General Insurance · intermediate
Health Insurance
Health insurance as general and health insurers sell it: the kinds of policy, room-rent limits, co-pay and deductibles, waiting periods, disclosure of pre-existing disease, why claims are refused, IRDAI's current rules and the Insurance Ombudsman.
- 01Types of Health InsuranceThe main kinds of health cover — indemnity and benefit-based, individual, family floater, group, top-up and super top-up — how each one pays, and what portability carries across when a policyholder changes insurer.
- 02Room Rent CappingHow a room-rent limit in a health policy works, why choosing a costlier room can reduce much more than the room charge through proportionate deduction, and how ICU limits fit in.
- 03Co-pay & DeductibleCo-pay and deductible — the two main ways a health policy makes the policyholder share the cost of a claim — how each is calculated, how they combine with each other and with room-rent limits, and who collects them.
- 04Waiting Period TypesThe three main waiting periods in a health policy — initial, specific-disease and pre-existing disease — the 36-month ceilings in force since 1 April 2024, and what happens to them on portability, on a higher sum insured and on a lapse.
- 05Pre-Existing Disease DisclosureWhat counts as a pre-existing disease, why it has to be disclosed in the proposal form, what an insurer may do with a disclosed condition, the consequences of hiding one, and the 60-month moratorium that limits later disputes.
- 06Claim Repudiation CasesWhat it means when a health claim is repudiated, the grounds insurers most often rely on, why a cashless approval is not the last word, and the route a policyholder can take when a claim is refused.
- 07IRDAI Health Insurance GuidelinesThe rules IRDAI currently applies to health insurance: where they are found, what they fix (waiting-period ceilings, the moratorium, free-look, portability, cashless and claim timelines), what they leave to each product, and the standard Arogya Sanjeevani policy.
- 08Ombudsman Case SummariesHow the Insurance Ombudsman resolves health insurance disputes: who can complain and when, the ₹50 lakh limit, mediation and awards, the time limits, and the consumer-commission alternative. The cases described are illustrations, not reported decisions.