Health Insurance Questionnaire — Sum Insured & Coverage

Instructions: Tick the option that applies to you.
(Yes = 2 | Not Sure = 1 | No = 0 → scoring optional at the end)

Section 1: Sum Insured Adequacy

· Is your sum insured high enough for a single major hospitalization in your city (₹5–10 lakh in Tier-2/3 cities, ₹15–25 lakh in metros)?
☐ Yes ☐ No ☐ Not Sure

· Is your cover amount sufficient to handle multiple hospitalizations in the same year (e.g., two family members falling ill)?
☐ Yes ☐ No ☐ Not Sure

· If a family member needed cancer treatment or a heart surgery (₹10–25 lakh typical cost), would your cover be enough?
☐ Yes ☐ No ☐ Not Sure

· Do you have a super top-up / additional cover to supplement your base policy?
☐ Yes ☐ No ☐ Not Sure

Section 2: Coverage Breadth

· Does your policy cover ICU charges fully (no daily caps)?
☐ Yes ☐ No ☐ Not Sure

· Are daycare procedures like chemo, dialysis, cataract, and angioplasty included?
☐ Yes ☐ No ☐ Not Sure

· Are pre-hospitalization (≥30 days) and post-hospitalization (≥60 days) expenses covered?
☐ Yes ☐ No ☐ Not Sure

· Does the policy cover organ transplant (including donor costs)?
☐ Yes ☐ No ☐ Not Sure

· Does it include modern treatments like robotic surgery, advanced cancer therapy, or genetic tests?
☐ Yes ☐ No ☐ Not Sure

· Are emergency ambulance charges included?
☐ Yes ☐ No ☐ Not Sure

Section 3: Special Benefits

· Does the plan include maternity & newborn coverage (if relevant to your family)?
☐ Yes ☐ No ☐ Not Sure

· Does it cover critical illnesses (stroke, kidney failure, liver transplant) without sub-limits?
☐ Yes ☐ No ☐ Not Sure

· Does it provide mental health coverage (hospitalization, counselling)?
☐ Yes ☐ No ☐ Not Sure

· Does your policy cover domiciliary treatment (at-home hospitalization) if beds are unavailable?
☐ Yes ☐ No ☐ Not Sure

· Does it offer international coverage for emergency medical treatment abroad?
☐ Yes ☐ No ☐ Not Sure

Section 4: Hidden Limits & Restrictions

· Are there no strict room rent limits (like 1% of sum insured per day)?
☐ Yes ☐ No ☐ Not Sure

· Are there no disease-specific sub-limits (e.g., cataract ₹50k max)?
☐ Yes ☐ No ☐ Not Sure

· Are co-pay requirements (your share of the bill) low or absent?
☐ Yes ☐ No ☐ Not Sure

· Does the policy include a restoration benefit (refills sum insured if used up)?
☐ Yes ☐ No ☐ Not Sure

· Are AYUSH treatments (Ayurveda, Homeopathy, etc.) covered if you choose them?
☐ Yes ☐ No ☐ Not Sure

16 - 20 Points Strong Cover (Well Structured and Covers most Critical Risks).

11 - 15 Points Moderate Cover (Some Gaps exist, consider upgrading).

6 - 10 Points Weak Cover (High Risk of Out of Pocket Expenses).

0 - 5 Points Barely Protected (Immediate review and Upgrade Required).