Health Insurance for Kids: What to Know Before Choosing a Plan

Welcoming a child into the world is a moment of joy and one that deserves the best protection right from day one. With that comes a growing demand for quality pediatric care, which isn’t always affordable. That’s why choosing the right health insurance for kids is more important than ever. 

But the dilemma doesn’t end here. At Ditto, we have seen several families caught off guard by long waiting periods, missing OPD coverage, or plans that don’t cover newborns at all!

That’s why, our in-house advisors have narrowed down the top 5 health insurance plans for children that offer comprehensive benefits. In this guide, we will also walk you through examples of what can go wrong when buying a plan and how to avoid those mistakes. 

Top 5 Health Insurance Plans for Kids in India

Plan Name	Entry Age for Kids	Exit Age for Kids (Family Floater)	Family Floater Structure	Waiting Period
HDFC Ergo Optima Secure	91 days (Family Floater, dependent) 5 years (Individual, parent proposer)	26 years	4 Adults + 6 Children	Initial: 30 days: Specific Illness (SI): 2 years Pre-existing disease (PED): 3 years
Care Supreme	91 days (Family Floater, dependent)	25 years	2 Adults + 2 Children	Initial: 30 days SI: 2 years PED: 3 years
Aditya Birla Activ One Max	91 days (Family Floater, dependent) 5 years (Individual, parent proposer)	26 years	2 Adults + 4 Children	Initial: 30 days SID: 2 years PED: 3 years
Niva Bupa Aspire Titanium+	Day 1 cover for newborn (if maternity claim was approved) 91 days (Family Floater, dependent)	Not Applicable	2 Adults + 4 Children	Initial: 30 days SI: 2 years PED: 3 years
ICICI Elevate	Day 1 cover for newborn (if maternity claim was approved 91 days (Family Floater, dependent) 5 years (Individual, parent proposer)	30 years	2 Adults + 3 Children	Initial: 30 days SI: 2 years PED: 3 years

To sum it up, our top picks strike a balance between newborn coverage, OPD benefits, and affordable premiums. These options are backed by Ditto’s conversations with concerned parents and our analysis of various insurance needs for children.

Do Kids Really Need Separate Health Insurance?

It depends. We will walk you through three options and explain what each one is best suited for. 

1) Group Health Insurance (via Employer)

Group plans can be convenient because they often cover the entire family, including children, at no extra cost. However, they come with limitations.

For instance, one of our customers who is a new mom, realized that her company’s ₹3 lakh group cover wasn’t enough when her baby needed emergency care. In the end, she had to pay ₹1.5 lakhs out of pocket due to room rent caps and other exclusions that she overlooked in her corporate policy’s fine print.

Ditto’s Take: A group health insurance cover ends when you leave your job, and many plans don’t include outpatient care or early newborn coverage. It’s great as a backup, but it may not be enough for your child’s primary protection. That’s why our advisors recommend opting for a retail plan in addition to your existing employee health insurance policy.

2) Standalone or Multi-Individual Child Plans

Standalone health insurance policies are the ones where each family member, including children, are insured individually with their own sum insured. These multi-individual policies ensure that one person’s claims do not affect another’s coverage. 

So, if you want your child to have dedicated coverage, standalone plans are an excellent choice. You or your spouse can easily become the proposer, that is, the person who buys and manages the policy on the child’s behalf. 

But here’s the catch: most insurers don’t allow individual plans for children under 5.

For example, a couple had a ₹15L floater covering them and their 4-year-old. But when the mother met with an accident, the cover was exhausted, and there was nothing left for the child.

The fix?

They bought a new ₹15L floater for the child and one parent. Later, the child was removed from the old family floater plan after serving all the waiting periods.

On a positive note, a few insurers allow you to purchase multi-individual plans. For instance, HDFC Optima Secure enables children aged 5 and above to be insured independently with the parent as proposer. 

For instance, if you are based in Chembur, Mumbai (pincode: 400088), here are some health insurance options you can consider for your child’s coverage:

Option 1: Family Floater (2 Adults + 1 Child)

Sum Insured: ₹15 lakhs

Total Premium: ₹30,743

Policy Type: Floater - Single policy covering all three members

Option 2: Split Policy

Sum Insured: ₹15 lakhs

Family Floater for Parents (2 Adults): ₹25,825

Individual Cover for Child (age 5): ₹10,930

Total Premium: ₹36,755

The difference between the premiums for option 1 and 2 is ₹6,012. This means you pay approximately 20% more if you choose the second option. However, it gives your child an independent cover, which can be advantageous.

Note: Standalone child plans can offer more focused protection, but they’re not always easy to get. And even when they do, premiums can be disproportionately high compared to coverage.

