HomeGENERAL10 Hidden Conditions of Health Insurance to know before you buy!

10 Hidden Conditions of Health Insurance to know before you buy!

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.

In this article, we’ll take a closer look at the top hidden conditions of health insurance which you shloud know before buying the perfect policy for you and your family. Let’s have a closed look as we talk about them in detail below:

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 fracton of amount to be deducted in place of complete payment of hospital bill.

What about 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, only after which the claim amount is paid to the patient. Also, you’re expected to only visit government approved AYUSH hospitals for treatments.

Why do companies reject 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, making 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 and can claim the cover amount from both of them without any hassle.

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.

Besides securing our health, it’s pivotal to focus on wealth-building habits for long-term success. Discover the Five Habits That Millionaires Follow to ensure a balanced approach to health and wealth. From the discipline of daily presence at the workplace to prioritizing health and diversifying income sources, these habits pave the way to financial freedom and stability. Embracing these habits can transform not only your financial future but also support a lifestyle where you’re not just surviving but thriving.

Reimbursement or Cashless: 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 make nodifications in health Insurance Policies?

Once an year, a routine checkup has to be conducted to oversee if the insurance policy needs to be modified such as adding or removing family members, adding a supertop up or topup, buying a policy rider or for diclosing new disease or health related habit.

Also, in case of marriage, spouse can be added mid-year if informed to the insurance issuing company within 90 days of wedding. 

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.

Is it possible to change 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 and 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 issuing insurance which need to be aid attention.

Should I Buy health insurance as an 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 which 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, making 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.


Summing up, we discussed about several factors which should be brought to notice while choosing a health insurance policy. 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

How do I choose the best health insurance policy?

There is no straight answer to finding the best health insurance policy as each individual has different set of pre existing diseases and affordability of the premium amount. However, there are few common factors which determine a good policy such as no room rent cap and minimum sublimits.

How much cover should I opt for?

A cover of Rs 10 Lakhs for Adults and Rs 5Lakhs for children is considered sufficient in a health insurance policy. The amount of health insurance you opt for is the base cover amount.

What type of plans are available in health insurance policies?

Companies provide two main categories of health insurance plans: Individual and Family Floater. Individual plans only provide insurance coverage for one person, whereas family floater policies are appropriate for two or more family members.

Found it useful? Subscribe to the LLA Newsletter “The Success Circle” for such insightful information every week and level up your financial knowledge! We share insightful information about tips and tricks which contribute to making you financially knowledgeable.

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