Know what your policy may actually pay.
Build a claim scenario from the clauses in your policy schedule or Customer Information Sheet. See insurer payments, family out-of-pocket exposure and every deduction in rupees.
Stress-test the same policy
One policy. Three hospital-bill scenarios.
The claim assumptions change while your policy limits remain fixed. This exposes where base cover, restoration or the super top-up begins to matter.
What to verify
Policy signals from this scenario
- Enter your policy details to generate clause-specific checks.
How the reality check works
Turn a complicated policy into a claim waterfall
A health-policy brochure may highlight a large sum insured, but a hospital bill is settled through several gates. This tool begins with the total bill, removes the non-payable amount you enter, estimates a room-linked reduction when the selected room exceeds eligibility, and applies any treatment sub-limit. It then shows the deductible and co-payment before testing the remaining amount against base cover, restoration that is genuinely available for this claim, and a super top-up.
The result is not one unexplained score. The family out-of-pocket estimate reconciles with the visible deduction waterfall, so you can identify which clause creates the largest exposure. Change one field at a time to test a proposed policy, your current policy and a renewal offer on comparable assumptions.
Read the result carefully
Cover amount and claim usability are different
A policy can have enough headline cover yet still leave a meaningful family contribution because some expenses are inadmissible or cost sharing applies. Room-rent proportional deduction is especially policy-dependent: enter only the charges that the wording links to room eligibility. A zero treatment sub-limit means the model does not impose one; it does not mean every treatment is covered.
Restoration should be counted only after checking whether it can be used by the same insured person, for a related illness, or before the base cover is completely exhausted. The super top-up shown here is a single-claim illustration. If your product uses an aggregate annual deductible, compare the insurer’s calculation with all admissible claims already made during that policy year.
Before a purchase or renewal
Five questions worth asking in rupees
- What would we personally fund on a ₹5 lakh, ₹10 lakh and ₹15 lakh claim?
- Can any member exhaust a shared floater before another family member needs it?
- Which room category is eligible, and which associated charges can be reduced?
- When exactly does restoration activate, and who can use it?
- Does the top-up use a single-claim or aggregate deductible?
Use the latest policy schedule, Customer Information Sheet and full wording. Do not enter diagnosis details or other sensitive health information into a general calculator.
Questions & answers
Health policy reality check FAQs
Does this calculator predict the final claim settlement? +
No. It explains the possible rupee effect of the clauses and amounts you enter. The insurer determines admissibility and settlement from the issued policy, medical records, bills and claim review.
What should I enter as non-payable items? +
Use items that the hospital estimate or policy identifies as excluded, non-medical or otherwise inadmissible. Do not use a generic percentage when an itemised estimate is available.
Why can a room-rent limit affect more than the room charge? +
Some policies may proportionately reduce specified room-linked expenses when the chosen room exceeds eligibility. The exact expenses and method are policy-specific, so confirm the wording before relying on this estimate.
When should restoration cover be entered? +
Enter it only when the restoration or recharge is available for the selected member and claim. Related illness, exhaustion conditions, earlier claims and same-person restrictions may affect availability.
How does the super top-up calculation work? +
This one-claim model applies the entered deductible threshold and then uses the super top-up only against an eligible amount left above the base or restored cover. Aggregate deductibles require year-to-date admissible claims to be checked separately.
Can I save a policy scenario without uploading medical documents? +
Yes. WhatsApp sign-in saves only the numerical inputs and displayed result. This version does not request diagnosis details, bills or policy PDFs.