3) Family Floater Plans

Family floaters are the most common way parents cover their kids. It means you have one policy, one premium, and shared coverage for the entire family. Most insurers allow children to be added from the 91st day after birth, and they can remain on the plan until the age of 25 to 30 years. 

However, family floaters are not ideal for covering kids if elderly parents or high-risk members are also on the same plan. Shared coverage can also leave the child vulnerable, especially if multiple claims are made in a year.

Ditto’s Take: Family floater plans are best for covering children, especially if there are no pre-existing conditions. So, make sure you take a sufficient coverage amount and choose comprehensive plans with features like unlimited restoration and competitive bonuses.

What to Look for in a Health Plan for Children

Health insurance for kids isn’t just about the coverage amount, but about a mix of features that offer complete protection. Here’s what to assess before you purchase a policy for your child:

1) Newborn Cover: What Most Parents Do Not Realize 

Most parents assume their baby is automatically covered under their health insurance plan the moment they are born. But in reality, most retail health insurance policies only start covering a newborn after 90 days of birth.

This means for the first three months, you either need a maternity-linked plan or be prepared to cover expenses out of pocket. So, when choosing insurance for your child, make sure you check the minimum age criteria and plan accordingly.

At Ditto, we’ve come across three retail plans that break this pattern: 1) Niva Bupa Aspire: This plan offers newborn coverage up to the full sum insured from Day 1, provided that the maternity claim for the mother was admissible. 2) Star Women Care Plan: Pregnant women can buy this plan after completing prescribed scans during the 12th and 20th week (at Star-approved centers). If accepted, the newborn is covered from birth, including congenital defects, for up to 25% of the sum insured in the first year. 3) Star Health Super Star Plan (with Women Care Add-On): This plan also offers Day 1 newborn coverage if scans are submitted during pregnancy. The newborn is covered for congenital conditions and hospitalization expenses till the end of the policy year, but with caps (e.g.,₹2 lakh for ₹5–25 lakh sum insured).

2) Health Checkups

Early detection is crucial when it comes to children, especially in cases of developmental delays or nutritional deficiencies. That’s why many health insurance plans offer annual health checkups for all insured members, including kids.

But not all health check-up benefits are created equal. Here’s what you need to check:

• Is it cashless or reimbursement-based?
• When can you claim the test: annually or only for the claim-free year?
• Are tests like physical examination, eye checkup, or doctor consultations included?
• Is it for adults only, or all insured members?

For instance, health checkups at HDFC Optima Secure are usually settled on a reimbursement basis. However, this option is available only after the first policy renewal, with limits ranging from ₹1,500 to ₹15,000 depending on the base sum insured.  

Care Supreme also offers preventive health checkups as an add-on, covering a package of tests for general health assessment. These are cashless, available once a year per insured person, and can be booked via the app at a network facility. However, the add-on excludes diagnostic or investigative tests meant to evaluate a specific illness or disease.

To sum it up: If you are buying the plan primarily to support your child’s health, make sure the check-up benefits include them too.

3) OPD: Small Bills, Huge Impact

Children fall ill frequently, but not every illness requires hospitalization. In fact, most health issues in the early years are handled through outpatient doctor visits, short-term medications, or minor procedures. This is where an OPD cover becomes valuable.

It specifically covers regular pediatrician check-ups, ear infections, and seasonal fevers. 

While OPD cover is useful, it often comes with limitations like high premiums, low sub-limits, and caps on the number of hospital visits.

Ditto’s Recommendation: If your child has recurring health issues or needs frequent check-ups, OPD coverage can save you money. Currently, HDFC Ergo Optima Secure and Care Supreme offer relatively useful OPD add-ons worth exploring.

4) Cashless Network Near Your Home

Children can go from fine to fragile in minutes due to a high-grade fever or an unexpected fall. In such moments, there’s no time to compare hospital networks. That’s why it’s critical to ensure your insurer’s cashless network includes a trusted pediatric hospital close to home because handling paperwork for reimbursement is the last thing you want to do in such emergencies.

For instance, HDFC ERGO health insurance has a good cashless network of pediatric hospitals like Apollo, Fortis, Manipal, and Rainbow Children’s Medicare Ltd. You can find these hospitals across major Indian cities like Bangalore, Mumbai, Hyderabad, and New Delhi. 

This makes HDFC ERGO an excellent choice for parents who want quick, hassle-free access to quality treatment for their children.  

5) Bonuses and Restoration Benefits

Kids with lower immunity can fall sick often. If one hospitalization exhausts the cover, restoration refills it, so future claims are still covered. It’s the simplest way to get higher coverage without paying extra premiums. 

