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Key features to look for in your health insurance policy before purchasing one

Dec 04, 2019 | 7 months ago | Read Time: 3 minutes | By iKnowledge Team

While most people reading this are leading healthy, long lives and will hopefully continue to do so, the risk of being hospitalized due to a sudden illness or critical injury is always around. A risk such as this must not be taken lightly, and fortunately new age health insurances are available to cover you in a ring of financial protection against rising medical expenses. Let’s look at few important features that could help you take a more informed decision.

Lifetime Renewability: IRDAI regulations have made it mandatory for insurers to provide health cover even at an age entry level of 65, much to the relief of the elderly. Most private insurers, however, do not have such age-limits in their health plans while most state-owned general insurers cap the entry age at 65. The regulations state that lifetime renewability is mandatory on all health policies. As a policyholder, you have the right to continue renewing your policy lifelong. This rule applies even if you make a claim in the previous year. Your insurer cannot deny renewal on arbitrary grounds and will have to provide rational reasons in writing to do so.

Pre-existing ailments: Health insurance plans cover pre-existing ailments after a waiting period of 48 months, with some companies going far less than that. However, this is conditional upon your absolute honesty during medical disclosures at the time of buying the policy. If in case you were unaware of the disease at the time of buying the policy and declare yourself as medically fit then the insurance company would still honor the pre-existing disease related claim after 48 months / the predefined waiting period.

Conditionally, if the insurer suspects that the buyer was aware of the pre-existing disease at the time of buying the policy then the company may refuse to honor the claim. This is the reason why you absolutely must disclose any pre-existing ailment during purchase for a smooth claim’s settlement process later on. Further, coverage of certain defined and specific ailments has a ‘waiting period’ of 12 or 24 months, post which they are covered for claim.

Sub-limit: This is a key feature to keep an eye out for. Sub-limit refers to limiting reimbursement of certain cost-heads to a pre-defined level. For example, reimbursement of room-rent may be capped at 1 percent of the sum insured. So, irrespective of the total sum insured under the policy, you may still end up paying partly unless you stick to the limit. Some companies don’t have any such sub-limits while few others offer an option to reduce premium payable by including sub-limits at the time of buying the plan.

Day-care and OPD expenses: Many health insurance plans have started covering claims for day-care expenses such as dialysis, chemotherapy, eye surgery and lithotripsy, among others. Insurance companies cover as many as 140 such surgeries, with or without any restrictions. Dental care neither fall under day-care and nor does it require 24-hour hospitalization. Such out-patient procedures are also being covered but with restrictions.

No medical tests up to age 45: Most insurers require candidates to undergo medical tests to determine their health and premium, which is overseen by a life underwriter. This isn’t a mandatory requirement until age 45, unless you have a medical history requires it as a necessity. You should, however, honestly disclose all past and existing medical treatments, if any. For easier claim settlement, it is natural to volunteer for a medical check-up/test if required by the insurer.


It is better to compare the policies of 2-3 of the country’s top insurers. Their inclusions and exclusions in the most basic plan must be carefully looked at. The premium isn’t the only criteria to consider, instead look for simple plans with less conditions and restrictions in them. There is no such thing as too safe and this applies to health insurance for your family as well as makes sure your family is safe from unforeseen medical contingencies. To know about Aegon Life’s life insurance products like term insurance and other products, visit our home page.


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