Nobody reads their health insurance policy carefully until they're trying to make a claim. By then, it's too late. We've seen this play out repeatedly. A client gets hospitalised, submits a claim — and discovers their insurer won't pay because of a clause buried on page 12 of a 40-page document. Here are the five most common surprises. 1. Pre-existing conditions have a waiting period If you already have diabetes, hypertension, thyroid issues, or any other chronic condition when you buy the policy, your insurer will typically not cover treatment related to those conditions for the first 2–4 years. This is called a waiting period, and it's standard across almost every health policy in India. What this means: If you buy health insurance after being diagnosed with a condition, you can still buy it — but you'll have to wait before that condition is covered. What to do: Buy health insurance early, before you have any conditions. The younger and healthier you are when you buy, the better. 2. Room rent sub-limits Many affordable health plans have a room rent sub-limit — a cap on how much the insurer will pay per day for your hospital room. For example, a policy might say: "Room rent covered up to 1% of sum insured per day." On a ₹5 Lakh policy, that's ₹5,000/day. In a decent private hospital in Delhi, Chandigarh, or Mumbai, a private room easily costs ₹8,000–12,000/day. You pay the difference. Worse: room rent sub-limits often proportionally reduce other expenses too (surgeon fees, medicines, etc.), meaning the actual impact is much larger than just the room difference. What to do: Choose policies with no room rent sub-limit, or specifically check this clause before buying. 3. Co-payment clauses Some policies — especially those with lower premiums — require you to pay a percentage of every claim. A 20% co-payment on a ₹5 Lakh claim means you're paying ₹1 Lakh out of pocket, no matter what. Senior citizen plans almost universally have co-payment clauses. Some policies for people over 45 also include them. What to do: Avoid co-payment clauses if possible, or factor in the cost before buying on the basis of a lower premium. 4. Specific procedure exclusions Cosmetic surgery, dental treatment, fertility treatments, vision correction (like LASIK), joint replacement (before a certain waiting period), weight loss surgery — these are commonly excluded or subject to specific waiting periods. Mental health treatment is also excluded from many older policies, though IRDAI has mandated coverage in recent years — check if your specific policy complies. What to do: If you anticipate needing any of these, specifically ask about them before buying. 5. Non-allopathic treatments Ayurveda, homeopathy, naturopathy — many policies either exclude these entirely or have a separate, lower sub-limit for AYUSH treatments. This matters if you prefer alternative medicine or want the flexibility to choose. What to do: Look for policies that specifically cover AYUSH treatments if this is relevant to you. The honest summary A ₹5 Lakh policy is not ₹5 Lakh of unconditional coverage. Depending on the insurer and plan, real-world coverage could be significantly less once sub-limits, waiting periods, and exclusions are factored in. This is why we read every policy document before recommending it — and explain every relevant clause to you before you decide. If you want us to review your existing policy and flag any coverage gaps, reach out to us. It's free, and it might save you a very unpleasant surprise down the line.