Health insurance in India is regulated by IRDAI, and every indemnity policy works on the same core mechanic: you pay an annual premium, and the insurer settles hospitalisation expenses up to your sum insured. What the premium buys Your premium is priced on age, city, sum insured, medical history and policy add-ons. Premiums rise in age bands (typically 5-year bands), so entering early locks a lower starting band and starts your waiting-period clock sooner. The four numbers that decide a policy 1. Sum insured — the annual limit. In metro cities, ₹10 lakh is a realistic floor for a family floater in 2026. 2. Room-rent capping — a single-private-room policy avoids proportionate deductions, where the insurer scales down the entire bill if you take a costlier room. 3. Waiting periods — 30 days initial, 24-48 months for listed illnesses, and up to 36 months for pre-existing diseases under current IRDAI norms. 4. Claim settlement and repudiation ratios — read them together with the insurer's average settlement time. Cashless vs reimbursement Cashless works only in network hospitals with pre-authorisation. Reimbursement means you pay and claim later, and you carry the documentation risk. Check the network list for hospitals near you before buying, not after. Common exclusions people miss Consumables (gloves, PPE, syringes) unless a consumables rider is added, non-medical items, OPD costs in base indemnity plans, and treatments taken abroad. How to read a policy wording Look for the sub-limits table, the proportionate-deduction clause, restoration benefit conditions and the definition of "day-care procedures". These four sections cause most disputed claims.
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