Health Insurance · intermediate
Health Insurance
How health insurance works in India: the kinds of policy, premiums and portability, room-rent limits, co-pay and deductibles, waiting periods, cashless and reimbursement claims, IRDAI's current rules, and how complaints are resolved.
- 01Types of Health Insurance PoliciesThe main kinds of health cover in India — indemnity and fixed-benefit, individual, family floater, group, top-up and super top-up — and what the law and IRDAI currently require on age, mental illness and AYUSH treatment.
- 02Premium Calculation & PortabilityHow a health insurance premium is built, the tax that applies to it, the limit on premium increases for senior citizens, and how portability lets a policyholder change insurer without losing credits already earned.
- 03Room Rent, Co-pay & DeductiblesHow room-rent limits, proportionate deduction, co-payment and deductibles divide a hospital bill between the policyholder and the insurer, and why these are terms of each product rather than figures fixed by IRDAI.
- 04Waiting Periods & Pre-Existing DiseasesThe waiting periods in a health policy — initial, specific-disease, pre-existing disease and maternity — the 36-month caps that apply since 1 April 2024, the duty to disclose, and the 60-month moratorium.
- 05Cashless & Reimbursement ClaimsThe two ways a health claim is paid — cashless at a network hospital and reimbursement after paying the bill — with the documents involved, the role of the TPA and the time limits IRDAI set in 2024.
- 06Claim Repudiation & Common RejectionsWhat repudiation of a health claim means, the grounds insurers commonly rely on, the steps IRDAI requires before a claim is rejected, how the 60-month moratorium limits non-disclosure disputes, and the routes open to a policyholder who disagrees.
- 07IRDAI Health Insurance GuidelinesThe rules IRDAI currently applies to health insurance — where they are found, what they require at purchase, at renewal and at claim time, what they leave to each product, and the standard Arogya Sanjeevani policy.
- 08Ombudsman & Grievance RedressalThe route a health insurance grievance follows — the insurer first, then IRDAI's Bima Bharosa portal, the Insurance Ombudsman or a consumer commission — with the time limits and money limits that apply at each stage.