Out-of-Pocket Cover
Consumables Cover
Pays for items that are otherwise non-payable, such as gloves, masks and some hospital supplies, up to the limits of the add-on.
Health cover that fits your family, explained clearly.
Cashless at network hospitals
Room rent limits explained
Tax benefit under Section 80D, as applicable
Health Insurance Advisory
Be ready for the cost of treatment
Medical costs keep rising, and a single hospitalisation without adequate cover can use up years of savings. A Distroo Advisor helps you compare health plans from partner insurers, understand clauses such as waiting periods, room rent limits and co-payments, and choose cover that matches your family's needs.
Room Rent Limits & Proportionate Deductions Explained
Guidance on Cashless Admission at Network Hospitals
Restoration and Top-Up Options Compared
AYUSH and Day-Care Treatment Cover Where Offered
Claim Guidance
How Cashless Hospitalisation Works
A hospital admission is easier when you know the steps. Here is how a cashless claim usually works, and where your Advisor helps. The insurer or TPA makes the decision.
Step 01
Inform & Present Your Card
At a network hospital, show your health card at the insurance desk and inform the insurer or TPA as your policy requires. Call your Advisor too.
Step 02
Pre-Authorisation
The hospital sends the cashless request. IRDAI's 2024 guidelines expect the insurer to decide within one hour of receiving the request.
Step 03
Cashless Treatment
If approved, eligible treatment costs are billed directly to the insurer, up to the limits in your policy. You pay non-payable items and any co-payment.
Step 04
Bill Review
Your Advisor can help you read the final bill against your policy terms so you know what is payable.
Step 05
Discharge
Final authorisation is sought at discharge. IRDAI's guidelines expect the insurer to respond within three hours. The insurer then settles eligible amounts with the hospital.
Policy Add-Ons
Optional Health Riders and Add-Ons
Standard plans can be strengthened with add-ons that reduce out-of-pocket costs. Each add-on has its own terms, limits and waiting periods.
Refill Option
Restoration Benefit
Refills your sum insured after a claim, within the same policy year, as per the plan's terms. Some plans allow it only for unrelated illness.
Outpatient Care
OPD & Diagnostics Cover
Covers specialist consultations, tests and pharmacy bills without hospital admission, up to a stated limit, in plans that offer it.
Worldwide Care
Global Treatment Cover
Some plans extend cover for planned or emergency treatment abroad. Check the countries, limits and exclusions.
Talk to an Advisor
Want help choosing health cover?
Share who needs cover and a Distroo Advisor will explain suitable options in plain language.
Know the Terms
Health Cover Inclusions & Exclusions
Typical clauses to understand before you buy. Your policy wording is the final word.
What Is Covered
CoveredTypical features of comprehensive health plans; check your policy
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In-Patient Hospitalisation & ICU
Room rent, nursing, ICU, surgeon and operation theatre charges for admissions of more than 24 hours, up to policy limits.
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Pre & Post-Hospitalisation Care
Tests, doctor visits and medicines for the number of days before admission and after discharge stated in your policy.
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Day-Care Procedures
Treatments that do not need a 24-hour stay, such as dialysis, chemotherapy and cataract surgery, as listed in the policy.
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AYUSH Treatment
In-patient Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in recognised hospitals, as covered by the policy.
What Is NOT Covered
ExcludedTypical exclusions; the policy wording is final
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Initial Waiting Period
Many plans exclude non-accidental illnesses for an initial period, commonly 30 days from the policy start.
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Pre-Existing Condition Waiting Period
Conditions you already have, such as hypertension or diabetes, carry a waiting period. IRDAI limits it to a maximum of three years.
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Cosmetic & Elective Procedures
Cosmetic or aesthetic procedures that are not medically necessary are generally excluded.
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Substance Misuse & Self-Harm
Treatment linked to substance abuse, alcohol rehabilitation or intentional self-injury is generally excluded.
Eligibility Checklist
Documents Required for Health Insurance
Having the right documents ready helps with cashless pre-authorisation and reimbursement claims.
Health Card / Policy Copy
Your digital or physical health card with the TPA identifier, or the policy number.
Government Photo ID
Aadhaar, passport or PAN of the patient.
Doctor's Admission Note & Prescription
The treating doctor's note advising admission.
Original Hospital Discharge Summary
A discharge summary with the diagnosis and treatment details.
Itemized Final Hospital Bills & Payment Receipts
Itemised hospital bills for room, doctor, pharmacy and diagnostics, with payment receipts.
Cancelled Cheque & Bank Passbook
For direct bank transfer of the reimbursement.
Previous Medical History & Test Records
Earlier discharge summaries and reports, such as ECG or diabetes records, for the baseline.
Pre-Policy Medical Check
Some insurers ask older applicants for a health check. Your Advisor helps you schedule it.
Age & Address Proof
Valid age and address proof, which the insurer needs for senior citizen plans.
Free Advisory Call
Book a One-on-One Consultation
Discuss your health history, dependants and goals with a Distroo Advisor.
Policy Review
Get Your Existing Policy Reviewed
Share your policy schedule and we will explain its key terms and possible gaps.
Free Health Advice
Explore Family Health Plans
Speak with a Distroo Advisor. We review the limits in your existing policy, explain room rent and co-pay clauses and walk you through suitable plans from partner insurers.
- Cashless claim guidance at network hospitals
- Help scheduling medical checks, if the insurer asks for them
- A named Advisor as your point of contact
FAQs
Frequently Asked Questions on Health Insurance
Answers about cashless admission, room rent limits and tax deductions.
In a cashless claim at a network hospital, the insurer or TPA pays eligible bills directly to the hospital, and you pay only what the policy does not cover. In a reimbursement claim, you pay the hospital first and submit bills and records to the insurer, which then refunds eligible amounts.
If a policy caps room rent and you choose a costlier room, the insurer may reduce other charges in the same proportion. For example, a cap of ₹5,000 a day with a room at ₹10,000 a day could mean associated charges are paid at 50%. Plans without a room rent limit avoid this. Read the clause before you buy.
Restoration refills your sum insured within the same policy year after it has been used, as per the plan's terms. Many plans allow the restored amount only for a different illness, so check the wording.
Under the old tax regime, premiums for self, spouse and children can be deducted up to ₹25,000 a year (₹50,000 if the person insured is a senior citizen), with a further ₹25,000 for parents (₹50,000 if they are senior citizens), subject to the law in force. The new tax regime does not allow this deduction. Please confirm with a tax adviser.
Yes. IRDAI's portability rules let you move to another insurer at renewal and carry forward credit for waiting periods already served, subject to the new insurer's underwriting. Apply well before your renewal date; insurers usually need 30 to 60 days. Your Advisor can help.