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- High sum insured options at affordable premiums
- Cashless treatment across a wide network of hospitals
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Why Health Insurance Matters When You Need It Most?
Have you ever received a call that a loved one has been hospitalised, leaving you worried about their recovery while wondering how you will manage the medical expenses?
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Choose a Hospital without Worrying About the Cost
When a family member needs hospitalisation, the first concern should be getting them the right care, not figuring out how to arrange the entire hospital bill. A health insurance policy with cashless treatment can help you access treatment at a network hospital without paying the approved amount upfront. IRDAI states that under a cashless facility, the insurer or TPA directly pays the network hospital for covered treatment to the extent pre-authorisation is approved. -
Save Lakhs of Rupees for a Treatment
A major hospitalisation can put considerable pressure on household savings, particularly when treatment involves surgery, specialised care or a longer hospital stay. Health insurance covers eligible medical expenses up to the policy's sum insured and applicable limits, helping you avoid paying the entire cost yourself.
The scale of hospitalisation expenses can be significant. According to the National Statistical Office's 75th Round survey, the average medical expenditure per hospitalisation was Rs 16,676 in rural India and Rs 26,475 in urban India. For private hospitals, the average was Rs 27,347 in rural areas and Rs 38,822 in urban areas.
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Get Treatment without Having to Arrange Immediate Funds
A medical emergency can leave little time to arrange a large amount of money. Cashless treatment can reduce this immediate financial pressure when treatment is taken at an eligible network hospital and the claim receives the required approval.
However, cashless does not mean every expense is automatically covered. Costs that fall outside the policy, exceed applicable limits or are not approved may still have to be paid by the policyholder.
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Support for Long-Term Health Conditions
Healthcare expenses do not always end when a patient leaves the hospital. Some health conditions may require repeated consultations, diagnostic tests, treatment or follow-up care. Depending on the policy, health insurance may cover eligible pre- and post-hospitalisation expenses, subject to specified limits, waiting periods and other policy conditions.
This can be particularly useful when medical expenses continue over time rather than coming from one hospital bill.
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Manage the Rising Medical Costs
The cost of hospitalisation can become difficult to manage when a medical emergency requires private healthcare or specialised treatment. NSO data shows that average out-of-pocket expenditure for a hospitalisation was Rs 15,937 in rural India and Rs 22,031 in urban India. At private hospitals, the average out-of-pocket expenditure was Rs 26,157 in rural areas and Rs 32,047 in urban areas.
Having adequate health insurance can help reduce the financial impact of eligible medical expenses and protect savings that may otherwise be used for an unexpected hospital bill.
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Tax Benefits
Health insurance can also provide a tax benefit under Section 80D of the Income Tax Act, subject to applicable conditions. For AY 2026–27, the Income Tax Department states that the deduction for premiums paid for self, spouse or dependent children is up to Rs 25,000, or Rs 50,000 where the relevant person is a senior citizen. A separate limit of Rs 25,000 applies to premiums paid for parents, increasing to Rs 50,000 if the parent is a senior citizen. The Rs 5,000 preventive health check-up benefit is included within the applicable limit.
Buying health insurance early also means lower premiums and shorter waiting periods.
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How much health insurance coverage do you need?
Buying health insurance is just the beginning. It is just as important to choose a sum insured that truly meets your needs. Many people only find out their coverage is too low when they get a big hospital bill.
For example, imagine you buy a health insurance plan with a Rs. 5 lakh sum insured for your father. If he needs bypass surgery and the hospital bill is Rs. 7.5 lakh, your policy will cover most of the cost, but you will still have to pay the remaining Rs. 2.5 lakh yourself. This shows why it is important to choose the right coverage amount.
The best health insurance coverage depends on your own healthcare needs, finances, and possible future medical costs. When choosing your sum insured, think about these factors:
- Your city of residence (Tier 1, Tier 2, or Tier 3)
- Your age and life stage
- Existing medical conditions
- Expected future healthcare costs and medical inflation
- The type of policy you are buying (individual or family floater)
Health insurance coverage based on your life stage
Your health insurance needs can change as your age, income, family responsibilities and healthcare requirements change. A plan that works for someone in their 20s may not provide the same level of financial protection when you have dependants or enter your 50s. Consider your life stage, existing health coverage, expected medical expenses and policy features when choosing the appropriate cover.
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Stage of Life
Age
Description
Ideal Health Insurance Coverage
Young & Starting Your Career
20–30 years
Building your career and financial independence
Up to ₹10 lakh
Newly Married
20–30 years
Starting a new family and planning ahead
₹10–20 lakh
Family & Growing Responsibilities
40–60 years
Managing family and increasing financial responsibilities
₹20–50 lakh
Protect Your Retirement
60+ years
Safeguarding your health and retirement savings
₹30–50 lakh
Pre-Existing Disease
Any age
Prioritising medical needs and adequate financial protection
Higher Cover + Super Top-Up
How does health insurance work?
Health insurance works by helping you pay for eligible medical expenses in exchange for a regular premium. Once you buy a policy, the insurer provides coverage up to the sum insured for covered treatments during the policy period.
Here's how it works:
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- Buy a policy: Choose a health insurance plan based on your healthcare needs and budget.
- Pay the premium: Pay the premium monthly, quarterly, or annually to keep the policy active.
- Get medical treatment: Visit a network or non-network hospital when you need medical care.
- Raise a claim: Opt for a cashless claim at a network hospital or pay the bills first and file a reimbursement claim.
- Claim settlement: The insurer verifies the claim and settles eligible medical expenses as per the policy terms and conditions.
Health insurance coverage based on your location
Health insurance coverage should align with your personal medical needs and financial situation. Ideally, your sum insured should be at least 50% of your annual income to ensure adequate protection. With rising healthcare costs, experts recommend opting for a health insurance cover of Rs. 10 lakh or more to comfortably manage medical expenses without financial strain.
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- City of residence: Coverage requirements can vary significantly between tier-1, tier-2, and tier-3 cities due to different medical costs.
- Age or life stage: Younger individuals typically need less coverage compared to older individuals who may have more health issues.
- Future hospitalisation costs: Consider the potential increase in medical expenses due to inflation.
Below is a table to help determine the ideal health insurance coverage based on different types of plans and city tiers:
Types of Health Insurance plans
Tier-1 City
Tier-2 City
Individual Health Insurance Plan
Rs. 15 lakh & above
Rs. 8-15 lakh
Family Floater Health Insurance Plan
Rs. 40 lakh & above
Rs. 25 lakh & above
Senior Citizen Health Insurance Plan
Rs. 25 lakh & above
Rs. 18 lakh & above
People can consider purchasing a Rs. 1 crore health insurance policy, which has become more affordable. This is particularly useful for long-term critical illness treatments or treatments abroad.Disclaimer: The above sum insured is suggestive and may vary as per the age and medical needs of the people.
Health insurance buying checklist
Before buying a health insurance policy, do more than compare premiums. Check the coverage, exclusions, waiting periods, claim conditions and out-of-pocket costs so you know what the policy actually offers when you need it.
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Check the sum insured: Choose a sum insured that reflects your family's healthcare needs and the cost of treatment in your city. IRDAI requires the Customer Information Sheet to state the policy's sum insured and coverage details, making these important points to review before purchase.
Review waiting periods: Check the waiting periods for pre-existing diseases and specified treatments before buying a policy. IRDAI states that waiting periods, including those for pre-existing diseases, can be up to 36 months, so compare these conditions carefully rather than looking only at the premium.
