Why does a ₹10L health insurance policy only cover ₹4.2L?

Co-pay deductions (10-20%), room rent sub-limits (proportional reduction), disease-specific caps (50% of sum insured), consumables exclusions, and waiting periods combine to reduce your effective coverage by 40-60%. Use our Insurance Coverage Calculator to see your policy's real number.

What is room rent sub-limit in health insurance?

Room rent sub-limit caps the daily room charge your insurer will cover (e.g., ₹8,000/day). If your actual room costs ₹12,000/day, the insurer applies a proportional reduction (8/12 = 66.7%) to your entire claim — not just the room cost. This is the biggest hidden reducer in health insurance.

Is co-pay health insurance worth it?

Co-pay plans cost 15-25% less in premium but you pay 10-20% of every claim from pocket. For healthy young individuals, the premium savings may outweigh the co-pay risk. For families or older adults, no-copay is strongly recommended.

The honest number on insurance

Your ₹10L health insurance
actually covers ₹4.2L.

PolicyBazaar compares premiums. We compare what your policy actually pays. Co-pay, sub-limits, waiting periods — the full truth.

Honest guides

10+

Insurers ranked

₹0

Always free

❤️

Health insurance

₹10L policy

₹10,00,000

₹4,20,000

🛡️

Term insurance

₹1Cr cover

₹1,00,00,000

₹92,00,000

🏥

Room rent trap

₹5L surgery

₹5,00,000

₹3,33,000

What your policy pays

Proportional reduction

👨‍👩‍👧

Insurance for Parents

60+ age guide

Typical ₹10L health policy — what you actually get

₹4.2L usable

₹5.8L lost to fine print

20% co-pay on claims above ₹2L-₹1,60,000

Room rent cap: ₹8,000/day (ICU ₹16K)-₹2,40,000

Disease-specific sub-limits-₹80,000

Consumables not covered-₹40,000

Pre-existing: 3-year waiting period-₹60,000

Effective usable coverage (year 1)₹4,20,000

Based on average policy terms across top 5 insurers.

Insurance guides

Health · 7 min

Your ₹10L health policy covers ₹4.2L — the full breakdown

Co-pay, room rent sub-limits, disease caps, consumable exclusions, and waiting periods explained.

Read →

Rankings · 6 min

Claim settlement ratios 2026: which insurer actually pays?

Every major insurer ranked by percentage of claims approved.

Read →

Term life · 5 min

Term insurance: ₹1Cr cover is actually worth ₹92L

Claim settlement ratio x sum insured = what your family gets.

Read →

Warning · 5 min

Room rent trap: how ₹8K sub-limit turns ₹5L surgery into ₹3L

Proportional reduction applies to ALL charges, not just room cost.

Read →

Guide · 6 min

Health insurance for parents: what to check before buying

Pre-existing waiting, co-pay, and network hospitals for 55+ age group.

Read →

Analysis · 5 min

Co-pay vs no co-pay: is the premium difference worth it?

20% co-pay saves ₹3K/year but costs ₹1.6L in one hospitalization.

Read →

Frequently asked questions

Does my ₹10L policy really only cover ₹4.2L?

On average, yes. Co-pay, room rent sub-limits, disease caps, and waiting periods reduce your usable coverage to 40-50% of the headline sum insured in year 1.

Which health insurer has the best claim settlement?

New India Assurance (95.2%), Star Health (89.4%), and HDFC Ergo (88.7%) consistently rank highest. Avoid insurers below 85%.

Should I take a policy with co-pay?

Generally no. The ₹3-5K annual premium saving is wiped out by one hospitalization where you pay 20% from pocket (₹1-3L).

How do I buy insurance for parents above 60?

Buy early (55-58), choose no co-pay, check network hospitals in their city, and consider a base + super top-up combo to save 30-40% on premium.