Many plans reward you by increasing your sum insured (in the range of 50-100%) every year if you don’t make a claim. 

For instance, Aditya Birla Activ One Max gives you a 100% bonus per annum up to 500% of the sum insured, regardless of claims. Conversely, Niva Bupa Aspire allows you to carry forward any unutilized sum insured up to 10x of the base amount, which works like a no-claim bonus.

Our Recommendations: 1) Opt for unlimited restoration benefits that apply to both the same and different illnesses, and get triggered even on partial exhaustion of the sum insured. 2) Look for inbuilt cumulative bonuses that increase your sum insured annually, even after a claim.

Standalone vs. Family Floater: What’s Better for Kids?

There’s no “one-size-fits-all” answer. It depends on what matters most to you: cost, flexibility, or complete peace of mind.

Let’s break it down.

Feature	Standalone Plan (for Child)	Family Floater
Cost	Higher premium (since it's a separate policy)	Lower premium (shared across family)
Eligibility	Offered from specific ages only (Say 5+ years old)	Day 1 cover for new born (if plan allows) or generally after 91 days of birth.
Sum Insured	Entire sum insured is reserved for the child	Shared sum insured; may get used up by other family members
Coverage Type	May include OPD, health checkups, and wellness benefits	Broader coverage, but not child-specific
Flexibility	Can upgrade or port child’s policy independently	One policy for all and harder to customize for just one person
Best For	Families with multiple children, aging parents, or frequent claims	Smaller families with low health risks
Long-Term Use	Easy to transition into an adult plan later	May need restructuring as the child grows older

To sum it up, a standalone plan is suitable if you want uninterrupted coverage for your child. Conversely, a family floater would be an excellent option if you are looking for budget-friendly, consolidated polices. 

Common Exclusions in Child Health Insurance Plans You Shouldn’t Miss

While child health insurance offers critical financial support, it’s not an all-inclusive cover. That’s why we recommend keeping an eye on these common exclusions: 

1) Genetic and Congenital Conditions

A congenital anomaly refers to a condition present since birth. These can be classified as internal congenital anomalies that affect organs and external congenital anomalies that affect external parts of the body. 

Most policies only cover internal congenital anomalies like heart defects and cleft palate, while the external anomalies like limb malformations are typically excluded. 

If your child has a congenital condition that is also categorized as a pre-existing disease, the coverage will depend on the medical underwriting. The insurer may either accept, reject, or impose waiting periods or premium loading charges based on the condition.

Quick Note: The IRDAI has directed all insurers to cover internal congenital diseases under health insurance policies. This means that newborns with internal congenital birth defects must be provided coverage from day one, without any waiting periods, sub-limits, or restrictive conditions.

2) Developmental Therapy and Learning Support

Speech therapy, occupational therapy, behavioral counseling, and ADHD support aren’t considered “medical treatments” by most insurers. They are often labeled as non-medical or educational expenses, which means claims are likely to get rejected. 

If your child is showing early signs of developmental delays, look for a plan that explicitly mentions coverage for OPD, counseling, or therapy sessions. 

The Niva Bupa Aspire plan is a good choice here as it offers you additional benefits through the WellConsult (OPD) add-on. Priced at ₹5,700 per annum, these benefits can be accessed only through the Niva Bupa app. They include: 

• Unlimited Tele-consultations 
• Physical Consultations and Diagnostics up to ₹10,000
• Pharmacy Coverage up to ₹2,500
• Unlimited Online Fitness, Diet, and Nutrition Coaching
• Up to 10 Online Emotional Wellness Sessions
• Cashless (Covered for Tele and Physical Benefits)
• Reimbursement (20% Co-pay)

3) Nutritional and Growth Supplements

Health insurance plans exclude expenses related to nutritional needs because these are often considered non-payable lifestyle or dietary choices. So, your kid’s plan will not include any nutritional therapy, growth hormone supplements, and protein powders or baby formulas.

4) Vision and Dental Cover

Dental treatments like cleanings, fillings, braces, or cosmetic work are excluded. Coverage applies only if dental procedures are needed due to accidental injuries or underlying conditions like oral cysts or infections. 

Most health insurance plans also exclude the costs of glasses, contact lenses, and eye checkups.

Note: 1) LASIK or corrective surgery may be covered only if the refractive error is: 2) Greater than +7.5 Diopters (e.g., +7.75D) Less than -7.5 Diopters (e.g., -7.75D)

How to File a Claim for Your Child?

We understand how stressful health emergencies are, especially when they involve your children. The last thing you want is a messy claim process.

