Insurance · Health cover
Health Insurance
Pays for hospitalization bills — pre, during, and post-treatment. ₹5L-₹50L cover for an Indian family of 4 typically costs ₹15K-₹40K/year. With medical inflation at 14%/year, even a basic ICU stay can wipe out 5+ years of savings without insurance. Buy before age 40 to lock in low premiums + skip pre-existing waiting periods.
Who needs this
Every Indian. Even if your employer provides cover, supplement with an individual plan that you keep through job changes. Critical illness + super top-up are essential add-ons after age 40.
Key decisions
- Q1
How much cover for a family of 4?
Tier-1 city: ₹10L base + ₹50L super top-up (deductible ₹10L). Tier-2/3: ₹5L base + ₹25L super top-up. Total premium typically ₹20-30K/year.
- Q2
Floater vs individual?
Family floater for nuclear family (1 sum insured shared). Individual for senior parents (their claim doesn't reduce your kids' cover).
- Q3
Room rent capping — does it matter?
Yes — heavily. Pick a plan with NO capping or single private AC room. Sub-limits can shrink your effective cover by 30-40%.
- Q4
Restoration benefit needed?
Yes. After a major claim, restoration restores your sum insured for unrelated claims in the same year. Standard now in most plans.
Top insurers ranked by claim settlement
Health Insurance — Claim Settlement Ratio
Source: IRDAI Annual Report 2024-25 · published values
- HDFC Ergobest95.35%
- Niva Bupa91.84%
- Star Health90.51%
- Care Health88.06%
- ICICI Lombard85.26%
- HDFC Ergo:Optima Secure — strongest base plan + restoration + no room-rent cap.
- Star Health:Comprehensive plan — broadest network, fastest cashless approval.
- Niva Bupa:ReAssure — strong restoration; good for families with children.
- Care Health:Care Plus — competitive premium; reasonable network.
- ICICI Lombard:Complete Health Insurance — strong urban network; bank-distribution advantage.
IRDAI rules + scheme specifics
- IRDAI standard 'Arogya Sanjeevani' policy — minimum benchmark; most insurers offer it.
- Pre-existing diseases (PED): typically 2-4 year waiting period.
- Maternity waiting period: 9-36 months depending on plan.
- Cashless treatment: only at network hospitals; check before admission.
- Claim settlement: 30-day TAT is IRDAI-mandated for non-PED claims.
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