Health Insurance in Mumbai

Over the years, IRDAI, or the Insurance Regulatory and Development Authority of India has long advocated purchasing comprehensive health insurance policies. While this led to an increased number of health insurance policyholders, the actual impact was felt after the pandemic hit. A first-hand and second-hand experience of the pandemic in its full effect, the ensuing sizeable hospital bills and the acknowledgement of the fragility of human lives acted as catalysts to boost the sale of health insurance plans. 

This popularity of health insurance policies was spread thin across all cities, irrespective of whether they were Tier 1, Tier 2, or Tier 3 cities. However, when it comes to Tier 1 cities like Mumbai, the purchase of health insurance plans holds a different significance. When thinking of health insurance plans in Mumbai, you need to consider requirements, significance, pricing, and top policies and insurers. 

Pro tip: The health insurance market can be a labyrinth. Instead of spending hours navigating through the hundreds of policies out there, why not book a 30-minute call with our expert IRDAI-certified advisors? We don’t spam or pressure you to buy. Just honest insurance advice.

Mumbai and Health Insurance 

Mumbai - a city with a sizeable population, is known to be a “City of Dream.” However, the city is extremely expensive, owing to - 

• The commercial hub of India: Mumbai is the home to the Bombay Stock Exchange and the National Stock Exchange. Naturally, the infrastructure across the city is pretty pricey. 
• Property prices are sky-high: Mumbai is geographically stunted, considering that the Arabian Sea surrounds it on one side. Naturally, the poor infrastructure pushes people to become willing to pay more for properties that would allow them to stay close to the city and its business centre. 
• Mumbai is the fashion capital of India. The city is luxurious and resonates with the royal lifestyle of the celebrities who reside there. 

Why do you need health insurance policies in Mumbai?

1. An expensive healthcare service bill: Mumbai has a high cost of living that also casts its shadow on the city's medical services. Being a Tier 1 city, Mumbai’s healthcare services are already more expensive than those of Tier 2 or Tier 3 cities. Additionally, since Mumbai calls for a higher cost of living, hospital bills can be quite expensive. 

Under such circumstances, you require funding that would kick in in times of medical urgencies/emergencies without eating away at your savings (that would be extremely useful in an expensive city like Mumbai). This is where a health insurance policy in Mumbai could come to your respite. 

2. The higher chances of lifestyle ailments: While staying in a Tier 1 city offers you exposure to better opportunities, it, unfortunately, also increases the chances of acquiring lifestyle ailments like hypertension, asthma, cholesterol, diabetes, and more. Credits for these ailments can be attributed to the “rat race” in Tier 1 cities, the busy livelihood, and the maximised efforts to build a career of fame and glory. 

Now, such lifestyle ailments might also require you to get frequent treatments or hospitalisations. Hence, you are looking at a sizeable bill (thanks to your location in a Tier 1 city) that requires a comprehensive and pocket-friendly health insurance policy. 

Things to remember when choosing health insurance plans in Mumbai

#1. Expect high premiums

Staying in a Tier 1 city means you have an expensive cost of living. Every aspect of your life incurs a higher bill. This tantamounts to a substantial financial burden. Subsequently, healthcare services in Tier 1 cities like Mumbai involve a much higher amount than those of Tier 2 and Tier 3 cities. As a result, health insurance providers demand a hefty premium that would cover the extensive bills. 

Let’s take an example to understand this difference in health insurance premiums better - 

Don, a 25-year-old healthy man, takes a ₹10 lakh health insurance policy. Here’s how his premiums would differ depending on whether he stays in a Tier 1 city (say Mumbai) or in a Tier 2 city (say Kochi)

(The plan and insurer used for the example are among the top 3 best health insurance providers across the country)

(Now, please remember that this is 10 lakhs covered for a healthy individual, i.e. no pre-existing ailments. Hence, the difference in premium, in this case, might not be much.)