The good part is that the steps are the same as those of a standard health policy. So let’s take a quick look: 

1) Cashless Claim

Step 1: Inform your insurer as soon as your child is admitted. Many insurers also allow pre-authorization if it’s a planned procedure. However, this should be initiated at least 24-48 hours in advance. In case of an emergency, you may inform the insurer within 24 hours of admission. 

Step 2: Share your health insurance ID card and policy details at the hospital's insurance desk.

Step 3: You may be asked to submit a few basic documents, such as your child’s birth certificate, your ID proof, doctor’s admission note or prescription, and policy number and insurer name. 

Step 4: The hospital and insurer coordinate directly. The insurer may also verify the case via a third-party aggregator (TPA).

Step 5: If approved, the bill (partially or fully) is settled directly with the hospital. You may still need to pay for non-medical items like gloves or food.

However, some policies like HDFC ERGO Optima Secure and Aditya Birla Activ One Max offer in-built consumable covers for non-medical items like gloves, oxygen masks, mineral water, etc. 

Non-payable items are also covered as optional add-ons in plans like Care Supreme (Care Shield) and Niva Bupa Reassure 2.0 (Safeguard+). 

2) Reimbursement Claims

Step 1: Inform your insurer about the hospitalization as soon as possible, even if it’s a day-care procedure.

Step 2: After discharge, collect all original documents, including your child’s hospital bills, discharge summary, doctor’s prescription, and other pharmacy bills. You must also fill out the claim form downloaded from the insurer’s website. 

Step 3: Submit the complete set to your insurer, either online or at the nearest branch.

Step 4: The insurer will verify the claim. If all goes well, you will receive the approved amount in your bank account within 2 to 3 weeks.

Reality Check: Reimbursement claims usually take longer. Missing even one document, like a signed bill or a stamped discharge note, can delay the process significantly.

When and How to Buy a Policy for Your Child?

Your child’s age plays a significant role in deciding the best insurance approach. Here's a simple breakdown:

1) Newborn to 5 Years

After the initial 90-day period where most health insurance plans don’t offer infant coverage, children automatically become eligible for standard health insurance. However, standalone policies in this age group are rare and often not available.

Best option: Add the child to a family floater with either parent as the primary insured.

2) 5 Years to 18 Years

At this age, children can be:

• Added to a family floater
• Covered under a separate individual policy (but the proposer must be a parent or guardian)

Quick Tip: Sometimes, a separate plan for the child can be cheaper if the parents are older and causing the family floater premium to spike. So, make sure to compare plans carefully before getting health insurance for kids. 

3) 18 Years and Above

Once your children turn 18, they are legally adults. However, they can still be a part of the family floater, depending on the insurer. A good option for them is to exit the shared cover plan and buy their own policy, which our advisors recommend for long-term benefits.

Pro Tip: 

• Premiums are lowest at this age, and starting a new policy now means they can easily serve out waiting periods while young and healthy. It’s also a great way to build financial responsibility and instill the habit of maintaining personal health coverage.

What About Documentation and Medical Checks? 

At Ditto, we usually recommend keeping the following documents ready when purchasing health insurance for kids: 

• Birth certificate and Aadhar (if available) of the child
• Your ID proof (as the proposer) - Aadhar and PAN card
• Address proof
• Medical reports, if the child has any pre-existing health conditions
• Medical check-ups are rare, but may be requested for high sum insured or special cases (depending on medical history)

Add-On Options Worth Exploring

• Consumables Cover: Many pediatric hospitalizations include non-medical items like gloves, baby wipes, or syringes, which standard policies don’t always cover.
• OPD or Annual Health checkups: While OPD covers may sound helpful for frequent doctor visits and vaccinations, we usually don’t recommend them. Moreover, annual health check-ups are already included in most comprehensive plans, so you don’t need to buy them separately.

Put simply, start by adding your child to a family floater, then explore individual plans as they grow.

Why Consider Ditto for Health Insurance

At Ditto, we’ve assisted over 7,00,000 customers with choosing the right IPD or OPD health insurance policy. Here’s why customers like Pankaj love us:

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Health Insurance for Kids: Key Takeaways

Choosing health insurance for kids can be overwhelming. Well, it doesn’t have to be, and you can select the best plan by keeping the following in mind:

• Your child’s coverage matters the most, so never compromise on features like newborn coverage, OPD covers, and wellness benefits.
• If you have more than one child or older parents, consider a separate plan instead of a family floater.
• Clarify things beforehand to ensure there are no unnecessary exclusions in your child’s health insurance plans. 

Still unsure which child health insurance plan is right for your family? WhatsApp us or book a free call with a Ditto advisor to get personalized, unbiased guidance. We will help you find the best protection for your little one.

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