Understand exclusions and sub-limits: Read the exclusions, room-rent limits, ICU limits and disease-specific sub-limits before choosing a policy. IRDAI specifically advises policyholders to check these restrictions because expenses beyond applicable limits may not be payable by the insurer.
Check co-payment and deductibles: Understand how much you may have to pay yourself when making a claim. IRDAI defines a deductible as an amount the insurer does not pay before applicable benefits begin, while co-payment requires you to share a specified part of the claim.
Verify the cashless hospital network: Check whether hospitals you are likely to use are part of the insurer's network. IRDAI advises buyers to review the list of eligible hospitals and healthcare providers for cashless treatment before purchasing a policy, particularly if you have a preferred hospital nearby.
Check pre- and post-hospitalisation cover: Look at whether the policy covers eligible medical expenses before and after hospitalisation and understand the applicable limits. This can matter when treatment involves consultations, diagnostic tests or follow-up care rather than only the hospital stay itself.
Disclose existing health conditions: Be transparent about your existing medical conditions when completing the proposal form. IRDAI warns that concealing pre-existing health problems can lead to claim disputes, rejection of claims or cancellation of the policy. Accurate disclosure helps the insurer assess the risk correctly.
Read the customer information sheet: Ask for the Customer Information Sheet (CIS) and compare it with the policy wording. IRDAI requires the CIS to include key details such as coverage, exclusions, sub-limits, deductibles, waiting periods and important policy provisions, giving you a simpler way to review the cover.
Use the free look period: Review the policy after receiving the documents instead of assuming everything matches what was explained during purchase. For eligible policies with a term of one year or more, IRDAI provides a 30-day free-look period to review the terms, subject to applicable conditions.
Renew the policy on time: Keep your health insurance active by paying the renewal premium within the applicable grace period. IRDAI states that the grace period is 30 days for quarterly, half-yearly and annual premium payments and 15 days for monthly instalments; coverage may not apply for the period where no premium is received.
How health insurance works ?
Imagine your father suddenly needs hospitalisation for a serious infection. The family has to arrange treatment quickly, while also figuring out how the hospital bill will be paid. This is where health insurance comes in. The process generally involves buying a policy, paying the premium, getting treatment and filing a claim for eligible expenses.
Here is how it can work in a real-life situation:
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Step 1: Buy a health insurance policy
Suppose you are 30 and decide to buy health insurance for yourself and your parents. You compare the sum insured, hospital network, waiting periods, exclusions and premium before choosing a policy. Once the policy is issued and the premium is paid, you receive coverage according to its terms and conditions.
For example, if you purchase a policy with a Rs 10 lakh sum insured, that amount represents the maximum coverage available under the policy, subject to applicable terms, limits and exclusions.
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Step 2: Pay the premium to keep the policy active
Now imagine your annual health insurance premium is Rs 18,000. You pay it within the required period to keep the policy active. The premium is the cost you pay for the insurance coverage; it does not mean the insurer will automatically pay every medical bill.
The policy documents specify the premium, sum insured, coverage and other conditions that apply to your policy.
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Step 3: Get medical treatment when you need it
A few months later, your father needs hospitalisation. You check the insurer's network and find that the hospital is eligible for cashless treatment. For planned hospitalisation, you generally need to initiate the pre-authorisation process through the hospital or insurer as required by the policy.
For example, if the hospital estimates the covered treatment at Rs 1.5 lakh, the insurer reviews the request before approving the cashless facility. The final amount payable depends on the policy's coverage, exclusions and approved claim amount.
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Step 4: Choose cashless or reimbursement claim
Suppose the treatment is at a network hospital and cashless treatment is approved. The insurer pays the approved eligible amount directly to the hospital, while you may still need to pay applicable deductibles, co-payments, non-covered items or amounts exceeding policy limits.
If you receive treatment at a non-network hospital or cannot use cashless treatment, you may need to pay the hospital bill first and then submit the required documents for reimbursement, according to the policy terms.
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Step 5: Submit the required documents
After treatment, imagine the hospital gives you the discharge summary, final bill, prescriptions and investigation reports. You submit the documents required by your insurer or TPA along with the claim form within the time limit mentioned in your policy.
For reimbursement claims, insurers may require documents such as hospital bills, payment receipts, discharge summaries and medical reports. The exact requirements and submission timelines can differ between policies.
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Step 6: The insurer reviews the claim
The insurer then checks whether the treatment is covered under the policy and whether the submitted documents support the claim. It may verify the diagnosis, treatment, hospitalisation and expenses before deciding the amount payable.
For instance, if the hospital bill is Rs 1.5 lakh but Rs 20,000 relates to expenses excluded under the policy, the insurer may not pay that excluded portion. The payable amount is determined according to the policy terms, applicable limits and claim assessment.
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Step 7: The approved amount is settled
Once the claim is approved, the insurer settles the eligible amount according to the applicable claim process. In a cashless claim, the approved amount is paid to the network hospital. In a reimbursement claim, the approved amount is paid to the policyholder according to the insurer's process.
Remember that a Rs 10 lakh sum insured does not mean every claim will be paid up to Rs 10 lakh. The actual settlement depends on the treatment covered, policy limits, exclusions, deductibles, co-payments and the amount admissible under the policy.
In simple terms: You pay the premium → the policy provides coverage → you receive eligible treatment → you file or initiate a claim → the insurer assesses it → the approved amount is settled according to the policy terms.Hence, as seen in the example above, health insurance in India works by providing financial protection to the insured against medical crises in exchange for a small premium. It is a great way to keep yourself and your family covered against the rising cost of medical expenses.
What are the key benefits of buying a health insurance plan?
Buying health insurance isn't just about ticking a box — it's what stands between a medical emergency and your savings taking a hit. Here's what you actually get when you're covered, explained through real situations rather than textbook definitions.
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1. Your hospital bills get taken care of, not your bank balance
When Rajesh, a 45-year-old accountant from Ahmedabad, was hospitalised for a cardiac angioplasty in 2025, his bill touched ₹3.2 lakh. Since he'd bought a ₹15 lakh health policy two years earlier, his insurer settled ₹2.9 lakh of it directly with the hospital. Without that cover, he'd have had to break a fixed deposit or borrow from family on short notice — during an already stressful time.
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2. It protects you against diseases that cost the most
Regular health plans cover everyday hospitalisation, but serious illnesses like cancer, kidney failure, or a major stroke often need far larger sums and longer treatment. This is where Critical Illness Insurance fills the gap — it pays out a lump sum on diagnosis of a listed illness, regardless of the actual treatment cost, which people typically use for expensive procedures, loss of income during recovery, or even a second opinion abroad.
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3. You save on income tax every year
This is the benefit most people forget until tax-filing season. Premiums paid toward health insurance qualify for deduction under Section 80D of the Income Tax Act. For instance, a 35-year-old paying ₹18,000 a year for a family floater policy (self, spouse, kids) can claim that full amount as a deduction — and if he's also paying for his senior citizen parents' policy, he can claim up to ₹50,000 more for that. That's a real reduction in taxable income, not just a policy perk.
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4. Cashless treatment means one less thing to worry about
Most insurers today have tie-ups with thousands of hospitals — for example, over 8,500 network hospitals across India in many major insurers' lists. At a network hospital, you can walk in, get treated, and walk out without settling the bill yourself; the insurer pays the hospital directly. Meera's appendicitis surgery mentioned earlier is a good example — she didn't arrange a single rupee upfront for a ₹1.18 lakh bill.
