A single serious hospitalisation can undo years of savings. Health insurance exists to break that link — so that a medical emergency stays a medical event, not a financial one. And after the IRDAI's 2024 reforms, the cover available to Indian families is more flexible and more policyholder-friendly than ever.
01. What health insurance is
Health insurance is an indemnity cover that reimburses, or pays directly, the cost of hospitalisation and related medical treatment. In exchange for an annual premium, the insurer meets covered medical expenses up to your chosen sum insured — protecting your savings from the rising cost of healthcare.
02. The main types of cover
Individual
A separate sum insured for each insured person.
Family floater
A single sum insured shared across the family — usually more economical.
Senior citizen
Designed for older entrants, with features suited to their needs.
Critical illness
A lump sum on diagnosis of specified serious illnesses, independent of hospital bills.
Top-up & super top-up
Affordable high cover that sits above a threshold / your base policy.
Disease-specific
Focused cover for conditions such as cancer or cardiac illness.
03. What a good policy covers
- In-patient hospitalisation — room, ICU, surgery, doctors' fees, medicines and diagnostics.
- Pre- and post-hospitalisation — expenses for a defined window before and after admission (commonly 30 and 60 days).
- Day-care procedures — treatments needing less than 24 hours' admission.
- Ambulance, domiciliary and organ-donor expenses, as per policy terms.
- AYUSH treatment — Ayurveda, Yoga, Unani, Siddha and Homeopathy, with wider recognition under the current framework.
- Modern treatments — specified advanced procedures such as robotic and other new-age treatments.
04. What the 2024 IRDAI reforms changed
- Pre-existing disease (PED) waiting period capped at 36 months — cannot be re-applied for declared conditions.
- Moratorium reduced to 5 years — after 5 continuous years, claims cannot be denied for non-disclosure except in proven fraud.
- Free-look period extended to 30 days to review a new policy.
- No maximum age cap on buying a health policy.
- Cashless Everywhere — cashless treatment even at non-network hospitals, subject to intimation.
- Faster cashless — authorisation targeted within 1 hour and final discharge within 3 hours.
05. Understanding waiting periods
| Initial waiting period | Usually 30 days from inception (accidents excepted). |
| Specific ailments | Certain listed conditions may carry a waiting period, commonly up to 24 months. |
| Pre-existing diseases | Now capped at a maximum of 36 months, often shorter. |
| Maternity | Where covered, a defined waiting period applies. |
06. How much cover do you need
Adequacy is everything. Medical inflation runs well ahead of general inflation, and metro hospital bills climb quickly. A practical approach for most families is a solid base policy paired with a super top-up — the top-up adds a large layer of protection at a modest premium. Sum insured should reflect your city, your family's age profile and the kind of hospital you would want to use.
07. Cashless vs reimbursement & the claim process
You can claim cashless (the insurer settles directly with the hospital) or by reimbursement (you pay and claim back). With cashless now available beyond the network, planning admissions and intimating the insurer early makes emergencies far less stressful. Keep your policy's Customer Information Sheet, ID and TPA/insurer helpline handy.
08. Tax on your premium
Under the old tax regime, health-insurance premiums qualify for deduction under Section 80D — broadly up to ₹25,000 for self and family, and an additional ₹25,000 (or ₹50,000 where parents are senior citizens), plus preventive health check-ups. These deductions are generally not available under the default new regime.
09. How Aurevian helps
Choosing health cover well means reading past the premium to the fine print — room-rent limits, sub-limits, co-pay, restoration, and how each insurer actually settles claims. Aurevian helps you compare policies on what matters, right-size the sum insured, structure base-plus-top-up efficiently, and stand by you at claim time — independent advice, on your side.
“The best time to understand your health policy is long before you are standing at a hospital admissions desk.”
