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0 Cr
Claims rejected in India last year
0 L
Indian families denied claims annually
1 in 3
Policies hide sub-limits in fine print
0%
Average claim rejection rate, India

Three things your insurance company hopes you never read.

Hidden sub-limits that gut your claim, clauses that break IRDAI law, and a settlement record they don't advertise. Every upload becomes a full report like the one below.

!
Hidden sub-limitsCaps that quietly shrink your whole claim
§
Illegal clausesWaiting periods longer than IRDAI allows
%
Settlement riskYour insurer's real claim record
www.findecode.app/report
Decode complete · 38 pages analysed

Arogya Family Floater — Comprehensive

Health insurance · family floater · Decoded against IRDAI Master Circular (May 2024) & market benchmarks

Insurer
Arogya Health Insurance
Sum Insured
₹5 Lakh
Issues Found
6
Report Date
14 Jun 2026
0
out of 100
Below Average

The verdict

A 1% room-rent cap and a 20% co-pay can quietly shrink this ₹5 lakh cover to barely ₹2 lakh of real protection.
3 Critical
2 Moderate
1 Info
How this report was built

Not a summary. A structured decode

Run through a purpose-built India health-insurance engine, not a generic chatbot. It checks against:

IRDAI Master Circular 2024
Every clause checked against the binding regulation
40+ clause-level checks
Sub-limits, co-pays, waiting periods, exclusions
Proportionate-deduction math
Models real Tier-1 hospital costs vs your caps
Market benchmark dataset
What strong policies actually offer, per dimension
Claim-settlement data
Your insurer's track record, with caveats
Plain-English translation
Every clause decoded for a non-expert
⚠ Your real exposure · worst realistic case
On a ₹4,00,000 hospitalization, choosing a ₹10,000/day Tier-1 private room (above your ₹5,000 cap) halves the eligible bill via proportionate deduction, and a 20% co-pay is then applied on what remains. The insurer pays ₹1,60,000 — you cover ₹2,40,000.
₹2,40,000
OUT OF POCKET · ON A ₹5 Lakh COVER
How you compare

Your policy vs the India standard

● ideal · ▲ your policy · hover any row for detail.

Room Rent LimitCap on daily room charge
Bottom 30%
Your room is capped at ₹5,000/day. Tier-1 private rooms run ₹8,000–12,000, which triggers proportionate deduction on the entire bill.
Co-PaymentYour share of every claim
20% — high
You pay 20% of every approved claim out of pocket, on top of all other deductions.
Pre-Existing Disease WaitBefore old conditions are covered
Non-compliant
IRDAI's 2024 Master Circular caps the PED waiting period at 36 months. Yours is 48.
No-Claim BonusCover added for claim-free years
Average at best
Strong plans add 50% of your sum insured per claim-free year. Yours adds only 10%.
Restoration BenefitRefilling cover after it runs out
Limited
Your cover only restores for a different illness, once a year — a second claim for the same condition isn't refilled.
Strong policies
Acceptable
Concerning
Your policy
The flaws, ranked by what they cost you

6 findings

#1criticalRoom Rent · Proportionate Deduction
A 1% room-rent cap shrinks every part of your bill — not just the room
Your room is capped at ₹5,000/day, but Tier-1 private rooms cost ₹8,000–12,000. When you exceed the cap, the insurer pays the SAME reduced proportion (50% here) on your whole bill — surgery, ICU, medicines included. On a ₹4 lakh claim that alone hands you roughly ₹2 lakh of the bill.
Your policy
1% of SI · ₹5,000/day
A strong policy
No room cap
Section 4.2 (a)
Room rent shall not exceed 1% of the Sum Insured per day; if exceeded, all associated charges shall be paid proportionately.
?
Smart move:Can I upgrade to a variant with no room-rent cap, and what's the premium difference?
#2criticalPre-Existing Disease · Non-Compliant
Your 48-month wait for pre-existing conditions breaks IRDAI law
Diabetes, hypertension and other pre-existing conditions aren't covered for 48 months. The IRDAI Master Circular (May 2024) caps this at 36 months — so this clause is non-compliant and can be challenged.
Your policy
48 months
A strong policy
≤ 36 months
Section 5.1
Any pre-existing disease shall be excluded until 48 months of continuous coverage have elapsed.
?
Smart move:IRDAI caps PED waiting at 36 months — will you correct this clause to comply?
#3criticalCo-Payment · Mandatory 20%
A mandatory 20% co-pay applies to every single claim
On top of every other deduction, you pay 20% of the approved amount yourself, with no option to remove it. After the room-rent deduction, this co-pay stacks on what's left — compounding your out-of-pocket cost on every hospitalization.
Your policy
20%, no opt-out
A strong policy
0% co-pay
Section 4.5
The insured shall bear 20% of each and every admissible claim.
?
Smart move:Is there a variant of this plan with no co-pay, and what would it cost?
#4moderateDisease Sub-Limits
Common surgeries are capped far below their real cost
Cataract is capped at ₹40,000 and knee replacement at ₹1,60,000 — but a single knee replacement in a Tier-1 hospital often runs ₹2.5–3.5 lakh. The gap is yours to pay.
Your policy
Cataract ₹40k · Knee ₹1.6L
A strong policy
No disease-wise sub-limits
?
Smart move:Can the disease-wise sub-limits be removed or raised on renewal?
Coverage map

