Who this cover is for
Individuals, young families, and seniors seeking hospitalisation cover, pre-existing disease management, and critical illness protection.
Coverage scope
Policy scope is governed by insurer terms, endorsements, and policy schedules. Common provisions include:
Inpatient Hospitalisation
Covers room charges, ICU fees, nursing expenses, surgeon charges, and operating theatre costs for treatments requiring 24+ hours.
Pre & Post Hospitalisation
Diagnostic tests, consultations, and medications typically covered for 30–60 days before admission and 60–180 days post-discharge.
Day Care Procedures
Advanced surgical treatments requiring less than 24 hours of hospitalisation such as cataracts, dialysis, and chemotherapy.
Cashless Network Access
Direct settlement coordination with hospital third-party administration (TPA) desks across partner hospitals.
Key limitations and exclusions
Every insurance contract outlines specific conditions, waiting periods, and deductibles to review before policy inception:
Standard Waiting Periods
Initial 30-day waiting period for illnesses (accidents covered day 1) and up to 36 months for pre-existing ailments (PED).
Room Rent Sub-limits
Policies with room rent limits (e.g. 1% of sum insured) trigger proportionate deduction across doctor and treatment fees.
Permanent Exclusions
Cosmetic surgery, self-inflicted injuries, and non-prescribed investigations are standard exclusions.
How Sanghvi Consultancy assists you
With 45+ years of insurance experience in Navrangpura, Ahmedabad, Sanghvi Consultancy provides personal policy guidance:
- We audit pre-existing conditions and evaluate insurer waiting periods across top insurers.
- We explain co-pay clauses and room-rent restrictions before you buy.
- Dedicated claim guidance during both planned hospital admissions and emergency claims.
Frequently asked questions
Can I port my existing health policy without losing waiting period benefits?
Yes. Under IRDAI guidelines, you can port to another insurer at renewal with at least 45 days notice, carrying forward accrued waiting period credits for pre-existing diseases.
What is the difference between cashless and reimbursement claims?
Cashless claims are settled directly between the insurer and network hospitals via pre-authorisation. Reimbursement claims require you to pay upfront and submit original bills and medical summaries within 15–30 days.
Discuss your policy with an advisor.
Get clear answers on policy terms, insurer waiting periods, and claim support without aggressive sales calls.