#2. Remember to get sizeable coverage 

By now, you know that hospitalisations in Mumbai would result in hefty bills. Subsequently, you would need substantial health insurance coverage to cater to the bills. On the other hand, since premiums get pretty pricey with a higher cover amount, you can always opt for a nominal base cover, say ₹10 - ₹15 lakhs accompanied by a Super Top-Up health insurance policy. (Read below to know more) 

#3. Check Super Top Up health insurance plans 

As mentioned before, a health insurance policy in Mumbai should necessarily have a substantial cover amount. However, since health insurance premiums are extremely pricey in Tier 1 cities like Mumbai, and if you are concerned about the affordability angle, then having a Super Top-Up health insurance policy might be helpful. The latter will offer you a multitude of perks - 

• High coverage can result in your total coverage being close to a crore. 
• Nominal premium since Super Top-Ups charges a minimum amount. 
• A single deductible is charged across the year. 

#4. Ensure that your health insurer has an extensive network of partner hospitals 

Cashless health insurance premiums can be a major benefit when there is an extensive hospital bill in question. To tap into this perk, you need to approach a partner hospital. Now, Mumbai might be a city spread across only 603.4 square kilometres, but it’s a city of commerce that hosts multitudes from all corners of the nation. Hence, there are multiple medical facilities all over the city. 

However, you need to ensure that your health insurer has a high number of network hospitals close to your residence. This will maximise your chances of tapping into the cashless health insurance perk, which will prevent you from spending a penny from your pocket.   

How to choose the best health insurance plans in Mumbai?

1. Choose the perfect health insurance provider. 

a. Claim Settlement Ratio: Calculated as the number of health insurance claims settled in a year against the number of claims raised to the insurer in the year, the Claim Settlement Ratio, or CSR, is one of the crucial metrics used to determine an insurer's credibility. It sheds some light on the insurer's claim settlement track record. 

Here is a quick look at the CSR of some of the top health insurance providers (average of data from 2021 to 2024) - 

However, it would be good to remember that CSR numbers can easily be misleading since they do not reflect whether the claim has been settled entirely or partially. A CSR of 90 or above is the best way forward for a credible health insurer. On the other hand, if an insurer’s CSR is less than 80, you might start looking around for other providers. 

b. Incurred Claim Ratio: An insurer's Incurred Claim Ratio (ICR) indicates the provider's future sustainability and, hence, its claim settlement potential. The ICR metric is measured by dividing the total amount spent settling claims against the total amount collected as premiums across the year. 

Here is a quick look at the ICR of some of the top health insurance providers (average of data from 2021 to 2024) - 

The ideal ICR of a health insurer lies between 50 and 70. An ICR of less than 50 suggests that the insurer is too focused on building its business profits, and an ICR of more than 80 means that the insurer is too focused on settling claims (which might seem great in the short term, but in the long run, the insurer might face a financial crunch). 

c. Complaint Volume: When choosing a health insurance provider, it's important to consider the number of complaints the insurer receives (per 10,000 claims filed). This metric offers valuable insight into the claim settlement experience of current policyholders. As most complaints arise from delayed or denied claims, the complaint volume strongly indicates the insurer's approach to handling claims and their ability to settle them efficiently.

Here is a quick look at the complaint volume of some of the top health insurance providers (average of data from 2021 to 2024) - 

d. Annual Average Business Income: While this may not be an exact measure of an insurer’s credibility, understanding their annual business volume helps you gauge the scale of the insurer’s operations and the potential size of its client base. Since you are entrusting a significant coverage amount to the insurer, choosing a medium- or large-sized provider with a strong client base is advisable, as this often reflects their reliability and established track record in the insurance industry.

Here is a quick look at the average annual business income of some of the top health insurance providers (average of data from 2021 to 2024) - 

2. Opt for the best health insurance policy

• Ample coverage 
• No room rent restrictions 
• No copayment 
• No disease-wise sub-limits 
• Unlimited restoration
• Low waiting period
• Daycare coverage 
• Domiciliary coverage 
• AYUSH coverage 
• Modern treatment coverage 

What are the Best Health Insurance Plans in Mumbai for 2025?

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