By Saral Agarwal
10 Things to Check Before Buying Health Insurance.
Let’s be honest—buying health insurance can feel like trying to solve a puzzle with missing pieces. There are so many choices, and the small print seems designed to confuse you! But don’t worry. Financial expert Saral Agarwal has your back with 10 simple things to check before you pick a health insurance plan. I’ve updated his advice for what’s happening in 2025, so you can make a choice you’ll feel good about.
1. Room Rent Limit
Here’s something most people don’t think about: many insurance plans only pay so much for your hospital room each day—usually just 1-2% of your total coverage. But here’s the crucial part that catches people off guard: if you exceed the room rent limit, the insurance company reduces your ENTIRE claim proportionally, not just the room rent difference.
For example, if your plan covers ₹5 lakhs with a 1% room limit (₹5,000 per day), and you choose a room costing ₹10,000 per day, you’re exceeding the limit by 50%. This means the insurance company will only pay 50% of ALL your medical expenses—including doctor fees, surgery costs, medicines, and everything else. So if your total hospital bill is ₹2 lakhs, you’ll only get ₹1 lakh from insurance, and you’ll have to pay the remaining ₹1 lakh yourself! With hospital prices going crazy in 2025, make sure your plan has a good room limit—or better yet, no limit at all.
2. Copayment Clause
Think of copayment as your “share” of every hospital bill. Some plans make you pay 10%, 20%, or even 30% of your medical costs out of your own pocket. That can add up fast when you’re already stressed about being sick! Look for plans where you don’t have to pay anything extra, or at least keep that copayment as low as possible. Most of the good plans do not have any copayment clause, so avoid any policy that offers this clause.
3. Cashless Hospital Network
This one’s a lifesaver—literally! Cashless means that when you’re admitted to a hospital, the insurance company pays directly. You don’t have to worry about arranging money during an emergency. But here’s the catch: it only works if your hospital has a tie-up with your insurance company. So check if the good hospitals near your home offer this feature. Trust me, you’ll thank yourself later.
4. Local Support and Service
Ever tried calling customer service when you’re feeling terrible? It’s awful! That’s why having a local agent or office is crucial—they’re your health insurance lifeline during tough times. A local agent gets to know you and your family’s health needs personally, and they can literally show up at hospitals to help with paperwork while you focus on recovery. They have the expertise to navigate complex claims, know exactly which documents to submit, and can get problems resolved in hours instead of days through their direct relationships with insurance company representatives. When medical emergencies happen outside business hours, good local agents often provide personal contact numbers for genuine help
5. Waiting Periods
Here’s where it gets tricky. You can’t buy insurance today and use it tomorrow for everything. Most plans make you wait 1-4 years before covering things like pregnancy, existing health problems, or major illnesses. It’s like buying a gym membership but not being allowed to use the weights for a year! Know these waiting times so you won’t be surprised when you need treatment.
6. No-Claim Bonus (NCB)
This is actually the fun part! If you stay healthy and don’t make any claims, most insurance companies reward you by increasing your coverage for free. It’s like getting a gold star for not getting sick. Some companies are more generous with these bonuses than others, so pick one that really rewards your good health. It is good to have restoration benefits.
7. Preventive Health Check-ups
More and more insurance plans now include free yearly health check-ups. Think of it as your insurance company helping you stay healthy instead of just waiting for you to get sick. These check-ups can catch problems early, which is way better (and cheaper) than dealing with major health issues later. See what tests your plan covers and use them every year!
8. Pre and Post-Hospitalization Coverage
Here’s what many people don’t realize: medical bills don’t start and stop at the hospital door. You might need tests before you’re admitted, or medicines and follow-up visits after you go home. Good plans also cover these costs, typically for 30-60 days before and after your hospital stay. Make sure your plan does this, or you could be stuck with surprise bills.
9. Daycare Treatments
Medical technology is amazing now! Lots of treatments that used to need days in the hospital can now be done in just a few hours. Traditional examples like chemotherapy, cataract surgery, and dialysis still fall into this category, but now we also have modern procedures like arthroscopic surgeries, angiography, endoscopies, lithotripsy for kidney stones, and even certain cancer treatments like radiotherapy sessions. Make sure your plan covers these “daycare treatments”—they’re becoming more common and can save you time and money.
10. Alternative Treatments
If you’re someone who prefers Ayurveda, Homeopathy, or other traditional treatments, check if your insurance covers them. Some plans do, some don’t, and some have weird limits. Know what you’re getting so you won’t be disappointed if you need these treatments.
What’s New in Health Insurance for 2025?
Health insurance is getting smarter and easier to deal with, which is great news for all of us:
- You can now buy plans, file claims, and even consult doctors through apps on your phone. No more drowning in paperwork!
- After all the COVID chaos, most plans now properly cover COVID-19 treatments and vaccines without weird exclusions.
- Mental health support is finally becoming normal in insurance plans—it’s about time!
- You can now mix and match coverage to fit exactly what you need and can afford.
- AI is making claims faster and helping suggest better plans for your specific situation.
- IRDAI’s Transformative Role in 2025: The Insurance Regulatory and Development Authority of India (IRDAI) has revolutionized health insurance this year by removing age limits for buying coverage, reducing pre-existing disease waiting periods from 4 to 3 years, and making AYUSH treatments fully covered without sub-limits. IRDAI also mandated coverage for severe conditions like cancer and AIDS, capped premium hikes at 10% for senior citizens, and strengthened cashless networks for faster claims—making health insurance truly accessible and trustworthy for every Indian.
With these 10 points in mind, you can pick a health insurance plan that actually protects you and your family without breaking the bank. Remember, the cheapest plan isn’t always the best deal—focus on getting coverage you can actually use when life throws you a curveball.
Watch Saral Agarwal’s full video here: 10 Things to Check Before Buying Health Insurance