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5. It covers more than just the hospital room
A decent health policy today typically includes pre-hospitalisation expenses (usually 30-60 days before admission) and post-hospitalisation expenses (60-180 days after discharge) — think diagnostic tests, follow-up consultations, and medicines. Rajesh's policy, for example, also covered ₹22,000 worth of follow-up cardiac check-ups and medication over the three months after his surgery, which would otherwise have been an out-of-pocket cost.
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6. Your premium doesn't shoot up just because you claimed once
Many plans offer a "no-claim bonus" — your sum insured increases (commonly by 5-50% depending on the insurer) for every claim-free year, at no extra premium cost. So someone who stayed claim-free for 4 years on a ₹5 lakh policy could be sitting on a cover of ₹7-10 lakh today, without paying a paisa more.
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7. It takes the financial pressure off your family
Perhaps the most underrated benefit: a health emergency in the family no longer means everyone else's financial plans get derailed. Whether it's a parent's surgery, a child's accident, or your own diagnosis, having a policy in place means the conversation stays focused on recovery, not on how to arrange money
Why should you buy health insurance plans online?
Here are the key benefits of buying health insurance plans online-
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Greater convenience
Buy your policy from the comfort of your home—no need to visit branches or schedule appointments with agents.
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Exclusive online discounts
Enjoy special premium discounts when you purchase your policy online.
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Lower premiums
Online plans are often more affordable as insurers save on administrative and operational costs.
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Minimal paperwork
Say goodbye to long forms—most online purchases require little to no physical documentation.
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Secure digital payments
Use safe and hassle-free digital payment methods instead of cash transactions.
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Quick and time-saving
The entire process—from purchase to policy issuance—takes just a few minutes.
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24x7 availability
Buy your health insurance policy anytime—even on weekends or public holidays.
Health insurance at a glance
Features | Specifications |
Premium starts | Rs. 9.3/day* |
Sum insured (medical coverage) | Rs. 5 lakh to Rs. 50 lakh |
Cashless treatment | 10,000+ hospitals |
Pre-and post-hospitalisation expenses | Covered |
Tax benefits | Included |
Ambulance expenses | Included |
Pre-existing diseases | Covered (according to the plan terms and conditions) |
Daycare procedures | Up to 527 daycare treatments |
What does health insurance cover and not cover?
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Inclusions
Here’s a quick look at the inclusions of Health Insurance policies:
In-patient hospitalisation expenses:
Get coverage for hospitalisation expenses incurred due to illness or accidental injuries sustained during the policy periodPre- and post-hospitalisation expenses:
Covers medical costs incurred due to an illness or injury from 60 days before hospitalisationCritical illnesses
Get coverage for critical illnesses such as asthma, cholesterol, diabetes, and high blood pressureRoad ambulance charges
Get coverage for road ambulance charges up to the amount mentioned in the policy details. The ambulance coverage is applicable for transporting the policyholder to the hospitalDomiciliary hospitalisation
Get coverage for availing of hospital-like treatment at homeDaycare procedures
Get coverage for daycare procedures that require less than 24 hours of hospitalizationMaternity cover
Get coverage for maternity-related expenses, including childbirth, delivery (normal or C-section), and other eligible pregnancy-related medical costs after the applicable waiting period, as specified in the policy.AYUSH treatment coverage
Get coverage for in-patient treatment under AYUSH systems of medicine, including Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy, when taken at recognised healthcare facilities as per the policy terms.Preventive and wellness benefits
Access preventive healthcare benefits such as annual health check-ups, wellness programmes, fitness rewards, health coaching, and other wellness initiatives offered under the policy to help maintain your overall health.Follow-up consultations and diagnostic tests
Get coverage for eligible follow-up doctor consultations, diagnostic tests, and investigations required after hospitalisation or as part of the treatment plan, subject to the policy's terms and conditions.Pre-existing diseases coverage
Get coverage for pre-existing diseases after completing the applicable waiting period mentioned in the policy. Once the waiting period is over, eligible treatment expenses related to these conditions are covered as per the policy terms.
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Exclusions
While health insurance provides financial protection against eligible medical expenses, every policy also has certain exclusions. These are treatments, conditions, or situations for which the insurer does not provide coverage. Reviewing the exclusions before purchasing a policy can help you understand its limitations and avoid unexpected claim rejections. Some common health insurance exclusions include:
- Self-inflicted injuries: Medical expenses arising from intentional self-harm or suicide attempts are generally not covered.
- Obesity or weight control treatments: Expenses related to weight loss, obesity management, or bariatric procedures are excluded unless specifically covered under the policy.
- Cosmetic or plastic surgery: Cosmetic procedures performed for aesthetic reasons are usually excluded unless they are medically necessary due to an accident, illness, or reconstructive treatment.
- Hazardous or adventure sports: Injuries sustained while participating in adventure or high-risk sports may not be covered unless the policy specifically includes such activities.
- Dental treatments: Routine dental procedures, cosmetic dental work, and orthodontic treatments are generally excluded unless required following an accident or covered as an add-on benefit.
- Medical aids: The cost of external medical aids such as hearing aids, spectacles, contact lenses, prosthetics, and similar devices is typically not covered unless explicitly mentioned in the policy terms.
Note: It is recommended to check your policy wordings to get a detailed list of exclusions.
Types of health insurance plans
Health insurance plans are designed to meet different healthcare needs. Understanding the available options can help you choose a policy that best suits your age, family size, and medical requirements.
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- Individual health insurance
Individual health insurance covers the medical expenses of a single individual up to the chosen sum insured.
Family health insurance
Family health insurance provides a shared sum insured for you, your spouse, children, and other eligible family members under one policy.Critical illness health insurance
Critical illness health insurance offers a lump-sum payout on the diagnosis of specified critical illnesses covered under the policy.Senior citizen health insurance
Senior citizen health insurance is Designed for individuals aged 60 years and above, covering age-related healthcare and hospitalisation expenses.Personal accident insurance policy
Group personal health insurance provides financial protection against accidental death, permanent disability, or partial disability caused by an accident.Super top-up health insurance
Super top-up health insurance enhances your existing health insurance coverage by providing additional protection once the deductible limit is crossed.
- Individual health insurance
Key factors to consider before buying a health insurance plan
Choosing the right health insurance plan requires more than comparing premiums. You should evaluate the coverage, policy terms, and insurer's service standards to ensure the plan meets your current ad future healthcare needs. Here are some of the most important factors to consider before purchasing a health insurance policy:
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- Scope of coverage: Review the benefits and medical expenses covered under the policy. Look for coverage for in-patient hospitalisation, pre- and post-hospitalisation expenses, daycare procedures, critical illnesses, maternity benefits, ambulance charges, modern treatments, and other relevant features based on your healthcare needs.
- Sum insured: The sum insured determines the maximum amount your insurer will pay during a policy year. Considering rising medical costs, choose a coverage amount that provides adequate financial protection. Families, individuals living in metro cities, and senior citizens may benefit from opting for a higher sum insured.
- Policy type: Health insurance plans are available in different forms, including individual plans, family floater plans, senior citizen plans, critical illness plans, top-up plans, and super top-up plans. Select a policy that aligns with your age, family size, and healthcare requirements.
- Waiting period: Most health insurance policies have waiting periods for pre-existing diseases, specified illnesses, maternity benefits, and certain treatments. Compare waiting periods across plans and choose one that offers favourable terms while meeting your healthcare needs.
- Co-payment clause: Some policies include a co-payment clause, where you agree to pay a fixed percentage of every admissible claim while the insurer pays the remaining amount. Although this may reduce the premium, it also increases your out-of-pocket expenses during treatment.
- Room rent limits: Certain health insurance plans place limits on the room rent they will cover during hospitalisation. Choosing a policy with no room rent cap, or a higher room rent limit, can help you avoid additional expenses if you opt for a higher-category room.
