Your policy covers cancer. But only ₹5L of it. You need ₹12L.
Welcome to the gap nobody sees coming.
Meet Neha. 48. Mumbai. School principal, ₹12L household income. Bought a ₹15L health policy because "cancer is covered."
Last month, she was diagnosed with breast cancer. Stage 2. Treatable, but expensive.
Chemotherapy: ₹6L. Surgery: ₹4L. Radiation: ₹2L. Total: ₹12L.
Her policy covers ₹15L. Should be fine, right?
Wrong.
Her policy has a cancer sub-limit: ₹5L. That's all the insurer will pay for cancer treatment, even though her total SI is ₹15L.
Out-of-pocket: ₹7L. On a ₹12L income, that's 58% of her annual salary.
Neha thought she was protected. She wasn't. Nobody explained that "covered" doesn't mean "fully covered."
The 5 Gaps That Hurt Most
1. Disease-Specific Sub-Limits
Your policy says "cancer covered." Buried on page 47: "Cancer treatment sub-limit: ₹5L." Even with ₹20L coverage, cancer gets only ₹5L. Everything beyond that is out-of-pocket.
2. Room Rent Caps
Your policy covers ₹10L, but room rent is capped at ₹3,500/day while Mumbai hospitals charge ₹5,500/day. Daily gap: ₹2,000. A 10-day stay: ₹20,000 out-of-pocket.
3. Missing Riders
Your base policy covers hospitalization. Maternity, critical illness, personal accident? Those aren't gaps — they're coverage you might need that simply isn't there.
4. Waiting Periods
You just bought a policy. Your father needs cardiac care next month. Claim denied — waiting period. Most policies have a 30-day general wait and a 24-36 month pre-existing disease wait.
5. OPD Exclusions
Your policy covers hospitalization. Routine diabetes checkups? Not covered. Annual cost: ₹15-20K out-of-pocket.
How to Check YOUR Policy
Step 1: Find your policy document. Download it from your insurer's website or dig it out of your email.
Step 2: Search for these terms:
- "Sub-limit" or "disease-specific limit"
- "Room rent" or "accommodation"
- "Waiting period"
- "OPD" or "out-patient"
- "Rider" or "add-on"
Neha could have caught her cancer sub-limit before the diagnosis. The clause was always there — in fine print nobody translated for her.
Generic advice ends here. These five gaps are real, but which ones apply to you is written in YOUR policy — go check what it actually says.