POLICY POINTINSURANCE SERVICES
Health insurance, explained

Understand your cover.
Choose with confidence.

Explore the essentials before choosing a policy for yourself or your family. Policy Point helps you discuss your needs and understand the terms that matter.

What to compare before choosing
ItemQuestion to ask
PremiumCan I sustain this at renewal?
Cover amountHow much is shared between insured members?
Room eligibilityWould choosing a different room reduce a claim?
Co-payment and deductibleWhat portion could I pay myself?
Waiting periodsWhen do key benefits begin?
Exclusions and limitsWhich treatments or expenses are restricted?
Hospital networkAre my preferred hospitals currently eligible for cashless claims?

01 / Insurance basics

What does health insurance do?

You pay a premium for cover against eligible medical expenses. The insurer pays according to the policy’s benefits, limits and exclusions. The sum insured is the cover amount; it does not mean every hospital bill is paid in full.

Cashless or reimbursement?

With approved cashless treatment, the insurer settles eligible expenses directly with the hospital. With reimbursement, you pay first and submit the required claim documents. Keep prescriptions, bills and discharge records. Non-covered charges remain payable by you.

Waiting periods and exclusions

Some benefits begin only after a waiting period. Initial cover, listed procedures, pre-existing conditions and maternity may have different rules. Exclusions describe what is not covered. Check the current policy wording and disclose your medical history accurately.

02 / Compare and choose

Compare the same essentials

Use the same insured members and cover amount when comparing quotes. Review room eligibility, co-payments, deductibles, treatment limits, waiting periods and exclusions alongside the premium.

What could you pay yourself?

A co-payment is your specified percentage of an admissible claim. A deductible is an amount you must meet before cover applies. A sub-limit caps a particular expense. Ask how these work together, including any deductions linked to room eligibility.

Check hospitals and claim support

Check your preferred hospitals with the insurer and confirm the cashless process. Ask what documents are needed, whom to contact during admission and how renewal works. Read the Customer Information Sheet and policy wording before deciding.

Your comparison checklist

List the people to cover, their ages, existing cover, medical history and a sustainable renewal budget. Then compare the benefits you need. A lower premium alone does not establish which policy suits your situation.

03 / Family coverage

Individual cover or family floater?

An individual policy provides a separate cover amount for the insured person. A family floater shares its cover across eligible family members. More than one claim can draw on that shared amount. Compare both structures for your family.

Parents and senior citizens

Compare including parents in a floater with arranging separate cover. Consider their medical history, available benefits, co-payments and waiting periods. Eligible relationships and entry conditions differ by policy.

Children, maternity and newborns

Check dependent-child eligibility and when cover must change. Maternity and newborn benefits are not automatic: verify whether they are included, their waiting periods, limits and the process for adding a baby.

04 / Benefits and features

Hospitalisation and related expenses

Review inpatient treatment, eligible day-care procedures, and expenses before and after an admissible hospitalisation. Covered expenses and time windows vary. Routine outpatient visits are not automatically included.

Restoration and bonus cover

Restoration can replenish cover under specified conditions. Check when it activates, how often, and whether it can cover the same illness or a later claim. Bonus rules also vary; additional cover should not be treated as unrestricted cash.

Optional benefits worth checking

Some plans include or offer health check-ups, ambulance cover or extra protection through add-ons. Review eligibility, limits, extra premiums and exclusions for each benefit. Choose features that address your needs rather than relying on the feature count.

This guide is general information. Benefits, eligibility, waiting periods and claim payments depend on the selected insurer’s current policy wording and your issued policy. Ask us to explain the documents before you buy.

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Further reading from insurers: Family cover · Health insurance · Restoration rules. Reviewed October 2026.

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