- Cashless hospital network: Check the insurer's network of cashless hospitals, particularly those located near your home or workplace. A larger network provides greater convenience and makes it easier to access cashless treatment during medical emergencies.
- Lifelong renewability: A policy with lifelong renewability allows you to continue your health insurance coverage regardless of your age, provided you renew the policy on time. This ensures uninterrupted financial protection throughout your life.
- Premium loading: Some insurers may increase premiums based on factors such as age, medical history, or previous claims. Understanding the insurer's premium loading policy can help you estimate the long-term cost of maintaining the policy.
- Claim settlement record: Review the insurer's claim settlement ratio and claim settlement process before making a decision. A higher claim settlement ratio, combined with an efficient claims process, indicates the insurer's ability to settle eligible claims promptly and reliably.
What are health insurance riders?
Riders are optional add-ons you can attach to your health insurance policy for an extra premium, giving you coverage that goes beyond your base plan. How much a rider costs depends on factors like your age, the sum insured you choose, and the kind of protection it offers. Here are five riders worth considering:
- Maternity Rider — Covers childbirth-related expenses, including delivery costs and pre/post-natal care. Some insurers extend this to cover the newborn for the rest of the policy term. Keep in mind this rider typically comes with a waiting period, which can be anywhere from 9 months to 6 years depending on the insurer.
- Consumables Rider — Hospital bills often include small non-medical items — gloves, syringes, bandages, registration fees, and the like — that base policies usually don't cover. These can add up to 10-20% of your total bill. This rider takes care of those costs, cutting down what you'd otherwise pay from your own pocket.
- Critical Illness Rider — Pays out a fixed lump sum if you're diagnosed with a serious illness like cancer or a heart condition for the first time during your policy period — regardless of your actual treatment costs. It usually comes with a 90-day waiting period and a 30-day survival clause, and most policies cover somewhere between 10 and 40 listed illnesses.
- Personal Accident Rider — Provides compensation if an accident leads to disability or death. A permanent total disability gets you the full sum insured, while partial disability pays out a proportion based on severity. It's sometimes called a double indemnity rider since your family receives a death benefit if the accident proves fatal.
- Hospital Cash Rider — Gives you a fixed daily cash amount to help cover incidental expenses while you're hospitalized. If you end up in the ICU, this doubles for those days. You'll need to be admitted for at least 24 hours for this to kick in, and the payout amount depends on your policy terms.
- Room Rent Waiver — Removes the cap on how much your insurer will pay toward your hospital room rent, letting you choose a room without worrying about sub-limits or paying the difference yourself.
Healthcare scenario in India: Why you need health insurance
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Current Health Scenario in India
India's health picture has shifted dramatically over the last decade. Diseases that were once associated mostly with people in their 50s and 60s — diabetes, hypertension, heart disease — are now showing up regularly in people barely past 30. Poor lifestyle choices, mounting work stress, pollution, and genetics are all playing a part, and the numbers back this up in ways that are hard to ignore.
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Diabetes has reached a scale few countries have seen
India now has close to 90 million people living with diabetes, making it the second-largest diabetic population in the world as of 2024, right behind China. This isn't just an "older adult" condition anymore — clinics across metros report diabetes diagnoses in patients in their late 20s and early 30s with increasing frequency. (Source: 11th Edition of the IDF Diabetes Atlas, The Lancet Diabetes & Endocrinology)
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Nearly 1 in 3 adults is living with high blood pressure
Hypertension affects about 28.5% of Indian adults, according to theNational Noncommunicable Disease Monitoring Survey (NNMS) 2017-18</a>. What makes this concerning is how silent it is — most people don't feel anything until it's caused damage to the heart, kidneys, or eyes.
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Cancer diagnoses are climbing steadily
100 out of every 1 lakh people in India were diagnosed with cancer in 2022. (Source: Ministry of Health & Family Welfare)
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Heart disease is hitting India's younger population hardest
According to the WHO, India accounts for one-fifth of all heart disease deaths globally — and unlike in many other countries, a significant share of this burden falls on younger adults, not just the elderly. (Source: National Library of Medicine, 2020)
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India carries the world's heaviest TB burden
India has the highest prevalence of tuberculosis anywhere in the world, accounting for 27% of all global TB cases. (Source: Global TB Report 2023)
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Mental health struggles remain widespread and underreported
Around 15% of Indian adults live with some form of mental illness, per the 2015-16 National Mental Health Survey (NMHS). (Source: Ministry of Health & Family Welfare)
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Dengue cases in India form a large share of the global count
In 2024, 14.1 million dengue cases were reported worldwide, and India alone accounted for over 2.3 lakh of them. (Source: National Centre for Vector Borne Diseases Control)
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Joint replacement surgeries are far more common than most realise
Roughly 2,00,000 joint replacement surgeries — both registered and unregistered — were performed across India in 2020 alone. (Source: Journal of Orthopedic Case Reports, 2025)
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Healthcare spending is putting a real dent in household budgets
Indian families spent more than ₹120 billion on medical and healthcare services in FY 2022, as per the CMIE-CPHS report. (Source: Forbes)
What are the eligibility criteria to buy a health insurance plan?
Whether you qualify for a health insurance plan depends on a few key factors — mainly your age and medical history. Here's a quick snapshot of what most insurers look at:
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Criteria
Specifications
Entry Age for Adults
18 years and above
Entry Age for Dependent Children
90 days to 25 years
Pre-Medical Screening
Required above 45/55/60 years, depending on the plan
- Age criteria — Any adult above 18 can buy a health insurance policy. Children can usually be added anywhere between 90 days and 25 years of age, though the exact cut-off varies by insurer and plan.
- Pre-medical screening — If you're above 45 or 55 (this threshold differs by insurer), you may need to undergo a medical check-up before your policy is issued. For senior citizen health plans, pre-policy medical tests are almost always mandatory.
- Disclosing pre-existing diseases — Conditions like diabetes, high blood pressure, heart disease, or kidney disease that you already have when buying the policy are treated as pre-existing diseases (PED). These typically get covered only after a waiting period of 1 to 3 years, and insurers will ask about them upfront at the time of purchase.
It's important to disclose all pre-existing conditions honestly — including habits like smoking or drinking — since hiding them can lead to claim rejection later, right when you need the payout the most.
Your insurer uses all of this information together to decide your final coverage and premium.
Benefits of buying health insurance at an early age
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Most people put off buying health insurance until their 30s or 40s, usually with the thought "I'm young and healthy, I'll deal with it later." That one decision, though, ends up costing more than most realise — both in money and in coverage gaps. Here's a real comparison that shows exactly why buying early makes a difference.
Consider two colleagues at the same company — Arjun, who bought a ₹10 lakh health policy at age 25, and his friend Vikram, who bought the identical plan, from the same insurer, at age 35. Here's how their situations played out differently.
