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Health insurance terms, explained

Each term below is explained the way it shows up in a real policy wording and at the hospital billing desk, with worked ₹ examples and the IRDAI rule behind it.

Costs you pay at claim time

• Room rent cappingThe three kinds of room limit, what “single private AC room” means, ICU caps and how to choose a limit.
• Proportionate deductionWhy a bigger room cuts your doctor and surgery bills too, with a worked example and a calculator.
• Co-paymentYour fixed share of every claim, why 20% co-pay often costs more than 20% of the bill, and the types to spot.
• Sub-limitsCaps on cataract, room rent, ambulance, AYUSH and more that apply whatever your sum insured, and where to find them.
• Non-payable itemsGloves, masks, attendant food and admin fees: IRDAI’s four lists of non-medical items and how consumables cover works.

Waiting periods and disclosure

• Pre-existing disease (PED)What counts as a PED, the 36-month waiting period, what to disclose and what happens if you don’t.
• Moratorium periodAfter 60 months of continuous cover, your insurer can’t contest claims for non-disclosure, except for fraud.

Bonuses and extra cover

• Restoration benefitHow a restored sum insured works, why it can’t top up the claim that used up your cover, and how products differ.
• No-claim bonus (NCB)How a cumulative bonus grows your cover, what a claim does to it, and how to keep it when you renew or port.