How to read a policy document: the 6 things that decide your claim

Almost nobody reads their policy document. It's long, densely written and arrives after you've already bought. But you don't need to read all of it, a handful of sections decide virtually every claim outcome. Here's where to look.

1. The schedule

The first page or two, and the most important. It states your sum insured, policy period, who is covered, and any specific exclusions or loadings applied to you personally. Check the names, dates of birth and nominee details are correct, errors here cause real delays later.

2. Waiting periods

Find the initial waiting period, the pre-existing disease waiting period, and any list of specific illnesses with their own waits. Note the actual dates these expire. This single section explains most 'my claim was rejected' stories.

3. Exclusions

The list of what the policy will never pay for. It's usually shorter than people fear, and reading it once removes almost all future surprises. Pay attention to anything relating to activities or treatments you might realistically encounter.

4. Limits and sub-limits

• Room rent capping, and whether proportionate deduction applies to the rest of the bill.
• Co-payment, the share of each claim you pay yourself.
• Disease-specific or procedure-specific caps, which often apply to common surgeries.

5. The claims procedure

How and within what timeframe you must intimate a claim, what documents are required, and where to send them. Knowing the intimation window in advance is worth more than any other preparation.

6. The free-look clause

You typically have 15 to 30 days after receiving the policy to read it and return it for a refund if it isn't what you expected. This is the one window where reading the document can still change your decision, which is exactly why it's worth doing then.

We go through these six sections with every customer at the point of buying, in plain language. If you already hold a policy and have never read it, send it across and we'll tell you what it actually says.

This guide is general information to help you understand your options, not financial or tax advice. Please consider your own circumstances and consult a qualified professional where needed.