Low premiums
Arjun locked in his ₹10 lakh cover for about ₹6,500 a year at age 25. Vikram, buying the exact same plan a decade later, paid closer to ₹11,000 a year — nearly 70% more, purely because premiums rise with age. Over the next 10 years, Arjun's early start could save him well over ₹50,000 in cumulative premiums, money he can put toward other financial goals instead.Lesser health issues
When Arjun applied at 25, he had no health conditions to declare, so his proposal was approved without a single medical test and with zero exclusions. Vikram, at 35, had mildly elevated cholesterol flagged in his pre-policy check-up, which meant the insurer added a specific exclusion clause for cholesterol-related treatment for the first two years. Buying young often means walking through the door with a clean slate.Completion of waiting periods
Most insurers apply a 2-4 year waiting period for pre-existing diseases and a 30-day initial waiting period for any illness (except accidents) right from day one. Since Arjun bought his policy at 25, his waiting periods were already long over by the time he actually needed treatment for a kidney stone at 29. Vikram, who bought later, would have had to wait out that same window while already dealing with early health concerns — a risky gap to have open during your 30s and 40s, when health issues typically start showing up.Comprehensive financial protection
Because Arjun stayed insured continuously from 25 onward, he also built up a no-claim bonus — his sum insured had grown from ₹10 lakh to ₹14 lakh by the time he turned 30, at no extra premium, simply for staying claim-free for those years. That extra ₹4 lakh buffer came in useful when he needed a minor surgery that cost ₹3.8 lakh — the entire bill was covered without dipping into savings.Tax benefits
Under Section 80D of the Income Tax Act, individuals below 60 can claim up to ₹25,000 a year in deductions on health insurance premiums (₹50,000 if the policy covers senior citizen parents). Arjun, paying ₹6,500 a year, could claim that full amount as a deduction from the very first year he started working — effectively lowering his taxable income right from the start of his career, while Vikram only began claiming this benefit a decade later.
Why compare health insurance plans online?
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Choosing a health plan isn't easy when a dozen insurers are all promising the "best" coverage at the "lowest" price. Comparing plans online cuts through that noise and lets you make a decision based on facts, not sales pitches.
Take Rohan, a 31-year-old from Chennai — he almost signed up with the first agent who called him, offering a plan for ₹9,200 a year. Out of curiosity, he compared it online first and found a nearly identical plan from another insurer for ₹7,400, with a better hospital network in his area.
Here's what comparing online actually gets you:
Access to accurate information — you see real plan details straight from insurers, not a filtered pitch from an agent pushing a particular product
Easy side-by-side comparison — features, sum insured, and premiums for multiple plans sit on one screen, so there's no need to sit through repeated agent meetings
Policies that fit your budget — since there's no agent commission built in, buyers often end up paying less for the same coverage
Visibility into claim settlement ratios and reviews — this shows how reliably an insurer actually pays out claims, which matters far more than a glossy brochure
What are the eligibility criteria to buy a health insurance plan?
Whether you qualify for a health insurance plan depends on a few key factors — mainly your age and medical history. Here's a quick snapshot of what most insurers look at:
Criteria | Specifications |
Entry Age for Adults | 18 years and above |
Entry Age for Dependent Children | 90 days to 25 years |
Pre-Medical Screening | Required above 45/55/60 years, depending on the plan |
- Age criteria — Any adult above 18 can buy a health insurance policy. Children can usually be added anywhere between 90 days and 25 years of age, though the exact cut-off varies by insurer and plan.
- Pre-medical screening — If you're above 45 or 55 (this threshold differs by insurer), you may need to undergo a medical check-up before your policy is issued. For senior citizen health plans, pre-policy medical tests are almost always mandatory.
- Disclosing pre-existing diseases — Conditions like diabetes, high blood pressure, heart disease, or kidney disease that you already have when buying the policy are treated as pre-existing diseases (PED). These typically get covered only after a waiting period of 1 to 3 years, and insurers will ask about them upfront at the time of purchase.
It's important to disclose all pre-existing conditions honestly — including habits like smoking or drinking — since hiding them can lead to claim rejection later, right when you need the payout the most.
Your insurer uses all of this information together to decide your final coverage and premium.
What are the eligibility criteria to buy a health insurance plan?
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Choosing a health plan isn't easy when a dozen insurers are all promising the "best" coverage at the "lowest" price. Comparing plans online cuts through that noise and lets you make a decision based on facts, not sales pitches.
Take Rohan, a 31-year-old from Chennai — he almost signed up with the first agent who called him, offering a plan for ₹9,200 a year. Out of curiosity, he compared it online first and found a nearly identical plan from another insurer for ₹7,400, with a better hospital network in his area.
Here's what comparing online actually gets you:
Access to accurate information — you see real plan details straight from insurers, not a filtered pitch from an agent pushing a particular product
Easy side-by-side comparison — features, sum insured, and premiums for multiple plans sit on one screen, so there's no need to sit through repeated agent meetings
Policies that fit your budget — since there's no agent commission built in, buyers often end up paying less for the same coverage
Visibility into claim settlement ratios and reviews — this shows how reliably an insurer actually pays out claims, which matters far more than a glossy brochure
Some common myths about health insurance
Before you buy a policy, it helps to separate fact from fiction. Here are a few misconceptions that trip people up:
- Health insurance is too expensive."
A basic health insurance plan can cost as little as a few hundred rupees a month, especially if you buy it young. The cost of not having cover — a single hospital stay — is almost always higher than years of premiums. - "I don't need health insurance because I have savings."
Savings can disappear fast in a medical emergency, especially with a serious illness or long hospital stay. Health insurance protects those savings so they're still there for the goals you actually saved them for. - "Online health insurance policies are not genuine or safe to buy."
Buying online is just as legitimate as buying through an agent — as long as you purchase directly from the insurer's website or a trusted platform. In fact, buying online often works out cheaper since there's no agent commission involved. - "A cheaper premium means a better health insurance plan."
A low premium can mean lower coverage, higher sub-limits, or more exclusions. It's worth comparing what each plan actually covers rather than just going by the price tag. - "I can buy health insurance right before I need surgery or treatment."
Every policy has an initial waiting period (usually 30 days) before most claims are payable, and pre-existing conditions take even longer. Buying insurance only works if you do it well before you actually need it. - "Once I buy a policy, my premium will never increase."
Premiums can increase at renewal — insurers revise pricing based on your age, claims history, and overall risk trends in the industry. It's a good idea to review your policy at each renewal rather than assuming it'll stay the same. - "Claims are always rejected or delayed."
Most claims get settled without issues as long as the information you provided at purchase was accurate and complete. Delays or rejections usually happen due to non-disclosure or incomplete documentation — not because insurers are looking for reasons to deny claims. - "I only need health insurance for myself, not my family."
A single hospitalisation for any family member — a child, spouse, or parent — can be just as financially draining. A family floater plan or individual policies for each member help make sure everyone's protected.
How to calculate health insurance premiums?
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Keeping a Mediclaim Policy active depends on one simple thing — paying your premium on time, every renewal cycle. But that premium amount isn't the same for everyone. Two people buying what looks like the same ₹5 lakh cover can end up paying very different amounts, sometimes a difference of ₹3,000-5,000 a year, depending on their age, gender, city, medical history, and the sum insured they choose.
For instance, a healthy 25-year-old in a Tier-2 city might pay around ₹5,000-6,000 annually for a ₹5 lakh policy, while someone in their 40s living in a metro like Mumbai or Delhi, with a mild pre-existing condition, could be quoted anywhere between ₹12,000-15,000 for the same cover. Smokers and people with a family history of illness typically see higher premiums too.
Rather than guessing, the easiest way to know your actual cost is through a health insurance premium calculator — a free online tool where you enter details like your age, city, and preferred sum insured, and it instantly shows you the premium you'd need to pay.
Which factors affect health insurance premium?
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Ever wondered why your colleague pays half of what you do for a similar health cover? Several factors quietly shape the final premium you're quoted, and understanding them can help you make smarter choices while buying a plan.
Age: Premiums rise steadily with age — a 25-year-old might pay around ₹6,000 a year for a ₹5 lakh cover, while a 45-year-old could pay ₹15,000-18,000 for the same amount.
