Check for Disease Wise Sub-limits
10 lakh cover at a premium of just ₹6,000 a year. That’s the offer in front of you. But instead of jumping for joy, you’re suspecting something already. This guy is offering you a price that nobody else is matching. You are sceptical and you ponder for a while. But you go ahead with his recommendation anyway since he is a family friend of sorts.
And then, one day, your worst fears come true. A slipped disk forces you into the operation theatre. You require extensive treatment. The final bill is hefty. ₹4,36,000 — inclusive of all costs. But despite your 10 lakh cover the insurer tells you they can only cover ₹2,00,000. You are outraged and you press for a clarification.
Eventually, they tell you your policy has disease wise sub-limits. Meaning, they have a cap on the total coverage amount specifically mandated for certain diseases.
For instance, cardiovascular diseases — They only pay ₹2,50,000
For knee replacements —₹2,75,000
For other major operations like the one you just had — ₹2,00,000
And finally, you realize how the company could offer you a ₹10 Lakh cover at such a low premium. They probably never end up paying the full cover amount in most cases.