Antyodaya Shramik Suraksha Yojana

The company underwriting the policy and paying claims. Distributors and web aggregators sell policies but never carry the risk, so this is the entity whose service and solvency matter.

The Unique Identification Number IRDAI assigns to an approved product. This is the identity key for insurance, the equivalent of a barcode: marketing names change and are reused, the UIN does not.

Whether the product is registered with IRDAI. Anything sold as insurance in India must be, so its absence is a signal to check what is actually being sold.

Whether the policy covers one person or a family under a single sum insured. A family floater shares one amount across everyone, so a single large claim can exhaust the cover for the rest of the year.

The cover amounts the policy can be bought at. It is the ceiling on what the insurer pays in a policy year, before any sub-limits cut it further.

Whether the cover refills after it is exhausted within one policy year, and on what terms. Some restore only for an unrelated illness, which is a much narrower promise than it sounds.

How much the cover increases for each claim-free year, and the ceiling it builds to. Check what happens after a claim: some policies reduce the accumulated bonus rather than simply pausing it.

How many procedures needing less than 24 hours in hospital are covered. Most modern surgery is day care, so a policy requiring a full-day admission for everything would exclude a great deal.

Whether treatment under Ayurveda, Yoga, Unani, Siddha or Homeopathy is covered, and up to what limit.

Whether treatment taken at home is covered when hospitalisation was advised but not possible. It is usually tightly conditioned in the wording.

Whether consultations and tests without admission are covered. Most indemnity policies exclude these, so it is a genuine differentiator where present.

Whether childbirth expenses are covered at all, before considering the waiting period that applies to them.

Health check-ups, discounts or reward points the policy includes. These are the features most often revised at renewal, unlike the cover terms.

'No cap' and '1% of sum insured per day' are wildly different products. A cap silently proportions down the entire claim, not just the room charge, because hospitals price surgery and consultation by room category.

The limit on intensive-care room charges, where it differs from the general room cap. ICU is where a capped policy hurts most, since these are the largest daily charges.

The share of every approved claim you pay yourself. A 20% co-pay on a ₹5 lakh claim is ₹1 lakh from your own pocket, and it applies on top of any deductible.

When the co-pay applies, such as above a certain age or in a higher-tier city. A policy with no co-pay at purchase can acquire one at a stated age.

Caps on specific treatments regardless of the total cover, such as a fixed amount for cataract. A policy with a large sum insured can still pay a small fraction of a bill because of these.

The period at the start when only accidents are covered, typically 30 days. Illness claims in this window are declined regardless of what the illness is.

How long you must hold the policy before a condition you already had is covered. It is the fact that most often turns a claim down, and it runs from policy start rather than from diagnosis.

The wait for named conditions such as hernia, cataract or joint replacement, usually one to four years. These are listed individually in the wording, separate from the pre-existing disease wait.

How long before maternity expenses are covered, often two to four years. It has to be planned for well in advance of needing it.

Whether the insurer settles directly with the hospital instead of reimbursing you later. Cashless works only at network hospitals and still needs pre-authorisation.

How many hospitals offer cashless treatment with this insurer. The count matters less than whether the hospitals you would actually use are in it, which the insurer's own list settles.

Whether a third-party administrator handles claims rather than the insurer directly. It adds a party between you and the insurer, which changes who to contact when a claim stalls.

The time the insurer states for settling a claim. IRDAI requires settlement within a defined window of receiving the last document, and the wording is where the insurer's own commitment is recorded.

How many days of expenses before admission are reimbursed, such as tests and consultations that led to it.

How many days of follow-up expenses after discharge are reimbursed, covering medication and review consultations.

The youngest age the policy can be bought at.

The oldest age at which the policy can be bought. Health cover bought before this age can usually be renewed for life, which is why entry age is worth acting on early.

The age at which cover ends. For term life this is the point the policy stops paying, and choosing it against your dependants' needs matters more than choosing the premium.

Whether a medical examination is required before cover starts. Where it is not, undisclosed conditions are more likely to surface as a dispute at claim time instead.

Until what age the policy can be renewed. Lifelong renewability matters most precisely when cover is hardest to buy fresh, which is at older ages.

How long one policy period runs. Multi-year policies fix the premium for that period and usually carry a discount.

How long premiums are paid for, which can be shorter than the cover period. Limited-pay policies finish paying early while cover continues.

How long after receiving the policy you can cancel it for a refund of premium less expenses. IRDAI mandates a minimum, and it is the window to read the wording properly.

How long after a missed due date the premium can still be paid without losing continuity. Letting it lapse resets the waiting periods you have already served, which is the costly part.

Whether the policy can be moved to another insurer while carrying over the waiting periods already served. IRDAI allows this for health policies at renewal, and it is what stops a switch resetting your cover.

Whether the premium and co-pay depend on the city you live in. Moving from a smaller city to a metro can raise the premium or add a co-pay at renewal.

What the policy never pays for. Reading these is the only way to know what the cover actually is, and the permanent exclusions IRDAI allows are now standardised across insurers.

A link to the full policy wording, the contract that governs every claim. Brochures summarise and simplify; only the wording decides what is paid.

A link to the insurer's brochure. Useful for orientation, but it is a summary and the wording overrides it wherever they differ.

Which version of the policy wording these facts were read from. Insurers revise wordings, so this records exactly which contract was in front of us.