Gender: Women often qualify for slightly different premium structures and specific benefits under Health Insurance for Women, designed around maternity and women-specific health needs.
City of residence: Metro cities like Mumbai and Delhi carry higher premiums than smaller towns, since treatment costs there are typically 20-30% higher.
Medical history: Pre-existing conditions like diabetes or hypertension usually push premiums up and may add a waiting period.
Sum insured and coverage type: A higher sum insured or add-ons like critical illness cover naturally increases the premium.
Lifestyle habits: Smoking or tobacco use can raise premiums by 15-20% compared to a non-smoker with the same profile.
How to file a health insurance claim?
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Knowing how to actually use your policy matters just as much as buying the right one. Health insurance offers two ways to file a claim — cashless and reimbursement — and understanding both can save you a lot of stress when a medical emergency actually shows up.
Take the example of Neha, a 38-year-old teacher from Jaipur, who needed gallbladder surgery in early 2026. Her total hospital bill came to ₹1,45,000. Here's exactly how her claim played out, step by step.
Cashless Claims — No Upfront Payment
In a cashless claim, the insured gets treated without paying the medical bill out of pocket — the hospital settles the bill directly with the insurer.
Step 1 – Get admitted to a hospital: Neha was admitted for her surgery and informed the hospital's insurance desk about her policy.
Step 2 – Hospital sends a pre-authorisation request: The hospital's TPA desk filled out a form with her diagnosis and estimated treatment cost, and forwarded it to the insurer.
Step 3 – Insurer approves the request: Within about 3-4 hours, the insurer approved her treatment cost for cashless settlement.
Step 4 – Treatment and discharge: After surgery, the hospital sent the final bill directly to the insurer, who settled ₹1,38,000 of the ₹1,45,000 bill — the balance ₹7,000 covered non-medical items outside her policy's scope.
Traditionally, cashless claims were only possible at a network hospital tied up with the insurer. That's changed with Bajaj Finserv's Cashless Everywhere feature — it lets you file a cashless claim even at a non-network hospital, up to your policy's sum insured limit. This mattered for Neha, since it meant she wasn't restricted to a fixed list of hospitals and could still avoid paying anything upfront even if her preferred hospital wasn't in the insurer's regular network.
Reimbursement Claims — Pay First, Claim Later
In a reimbursement claim, the insured pays the medical expenses first and gets the amount reimbursed by the insurer afterward. Had Neha gone to a hospital where even Cashless Everywhere wasn't applicable, here's how the process would have looked:
Step 1 – Pay the full bill upfront: She would have needed to arrange the entire ₹1,45,000 herself at the time of treatment.
Step 2 – Collect all original documents: This includes the discharge summary, detailed hospital bills, payment receipts, doctor's prescriptions, and diagnostic reports.
Step 3 – Submit the claim form: A duly signed reimbursement claim form, along with the supporting documents, needs to be submitted to the insurer within the specified time limit (usually 15-30 days from discharge).
Step 4 – Insurer verifies the claim: The insurance company checks the submitted bills and documents against the policy terms and conditions.
Step 5 – Amount credited to your account: Once approved, the eligible amount is transferred to the policyholder's bank account, which typically takes 15 to 30 days.
Why This Matters
Neha's case shows the real difference between the two routes: going cashless meant she didn't have to arrange a single rupee during an already stressful time, while reimbursement would have meant finding ₹1.45 lakh on short notice and then waiting weeks to get it back. Checking whether cashless treatment — including through options like Cashless Everywhere — is available at your hospital before admission can make a real difference to how smoothly your claim goes through.
Common reasons why health insurance claims get rejected
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A rejected claim is one of the most frustrating things that can happen after you've already been through a medical emergency. More often than not, though, the rejection isn't because the insurer is being difficult — it's because of a gap somewhere in the paperwork or the policy terms that could have been avoided. Here's a look at the reasons that come up most often, and what they actually mean for you.
Reason for Rejection
What It Means
Real Example
Claiming during the waiting period
Most policies have an initial waiting period (usually 30 days) for any illness, and a separate 2-4 year waiting period for pre-existing diseases. Claims filed within this window are declined.
Rakesh bought a policy in March and was hospitalised for viral fever in the first week of April — his claim was rejected since it fell within the 30-day initial waiting period.
Non-disclosure of pre-existing conditions
If you don't declare an existing health condition at the time of buying the policy, and it later turns out you knew about it, the insurer can reject the claim entirely.
A policyholder with undisclosed diabetes had a related claim denied after the hospital's medical records revealed a diagnosis dating back two years before the policy purchase.
Incomplete or incorrect documentation
Missing bills, an unsigned claim form, or mismatched patient details can stall or reject a claim, even if the treatment itself is valid.
A reimbursement claim worth ₹85,000 was delayed by three weeks simply because the discharge summary wasn't attached in the first submission.
Treatment not covered under the policy
Certain treatments — cosmetic procedures, infertility treatment, or specific alternative therapies — may be excluded depending on your plan.
A claim for cosmetic dental work was rejected outright since it fell outside the policy's defined coverage.
Claim filed after the deadline
Reimbursement claims usually need to be filed within 15-30 days of discharge. Filing late, even by a few days, can lead to rejection.
A policyholder submitted his claim 40 days after discharge, missing the insurer's 30-day window, and the claim was denied.
Treatment at a hospital that doesn't meet the policy's definition
Some policies specify a minimum bed count or infrastructure standard for a facility to qualify as a "hospital." Treatment at a small clinic that doesn't meet this definition may not be covered.
A claim for a minor procedure at a small nursing home was rejected as it didn't meet the insurer's defined hospital criteria.
Room rent exceeding the policy limit
If your plan has a room-rent capping clause and you opt for a room above that limit, the insurer may proportionately reduce the entire claim amount, not just the room charges.
A policyholder with a ₹5,000/day room-rent limit chose a ₹9,000/day room, resulting in a proportionate cut across the whole bill, not just the extra room cost.
Fraudulent or exaggerated claims
Submitting inflated bills or fabricated documents leads not just to rejection but can also result in the policy being cancelled altogether.
An insurer detected inconsistencies between the hospital's actual billing records and the submitted claim amount, leading to a full claim denial.
The takeaway: Most rejections trace back to something that could have been checked beforehand — reading the policy wording carefully, disclosing your full medical history honestly, keeping documents organised, and filing within the given timeline. A little care at the start of the process usually means one less headache when you actually need to use your policy.
What are the documents required for health insurance?
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To buy or renew a health insurance policy in India, you’ll need to submit a few KYC (Know Your Customer) documents for identity and address verification. Below is the list of commonly accepted documents:
- Identity proof – Aadhaar Card, PAN Card, Passport, Voter ID, or Driving Licence.
- Address proof – Aadhaar Card, Passport, Utility Bills, or any other valid address proof.
- Age proof – Birth Certificate, Passport, Aadhaar Card, or Driving Licence.
- Passport-sized photographs – Recent photographs of the proposer and insured members, if required.
- Medical reports – Pre-policy medical examination reports, if requested by the insurer based on age, sum insured, or medical history.
- Income proof – Salary slips, bank statements, or Income Tax Returns (required for certain plans).
- Completed proposal form – A duly filled application form containing personal, nominee, and health-related details.
- Existing policy details – Previous health insurance policy documents if you are porting or renewing a policy.
