Health Insurance Buying Guide 2026: Waiting Period, Cashless Rules, Moratorium & Delhi Checklist

A good health-insurance policy should be judged by what happens at claim time, not only by the annual premium. For families in Delhi NCR, the key checks are hospital network, room-rent restrictions, co-payment, sub-limits, waiting periods, restoration rules, claim process and how much cover remains after one large hospitalisation.

How much health cover should a Delhi family buy?

IRDAI does not prescribe a single “correct” sum insured for every family. The right amount depends on age, existing illnesses, hospital preference, room category, employer cover and the family's ability to absorb a large medical bill.

For Delhi NCR, compare the likely cost of treatment at the hospitals you would actually use. A practical structure can be a meaningful base policy plus a super top-up, but the deductible and policy wording must be understood before purchase.

Family floater vs individual policy

Waiting period and pre-existing disease rules

IRDAI’s current health-insurance guidance states that waiting periods, including pre-existing disease waiting periods, may be up to 36 months from commencement of the policy.

This does not mean every policy uses the maximum. Compare the actual policy wording. If two policies are otherwise similar, a shorter waiting period can be valuable for a person with declared medical history.

Moratorium: what 60 continuous months means

After completion of 60 continuous months of coverage, including applicable portability and migration credits, the policy and claim generally cannot be contested on grounds of non-disclosure or misrepresentation except in cases of established fraud.

Where the sum insured is later enhanced, the 60-month period applies separately to the enhanced portion from the date of enhancement.

Cashless claim timelines

IRDAI's current health-insurance guidance gives specific service timelines:

These timelines are important during an emergency, but they do not replace the need to confirm that the hospital is in the insurer's active cashless network and that the treatment is covered by the policy.

Hospital network: the Delhi-specific check

Do not compare insurers only by the headline number of network hospitals across India. Make a short list of hospitals you would realistically use near home and work, then verify their cashless status directly with the insurer before purchase and again before a planned admission.

Also check whether major hospitals you prefer have been removed from or added to the network since the last renewal. Network arrangements can change.

Room-rent limits and proportional deduction

A room-rent cap can materially increase out-of-pocket cost. If the policy allows only a lower room category and the insured chooses a higher room, some policies may apply proportionate deductions to associated hospital charges. A plan with no room-rent sub-limit can therefore be more useful than a cheaper policy with a restrictive room cap.

Co-payment and sub-limits

Co-payment means the policyholder bears a specified percentage of an admissible claim. A 20% co-pay on a ₹5 lakh admissible bill means ₹1 lakh is borne by the insured.

Sub-limits cap specific treatments, procedures or expenses. Review cataract, joint replacement, ambulance, modern treatments and disease-specific limits where applicable.

Restoration benefit

Restoration can refill the sum insured after a claim, but the wording matters. Check whether restoration applies:

• after partial or complete exhaustion;
• for the same illness or only unrelated illnesses;
• once or multiple times in a year;
• immediately or only after the base cover is exhausted.

Portability and migration

IRDAI allows portability/migration credits for items such as sum insured and waiting-period credit, subject to the applicable rules. If you are unhappy with your current insurer, do not simply let the old policy lapse and buy a new one without checking whether accumulated waiting-period credits can be preserved.

Section 80D tax deduction

Health-insurance premium may qualify for deduction under the applicable income-tax provisions where the taxpayer is eligible and uses the tax regime that permits the deduction. The tax benefit should be treated as secondary; the policy should first be selected for claim protection.

Practical buying checklist

1. Write down the hospitals you would actually use.
2. Verify current cashless empanelment.
3. Check room-rent cap and ICU cap.
4. Check mandatory co-pay.
5. Read disease/procedure sub-limits.
6. Check PED and specific waiting periods.
7. Review restoration wording.
8. Check consumables/non-medical expense treatment.
9. Compare base cover and super top-up options.
10. Disclose medical history completely and accurately.
11. Read the Customer Information Sheet and full policy wording before paying.

Common mistakes

• Choosing the cheapest premium without checking claim restrictions.
• Adding senior parents to a small floater without modelling claim impact.
• Assuming every nearby hospital is cashless.
• Not disclosing a prior diagnosis or medication.
• Confusing restoration benefit with unlimited cover.
• Ignoring co-pay and room-rent restrictions.

Frequently asked questions

Official references

• IRDAI — Health Department FAQs and service timelines
• IRDAI — Master Circular on Health Insurance Business