What's covered, capped, and excluded

Covered
  • In-patient hospitalization
  • Pre & post hospitalization (30/60 days)
  • Day-care procedures
  • Ambulance (up to ₹2,000)
  • AYUSH treatment
Capped / sub-limited
  • Room rent — 1% of SI/day
  • Cataract — ₹40,000
  • Knee replacement — ₹1,60,000
  • ICU — 2% of SI/day
Excluded
  • Pre-existing disease (first 48 months)
  • OPD & diagnostics
  • Maternity & newborn
  • Mental-health hospitalization beyond limits
Future outlook

Will this cover keep up with you?

At ~14% medical inflation, a serious hospitalization costing ~₹8.0 L today rises fast; a flat sum insured doesn't. Illustrative.

Today
₹8.0 L
est. major-claim cost
Exceeds your ₹5 Lakh cover
In 5 years
₹15.4 L
est. major-claim cost
Exceeds your ₹5 Lakh cover
In 10 years
₹29.7 L
est. major-claim cost
Exceeds your ₹5 Lakh cover

A single major hospitalization could already exceed this cover today.

What's missing

Benefits strong policies include that yours doesn't

!
OPD & diagnostics coverDoctor visits, tests and pharmacy aren't covered — a recurring annual cost most strong plans now include.
!
Maternity benefitNo maternity or newborn cover, even with a 9–36 month waiting period option.
!
No room-rent-cap optionThere's no variant that removes the room cap — the single biggest driver of your out-of-pocket risk.
!
Air ambulanceEmergency air evacuation isn't covered, unlike most comprehensive plans in this band.
This analysis is unbiased. FinDecode has no insurance to sell and earns nothing from your choice. We just decode what you have.

This is a sample FinDecode report shown for illustration only. Your report is generated entirely from your own uploaded policy. Educational information, not financial advice.

Your insurance company has read this policythousands of times.

You haven't.

They wrote the fine print to win. One 60-second scan puts you on the other side of the table, so you know exactly what to question, refuse, and renegotiate before you pay a rupee.

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Step 02 · Decode
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Every line checked against the IRDAI Master Circular, insurer-specific patterns, and three years of claim settlement data. Sixty seconds, end to end.
Step 03 · Decide
Plain-English findings
Red, yellow, and green flags. The rupees at stake on each one. The exact questions to raise with your insurer. And your full report, downloadable as a PDF, instantly.

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Your questions, answered.

Is this legal advice? +
No. We're an AI analysis tool: we tell you what's in your document and what IRDAI regulations say. For disputes, contact a lawyer or the Insurance Ombudsman. We surface the facts; you decide what to do with them.
What happens to my PDF? +
Encrypted in transit with bank-grade TLS. Used only to generate your report, then deleted as soon as your full report is generated, and removed automatically otherwise. We never sell or share your documents, and we never train AI models on them.
Why not just use ChatGPT? +
You can ask a chatbot, but you'll get generic guesses, not a defensible report. FinDecode runs your policy through a proprietary engine that scores 50+ clause-level signals against India's insurance regulations, real claim-settlement data, and our benchmark library of what strong policies actually offer. We don't reveal the exact method (that's what makes it impossible to copy), but it's why you get precise rupee figures, citations, and an instantly downloadable report a general AI can't produce.
Buying, renewing, or already insured? +
Works for all three. Buying? Decode the fine print before you commit. Already covered? Find out exactly what you can claim, what to renegotiate at renewal, and where a clause breaks IRDAI rules. Most people decode a policy they already hold, and wish they'd done it sooner.
Which policies does this work on? +
Health, term life, motor, travel, and home insurance: any policy issued in India by an IRDAI-registered insurer. Loan agreements, credit card terms, and NBFC contracts come next.