Documents required for filing a reimbursement claim
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When you pay for treatment upfront and claim it back later, having the right paperwork ready makes the process far smoother. Here's what insurers typically ask for:
Duly filled and signed claim form
Doctor's prescriptions for hospitalisation, medicines, and diagnostic tests
Original hospital documents — final bill, discharge summary, and investigation reports
Hospital bill payment receipts
Copy of the health insurance policy
Valid photo ID proof
Proof of bank account (cancelled cheque, passbook, or bank statement)
FIR or MLC, if the claim is accident-related
Any additional documents the insurer may request
How Bajaj Finance helps NRIs with health insurance plans?
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Non-Resident Indians (NRIs) can also secure medical protection for themselves and their families in India through NRI health insurance[1] plans. These plans are designed to cover hospitalisation expenses incurred during visits to India or for family members residing here.
Key highlights of health insurance for NRIs:
- Coverage in India: Offers protection for medical treatments and hospitalisation expenses incurred within India.
- Cashless treatment: Access to network hospitals across India for seamless cashless claims.
- Flexible sum insured options: Choose coverage ranging from Rs. 5 lakh to Rs. 1 crore, based on your healthcare needs.
- Easy online purchase and renewal: NRIs can buy or renew their policies online without being physically present in India.
- Tax benefits: Premiums paid are eligible for tax deductions under Section 80D of the Income Tax Act.
Eligibility:
- NRIs aged 18–65 years (may vary by insurer).
- Valid Indian passport and bank account for premium payment and claim settlement.
Example:
If you frequently travel to India or have dependent parents here, an NRI health insurance plan ensures they receive quality care without financial strain.
Common Health Insurance Terms
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Understanding common health insurance terms can make it easier to compare policies, understand coverage and avoid confusion while buying or using a policy. Here are some commonly used terms explained in simple language:
Health Insurance Claim: A health insurance claim is a formal request made by the policyholder to the insurer for payment of eligible medical expenses covered under the policy. Claims can generally be settled through cashless treatment at network hospitals or through reimbursement, depending on the policy and treatment. Read more about the Health insurance claim process to understand the steps involved.
Co-payment: Co-payment, or co-pay, is the portion of an eligible medical expense that the policyholder has to pay from their own pocket. For example, if a policy has a 10% co-payment clause, the policyholder may have to bear 10% of the admissible claim amount while the insurer pays the remaining eligible amount, subject to policy terms. Learn more about Co-payment in health insurance.
Cumulative Bonus: A cumulative bonus is an increase in the sum insured or an additional benefit offered for certain claim-free policy years, as specified by the policy. It can help increase available coverage over time without necessarily requiring a proportionate increase in the base sum insured. The exact benefit and limits vary between policies. Know more about Cumulative bonus in health insurance.
Deductible: A deductible is the amount that the policyholder must pay towards covered medical expenses before the insurer starts paying, as applicable under the policy. It may be specified as a fixed amount or in another manner depending on the policy structure. Understanding the deductible is important because it directly affects the amount payable by the policyholder during a claim. Read about Deductible in health insurance.
Domiciliary Treatment: Domiciliary treatment refers to eligible medical treatment taken at home instead of a hospital because the patient's condition may not allow hospitalisation, or because a hospital bed may not be available, subject to the conditions specified in the policy. Coverage is not automatic for every type of home treatment, so the policy wording should be checked carefully. Explore Domiciliary treatment for more details.
Grace Period: A grace period is the additional time provided by an insurer after the premium due date to renew a health insurance policy. The length of the grace period depends on the policy terms. Policyholders should renew within the applicable period to avoid an interruption in coverage and potential impact on policy benefits. Learn more about the Grace period in health insurance.
Health Insurance Portability: Health insurance portability allows eligible policyholders to transfer certain policy benefits, such as applicable accrued credits, from one insurer to another while maintaining continuity, subject to applicable rules and conditions. It can be useful when a policyholder wants to change insurers without losing eligible continuity benefits. Understand Health insurance portability.
Pre-existing Diseases: Pre-existing diseases are medical conditions that existed before the commencement of the health insurance policy, as defined under the applicable policy terms. Such conditions may be covered after a specified waiting period, depending on the policy. Therefore, disclosing relevant medical information accurately when purchasing a policy is important. Read more about Pre-existing diseases.
Health Insurance Premium: A health insurance premium is the amount paid by the policyholder to keep the insurance policy active. The premium may depend on factors such as the insured person's age, coverage selected, policy features and other underwriting considerations. Understanding the premium and payment schedule can help policyholders maintain continuous coverage. Learn more about Health insurance premium.
Why should you choose Bajaj Finserv for your health insurance needs?
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Buying health insurance shouldn't mean endless paperwork or chasing an agent for updates. Bajaj Finserv brings together comparison, purchase, and claim support on a single platform, so the entire experience — from choosing a plan to actually using it during a hospital stay — stays simple.
Here's what sets Bajaj Finserv apart when it comes to health insurance:
Cashless claim processing in 30 minutes: At network hospitals, cashless claims are processed within 30 minutes, so you're not left waiting during a medical emergency.
10,000+ network hospitals: Cashless treatment is available across a wide network of hospitals nationwide, giving you options no matter which city you're in.
Coverage up to ₹50 lakh: Plans on the platform go up to a ₹50 lakh sum insured, with premiums starting as low as ₹1,469, so you can pick a cover that actually matches your medical needs.
Buy a policy in minutes, no agent required: Skip the branch visits — compare and buy a plan directly online, with no brokerage fees eating into your premium.
Compare multiple insurers on one platform: Health insurance plans from leading insurers are listed side by side, so you can compare coverage, premiums, and features before deciding.
Up to 527 daycare procedures covered: Treatments that don't need 24-hour hospitalisation are also covered, along with pre- and post-hospitalisation expenses.
Tax benefits under Section 80D: Premiums paid qualify for deductions under Section 80D of the Income Tax Act, adding a financial upside beyond the health cover itself.
Policy Benefits
Frequently asked questions
Overview
Features
Coverage
How much does an individual need to pay to get a health insurance plan?
The premium for a health insurance plan depends on factors like age, medical history, sum insured, type of coverage, and add-on benefits. Higher coverage and additional riders usually increase the premium amount.
How to calculate health insurance premium online?
Visit the insurer’s website, open the premium calculator, enter details like age, gender, coverage amount, and medical history. The calculator will instantly show the estimated premium.
Can I avail of tax benefits against premiums paid towards health insurance policy?
Yes. Under Section 80D of the Income Tax Act, you can claim tax deductions on health insurance premiums paid for yourself, family, and parents, subject to applicable limits.
What is the cost of health insurance in India?
The cost varies based on age, health condition, coverage amount, city, and policy benefits. Premiums are generally lower for younger individuals.
What is the cost of a health insurance plan per month?
Monthly premiums can start from around ₹300 and increase depending on the sum insured, age, and additional benefits chosen.
Can we get health insurance money back?
Some plans offer return-of-premium benefits or No Claim Bonus (NCB), which may increase your coverage or reduce future premiums.
How does smoking or tobacco use affect premiums?
Smokers and tobacco users generally pay higher premiums because they are considered at higher risk for lifestyle-related diseases.
Is it better to pay health insurance annually or monthly?
Annual payments are usually more cost-effective, while monthly payments provide flexibility and easier budgeting.
How many times can I claim medical insurance?
You can claim multiple times during a policy year until the sum insured limit is exhausted.
Will my existing health insurance policy cover hospitalisation expenses during COVID-19?
Most health insurance plans cover COVID-19 hospitalisation, including pre- and post-hospitalisation expenses, depending on policy terms.
Are any waiting periods applicable to claims under COVID-19?
Yes. Many COVID-19 policies have a waiting period ranging from 15 to 30 days.
Will the policy cover the expenses for home quarantine?
Many insurers cover home care treatment if home isolation is medically advised.
