Insurance Policy Comparison (India): Cover and Exclusions

About the Insurance Policy Comparison (India): Cover and Exclusions

Two health policies can look alike on the brochure and pay very differently. What decides a claim sits in the policy wording and the one-page Customer Information Sheet (CIS) every insurer must give you: the room-rent and ICU limits, the co-payment and any deductible, the sub-limits on treatments such as cataract, the waiting periods for illness, listed diseases, pre-existing diseases and maternity, the restore benefit and the bonus, and the exclusions.

Open two to four documents — PDFs with a text layer, Word files, text or web pages saved from the insurer’s site — and the comparison reads each one and lines the terms up side by side, with the sentence and the page every value came from and a plain-language note on what it means. Where the documents differ, it says which is more in your favour on that term. A term it cannot find is shown as not found: it never guesses, and you can correct any value. Motor policies get their own terms (IDV, deductibles, no claim bonus, add-ons). Your documents are read on your device and never uploaded. Without a pass you see a free preview of your own comparison: how many terms and exclusions were found in each document, with the first rows of each table, while the rest, the PDF report, the CSV and Copy summary unlock with a Pro pass. This is a reading aid, not advice: the policy wording decides.

Common uses

• Compare two health policies you are offered, term by term, before you buy.
• Check your renewal or ported policy against your old one for new limits or longer waits.
• See what a policy really says about room rent, co-payment and maternity before a planned treatment.
• Compare two motor quotes on their deductibles, no claim bonus and add-ons.

What the comparison reads

For health policies: the product, the insurer and its UIN; the sum insured and whether it is individual or floater; the room-rent and ICU limits, co-payment (and any zone co-payment), deductible, ambulance and the cataract and modern-treatment sub-limits; the initial, specific, pre-existing-disease and maternity waiting periods; the days covered before admission and after discharge, day care, treatment at home, AYUSH, the organ donor, restoration and the cumulative bonus; the free-look and grace periods, the moratorium and portability. For motor policies: the IDV, the compulsory and voluntary deductibles, the no claim bonus, the owner-driver personal accident cover, the add-ons and the free-look period. Each value comes from the words around its term, with the passage shown, so you can check it in a second.

The Customer Information Sheet

IRDAI requires a one-page Customer Information Sheet with every health policy, in a fixed format: what the policy covers and does not cover, the waiting periods, the financial limits (sub-limits, co-payment, deductible), the claims procedure and your rights (Master Circular on Health Insurance Business, Annexure-1). It is the quickest document to compare. It lists only the main exclusions, so an exclusion “not found” in a CIS may still be in the wording: open the wording for the full list.

Waiting periods and the limits IRDAI sets

IRDAI’s health insurance FAQs say no waiting period of a health policy may be longer than 36 months, including the one for pre-existing diseases; the free-look period is 30 days from receiving the policy document; the grace period to renew is 15 days for monthly premiums and 30 days otherwise; and after 60 continuous months of cover a claim cannot be contested for non-disclosure, except for established fraud. The comparison notes any waiting period above 36 months, and a free-look period shorter than 30 days, which usually means the document is old or was misread.

Exclusions and their codes

Wordings written to IRDAI’s standard carry codes for the common exclusions: Excl01 pre-existing diseases, Excl02 specified diseases and procedures, Excl03 the first 30 days, then investigation, rest cure, obesity, change of gender, cosmetic surgery, hazardous sports, breach of law, excluded providers, alcoholism, health hydros, dietary supplements, refractive error, unproven treatments, sterility and infertility, and Excl18 maternity. The comparison finds them by their codes or their words, and a few common ones outside the list (treatment outside India, war and nuclear risks, dental treatment, spectacles). A waiting period stated without its code counts as the exclusion it stands for.

Before you choose

A difference on one term is not the whole policy: the premium, the network hospitals and the insurer’s claims record matter too. Ask the insurer or your agent about any term not found here and get the answer in writing. If a claim is later refused against the wording, complain to the insurer first, then through Bima Bharosa and the Insurance Ombudsman.

Limitations

• A reading aid, not advice: values are read from the text and can be wrong when a sentence is unusual or a table is split across lines. Check each one against its passage.
• Scanned PDFs have no text to read: make them searchable with an OCR tool first.
• Terms are compared one by one; the comparison does not price the policies or rank them as a whole.
• Travel, life and home policies get only the general terms (sum insured, deductible, pre-existing conditions, free-look and grace periods) and their exclusions.

Privacy

On this device; its files download once

Everything happens in your browser. What you enter or open here is not uploaded or stored by MySmartCoPilot. Loads the PDF and Word readers and the PDF engine from this site the first time they are needed. Your documents are read on this device and never uploaded.