies come in various types, including individual plans, family floater plans, senior citizen plans, critical illness plans, and top-up/super top-up plans. Individual plans cover only one person, while family floater plans provide coverage to an entire family under a single sum insured. Critical illness plans offer a lump sum payment upon diagnosis of specific life-threatening diseases, and top-up plans provide additional coverage beyond the base policy. It’s important to select a plan that aligns with your specific healthcare needs and financial situation.
Yes, health insurance policies often come with hidden conditions that might affect your claims. Common hidden conditions include sub-limits on specific treatments, room rent limits, waiting periods for pre-existing diseases, and exclusions for certain treatments like AYUSH (Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy). Additionally, some policies might not cover certain procedures unless specific criteria are met, such as 24-hour hospitalization requirements. It’s essential to thoroughly read the policy document and clarify any doubts with the insurer to avoid surprises during claims.
Health insurance in India typically does not cover pre-existing diseases during the waiting period, cosmetic treatments, routine dental and vision care, and conditions resulting from self-harm or substance abuse. Other common exclusions include maternity expenses (unless specified), alternative treatments (unless covered), congenital diseases, and overseas treatment unless the policy explicitly includes these.
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