If you have never bought health insurance, every comparison site will sell you a plan in six minutes. Don't. Twelve questions answered up-front will save you from the four most common regrets people arrive at 36 months into their first policy.

The regrets are always the same: room-rent cap that makes the good hospitals unaffordable, a co-pay clause nobody explained, parents who cannot be added, or a plan that looked cheap until a claim arrived. None of them are hard to avoid — they just require you to think for 30 minutes before buying.

The 12 questions to answer before you buy

1. What is your current household income? The rule of thumb for minimum sum assured is five times your monthly income, with a floor of ₹5L. A family earning ₹80,000/month should be looking at ₹4L minimum — the floor pushes them to ₹5L. At ₹2L/month, ₹10L is the right floor.
2. Any pre-existing conditions in the household? Conditions in the household determine which insurer is likely to accept you, at what loading, and how long the PED waiting will be. This answer shapes your shortlist.
3. Will the plan cover dependent parents? Adding parents to a family floater changes the premium substantially — especially if they are over 60. Some plans do not allow parent inclusion at all. Decide this before you start comparing plans.
4. What is the room rent at your nearest two good hospitals? Look up the actual private ward rate. If you are in a tier-1 city, ₹5,000–₹8,000/day is common. A plan with a 1% room-rent cap on a ₹5L policy gives you ₹500/day. That is the maths you need to do.
5. Do you want OPD cover? Outpatient cover (consultations, diagnostics, medication) is an add-on that typically costs 25–35% more on premium. For young, healthy households it may not be worth it. For households with chronic conditions requiring regular monitoring, it can pay for itself.
6. Do you need maternity cover? Maternity adds a 2-year waiting period and a sub-limit (typically ₹50,000–₹1L). Buy it before you need it. If maternity is a 3-year-out consideration, start the waiting period now.
7. Day-care and AYUSH? Modern plans include day-care procedures (600+ listed procedures that do not require overnight admission) and AYUSH treatments. Older or cheaper plans may not. Verify both are present.
8. Is there a cumulative bonus? Plans that add 5–50% to the sum assured each claim-free year are worth choosing over otherwise equivalent plans that do not. Over 5 claim-free years, a 10%/year cumulative bonus turns ₹5L into ₹7.5L coverage.
9. Is there a restoration benefit? If the sum assured is exhausted in a single admission, a restoration benefit refills it for the rest of the policy year. Read the trigger conditions carefully — some restore only after full exhaustion, others restore after any claim.
10. What is the network hospital count and cashless ratio? Look for more than 10,000 hospitals in the network. Look for a cashless settlement ratio above 85%. Check that your two nearest hospitals of choice are in the network before buying.
11. What is the claim settlement ratio? Look at the ratio over the past three years, not just the most recent year. A good benchmark is above 95% consistently. One good year followed by two average years is not a trend.
12. Who is your advisor? If the answer is “a comparison website that sold me the plan in six minutes,” you are not the customer — you are the underwriting product. An advisor who knows your household profile will get you to the right plan faster than any algorithm.

Sum assured: how much, why

The 5x monthly income rule of thumb works as a starting point. It breaks down for very high earners (₹5L sum assured is inadequate for a family in a metro) and for households with chronic conditions (higher sum assured absorbs the recurring hospitalisation costs better).

A more useful framing: think about the cost of a 15-day ICU admission at your preferred hospital. That is your minimum sum assured. Most tier-1 city ICU admissions for a serious event will cost ₹5–15L. Price your cover to the actual risk, not to a formula.

Individual vs family floater

A family floater gives the whole family one shared pool of cover. It is cheaper per person but vulnerable to a single large claim depleting the pool for the year. Individual plans are more expensive but each member has independent cover.

The practical answer for most households: individual plans for working adults, a separate senior citizen plan for parents above 60. Family floaters work best when all members are young and healthy with low claim risk.

The four traps to avoid

The WatchOut section below covers the four most impactful structural traps in first-time health plans. These are not rare edge cases — they are standard features of commonly sold plans that trip up buyers who did not read the policy.

Room rent caps, co-pay clauses, restoration triggers, and online-only support trade-offs are all worth understanding before you sign. The difference between a plan that works when you need it and one that disappoints is usually one of these four.

Insurance is a contract between you and the insurer. This article is general information only — speak to a licensed advisor about your specific situation before making decisions.