Worked Examples and Buying Checklists
Health insurance buying checklist for India: from proposal form to free-look period
A step-by-step checklist for buying or renewing health insurance in India, covering cover size, clauses, disclosures, network hospitals, premium, tax and the 30-day free look.
Buying health insurance well comes down to five steps in order: decide the structure (who goes on which policy), size the cover for one serious hospitalisation in your city, compare the clauses that decide claims (room rent, co-pay, sub-limits, waiting periods), fill in the proposal form completely and truthfully, and read the policy during the free-look period, which is 30 days for new retail policies under IRDAI's current rules. Most claim disputes trace back to a step that was skipped, usually the proposal form. This checklist takes you through each step, with links to the worked examples.
This is the overview for the Worked Examples and Buying Checklists section. The interactive policy checklist lets you tick items off as you go.
Step 1: decide who goes on which policy
- List each person, age, and any diagnosed condition or regular medicine.
- Young, healthy members: usually one family floater.
- Members over about 55, or with chronic conditions: usually a separate policy.
- Note any employer cover and any eligibility for Ayushman Bharat PM-JAY, including the Vay Vandana card for those aged 70+.
Guides: individual vs family floater, insuring parents and senior citizens.
Step 2: size the cover
- Estimate the cost of one serious admission (cardiac, cancer, major surgery, long ICU stay) in the hospitals you would use.
- Add a margin for medical inflation over the next 5 years.
- Decide whether to reach that figure with a higher base sum insured or a base plus a super top-up.
Guides: how much sum insured do I need, super top-up vs higher sum insured.
Step 3: compare the clauses that decide claims
| Clause | What to look for | Where to find it |
|---|---|---|
| Room rent | No limit or single private room is safest | Policy schedule, CIS |
| Co-pay | None, or only where you accept it (age, zone) | CIS |
| Sub-limits | Cataract, joint replacement, named procedures | Wording annexure |
| Waiting periods | Initial, PED (max 36 months), specific diseases, maternity | CIS |
| Pre/post hospitalisation | Number of days | Schedule |
| Restoration and bonus | Conditions; same-illness rules | Wording |
| Non-payables | Consumables cover if needed | Annexure |
| Network | Hospitals near home for cashless | Insurer or TPA website |
Guides: room-rent limits, co-pay and sub-limits, waiting periods.
Step 4: compare quotes on total cost
Put the quotes side by side against the same test bill: premium + what you would pay on that bill. A quote that is ₹4,000 cheaper but has a 1% room-rent cap can cost ₹60,000 or more on one admission.
Guide: compare health insurance quotes, worked example. Tool: quote comparison.
Step 5: fill in the proposal form yourself
- Disclose every condition, test result, medicine, surgery and hospital admission in the look-back period, for every person, even if minor or controlled.
- Do not let an agent or a website fill answers for you. Check the final proposal copy the insurer sends.
- Disclose existing policies with other insurers.
- Keep copies of medical reports you submit.
Why it matters: non-disclosure is the most common ground for rejection until the five-year moratorium applies. See non-disclosure and the moratorium.
Step 6: pay and check the documents
| Document | What to check |
|---|---|
| Policy schedule | Names, ages, sum insured, zone, start date, add-ons |
| Customer Information Sheet | Waiting periods, co-pay, limits match what you were told |
| Policy wording | Definitions, exclusions, claim procedure |
| Premium receipt | Mode of payment (non-cash for the tax deduction); no GST on an individual or floater policy |
| Health card / e-card | Policy number and TPA helpline |
Remember: the individual health insurance premium is GST-exempt from 22 September 2025. See GST on health insurance.
Step 7: use the free-look period
For a new retail health policy of at least one year, you have 30 days from receiving the policy document to review it and cancel if it does not suit you. The insurer refunds the premium after deducting proportionate risk premium for the days covered, stamp duty and medical examination costs it bore. The free look applies to new policies, not to renewals. Read the wording in this window, not after a claim.
Step 8: set up for tax and renewal
- If you use the old tax regime, keep receipts for the health insurance deduction. See Section 80D and the Income-tax Act, 2025.
- Diary the renewal date and the end of the grace period.
- If you plan to switch insurers, start the portability request well before renewal. See porting your health policy.
Worked example: applying the checklist
Illustrative. Kavya (31) and Rohan (33), Pune, one child (2), Rohan's parents (62 and 59) in Nashik. Rohan has employer cover of ₹5 lakh.
- Structure: floater for the three of them; separate floater for the parents.
- Cover: ₹10 lakh base floater + ₹25 lakh super top-up with a ₹10 lakh deductible for the young family; ₹10 lakh for the parents.
- Clauses: rejected one quote for a 1% room-rent cap; chose a parents' plan with a co-pay only above age 65 after comparing the price difference.
- Proposal: declared Rohan's father's diabetes and mother's thyroid condition with reports.
- Free look: found the parents' policy listed a 24-month wait for cataract; accepted it knowingly.
- Tax: Rohan files under the new regime, so no deduction; Kavya files under the old regime and pays the parents' premium from her account, so she checks the deduction rules for parents.
Frequently asked questions
Can I change insurer during the free-look period instead of cancelling?
You can cancel and buy elsewhere, but the new policy starts its own waiting periods. Porting is for renewals.
Is it safe to buy online?
Yes, if you buy from an insurer, or an intermediary registered with IRDAI, and the policy document reaches you from the insurer. Verify registration on the IRDAI website.
Should I buy add-ons?
Only where they change a likely claim: consumables cover, room-rent waiver, PED wait reduction. Price each add-on against the claim it would change.
Sources and where to check
- IRDAI — policyholder protection rules, free-look period, list of insurers and intermediaries
- Bima Bharosa — complaints
- Income Tax Department — health insurance deduction