What are pre-existing diseases in health insurance?
These are illnesses or medical conditions diagnosed before purchasing the policy, such as diabetes, asthma, or thyroid disorders.
Does health insurance cover pre-existing conditions?
Yes, many insurers cover pre-existing diseases after a waiting period, usually between 2–4 years.
What is a ‘waiting period’ in health insurance?
It is the duration during which certain claims are not allowed after buying the policy.
Which is the best health insurance plan in India?
There is no single "best" health insurance plan in India. The right plan depends on your age, medical history, budget, coverage needs, network hospitals, claim settlement process, and additional benefits. Compare multiple plans before making a decision.
Is a PAN card mandatory to buy health insurance?
No, a PAN card isn't mandatory to purchase a health insurance policy. Insurers may ask for it only to verify your identity and age, not as a compulsory requirement.
When is open enrollment for health insurance in 2026?
India does not have a fixed open enrollment period for purchasing health insurance. You can buy or renew a health insurance policy at any time during the year. However, some employer-sponsored group health insurance plans may have specific enrollment windows set by the employer.
What is a deductible in health insurance?
A deductible is the amount you must pay out of your own pocket before your health insurance policy starts covering eligible medical expenses. Once the deductible is met, the insurer pays the covered expenses according to the policy terms and conditions
Is income proof required to buy health insurance?
No, most insurers don't ask for income proof when you buy a health insurance policy. Basic KYC documents like ID and address proof are usually enough.
Can I buy a health insurance policy without going through an agent?
Yes, you can buy health insurance directly from the insurer's website or through an online platform like Bajaj Finance Insurance Mall — no agent required. This also means no brokerage fees, and you can compare and choose your plan at your own pace.
What is the policy tenure for health insurance plans?
Health insurance plans in India are usually available for 1, 2, or 3-year terms, and some insurers even offer up to 5 years. Longer tenures often come with a discount on the total premium, so it's worth comparing before you decide.
What's the difference between an individual and a family floater health insurance plan, and which should I choose?
An individual plan gives each family member their own separate sum insured, while a family floater plan lets the whole family share one common sum insured — usually at a lower combined premium. Floater plans work well for younger, smaller families; if your family has older members or someone with health conditions, individual plans might offer more reliable coverage since one person's claim won't eat into everyone else's cover.
Can I buy separate health insurance for my spouse or siblings?
Yes. You can insure your spouse, siblings, or any other family member either under their own individual policy or by adding them to a family floater plan, depending on what suits your household better.
Which diseases or conditions are usually not covered under health insurance?
Most health insurance policies exclude HIV/AIDS treatment (though a few insurers do cover it), congenital external conditions, sexually transmitted diseases, and cosmetic or dental treatment unless medically necessary. Since exclusions vary by insurer, it's a good idea to check your specific policy wording for the full list.
Is there a health insurance plan with no waiting period at all?
Every health plan has a standard 30-day initial waiting period, except for accidental hospitalisation, which is covered from day one. Some insurers do offer "Day 1 coverage" for select pre-existing conditions as an add-on, letting you skip the usual multi-year wait.
Is GST applicable on health insurance premiums in 2026?
Yes. As of 2026, health insurance premiums in India continue to attract 18% GST. The GST is included in the total premium payable by the policyholder. While there have been discussions about reducing or exempting GST on health insurance, no nationwide change has been implemented so far.
When is open enrollment for health insurance in 2026?
Unlike some countries, India does not have a fixed open enrollment period for health insurance. You can purchase a new health insurance policy or port your existing policy at any time during the year.
However, it is advisable to:
- Buy health insurance early to complete waiting periods sooner.
- Renew your policy before its expiry date to avoid a break in coverage.
- Port your policy before the renewal date if you wish to switch insurers.
What is PM Modi's ₹5 lakh medical insurance scheme?
The ₹5 lakh medical insurance scheme refers to Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), a government-sponsored health insurance scheme.
Key features include:
- Provides up to ₹5 lakh per family per year for eligible secondary and tertiary hospitalisation.
- Offers cashless treatment at empanelled public and private hospitals across India.
- Covers eligible families identified under government criteria.
- Includes hospitalisation, surgeries, medicines, diagnostics, and other eligible medical expenses.
- There is no restriction on family size, age, or gender for eligible beneficiaries.
Eligibility is determined based on government databases and specified beneficiary criteria.
How do I choose the best health insurance plan for my needs?
When comparing health insurance plans, consider the following factors:
- Choose an adequate sum insured based on your age, city, family size, and expected healthcare costs.
- Review the coverage for hospitalisation, daycare procedures, pre- and post-hospitalisation, critical illnesses, maternity, AYUSH treatments, and wellness benefits.
- Compare waiting periods for pre-existing diseases and specified treatments.
- Check the network hospitals to ensure cashless treatment is available near your home or workplace.
- Review co-payment, deductibles, and room rent limits to understand your out-of-pocket expenses.
- Compare premiums without compromising on essential coverage.
- Evaluate the insurer's claim settlement record and customer service quality.
- Look for lifetime renewability and optional add-ons such as restoration benefits, no-claim bonus, or critical illness cover.
Choosing a plan that balances comprehensive coverage, affordability, and a reliable claims experience will help ensure long-term financial protection against medical expenses.
Disclaimer
*T&C Apply. Bajaj Finance Limited (‘BFL’) is a registered corporate agent of third party insurance products of Bajaj Life Insurance Limited (Formerly known as Bajaj Allianz Life Insurance Company Limited), HDFC Life Insurance Company Limited, Life Insurance Corporation of India (LIC), Axis Max Life Insurance Limited((formerly known as Max Life Insurance Company Limited.), Bajaj General Insurance Limited(Formerly known as Bajaj Allianz General Insurance Company Limited), SBI General Insurance Company Limited, ACKO General Insurance Company Limited, HDFC ERGO General Insurance Company, TATA AIG General Insurance Company Limited, ICICI Lombard General Insurance Company Limited, New India Assurance Limited, Chola MS General Insurance Company Limited, Zurich Kotak General Insurance Company Limited, Star Health & Allied Insurance Company Limited, Care Health Insurance Company Limited, Niva Bupa Health Insurance Company Limited, Aditya Birla Health Insurance Company Limited and Manipal Cigna Health Insurance Company Limited under the IRDAI composite registration number CA0101. Please note that, BFL does not underwrite the risk or act as an insurer. Your purchase of an insurance product is purely on a voluntary basis after your exercise of an independent due diligence on the suitability, viability of any insurance product. Any decision to purchase insurance product is solely at your own risk and responsibility and BFL shall not be liable for any loss or damage that any person may suffer, whether directly or indirectly. For more details on risk factors, terms xit and conditions and exclusions please read the product sales brochure & policy wordings carefully before concluding a sale. Tax benefits applicable if any, will be as per the prevailing tax laws. Tax laws are subject to change. BFL does NOT provide Tax/Investment advisory services. Please consult your advisors before proceeding to purchase an insurance product. Visitors are hereby informed that their information submitted on the website may also be shared with insurers. BFL is also distributor of other third party products from Assistance service providers such as CPP Assistance Services Private Limited, Bajaj Finance Health Limited. etc. All product information such as premium, benefits, exclusions, value added services etc. are authentic and solely based on the information received from the respective Insurance company or the respective Assistance provider company.
Note- While we have made all the efforts and taken utmost care in gathering precise information about the products, features, benefits etc. However, BFL cannot be held liable for any direct or indirect damage/loss. We request our customers to conduct their research about these products and refer to the respective products sales brochure and policy/membership wordings before concluding sales.