Section 80d caps

When you buy health insurance, the brochure lists a number. When you actually need it, you find out it came with fine print. This article walks through the clauses insurers never put on their homepage.

The three waiting periods you must know

Every retail health policy has three stacking waiting periods: the initial waiting period (30 days after issuance for non-accidental illnesses), the specific illness waiting period (1–2 years for diseases like cataract, hernia, hysterectomy), and the pre-existing disease (PED) waiting period — this is the big one.

1. Pre-existing diseases (PED)

The standard PED waiting is 3 years. "Day 1 PED cover" plans exist, but they price in 30-40% higher. A few insurers — Niva Bupa and Care Health, notably — offer 1-year PED waiting as a rider.

2. Sub-limits and co-pay

Even inside the waiting period, many plans cap payouts. Room rent capped at 1% of sum insured? That's a ₹3,000/day cap on a ₹3L plan — far below the ICU in a Tier-1 city.

"If your policy has a room rent cap, assume everything else — surgeon's fees, ICU, medicines — is capped proportionally too."

How to compare on waiting periods

When comparing plans on Klaro Care, turn on the "PED Day 1" filter to surface plans that waive the waiting. It'll cost more, but it's worth it if you or a covered family member has a condition.