Understand Your Health Insurance Policy

What is a health insurance policy?

A Health insurance policy is a contract underscored by one key arrangement – You pay a sum every year or every 2 years or every 3 years, depending on how you structure the policy and you get the insurance company to pay for all medical expenses you incur when you’re eventually hospitalized.

The sum you pay every year is called the premium. And the protection you receive in return is characterized by the total cover or the Sum Insured. So the first question you consider when buying a health insurance policy is this –

What kind of cover should I need? Or in other words what is the ideal Sum Insured?

Well, that depends on a few things. But in general, a cover of anywhere between ₹10–20 lakhs is a good option to consider. If you go under ₹10 lakhs, say ₹2–3 lakhs, then you run the risk of short-changing yourself.

Sure, ₹2–3 lakhs isn’t a modest sum by any account. But it isn’t a life-changing sum either. If you’re ever hospitalized for an ailment, you will likely be able to put together this kind of money without an insurer. It won’t be pleasant and it most certainly won’t be easy. But it’s something that you can hope to cobble together if you really need the cash.

What will cripple you however is the bone marrow transplant that costs ₹20 lakhs. Or the recurring cancer treatment that can push you to the brink of financial ruin. And the ₹2–3 lakh figure simply won’t cut it. Also, medical costs keep rising disproportionately each year. In fact, medical inflation is routinely pegged at 10+%. So if you buy a ₹5 lakh plan today, it may only be worth ₹2.5 lakhs in a few years because inflation is making everything more expensive.

So starting off at ₹1–5 lakhs may not be the most prudent option. Unless you simply don’t have the provision to set aside more money. In which case some cover is better than no cover.

Alright, but if ₹1–5 lakh isn’t an option, where are we drawing the line then? Should we go ₹50 lakhs? or ₹1 crore? What’s the top limit?

Well in our experience, even the more expensive treatments hardly ever breach the ₹20 lakh mark. You’d have to really struggle to find a comprehensive list of treatments that will cost you more. Also in most cases, health insurance policies offer you significantly higher protection than you may have imagined. For instance, with a comprehensive policy, you could get a base cover of say ₹10 lakhs, a no-claim bonus that could add another ₹10 lakhs in a couple of years, and a restoration benefit that would offer you an additional ₹10 lakhs worth of protection. All in all, you’d be covering for most exigencies by picking a cover anywhere between ₹10–20 lakhs without spending a fortune.

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How to buy a health insurance policy?

Before buying a health insurance policy, you need to consider a few key things.

First, pick the right insurer.

1. A good insurer should have a robust claim settlement ratio, any figure greater than 90% is stellar.
2. A good insurance company should have a large network of partner hospitals. Preferably 7000+.
3. A good insurer should have an extensive track record. Anything greater than 5 years is a pretty decent number.
4. A good insurer should also host an extensive product portfolio. Products that cover use cases with maternity benefits, outpatient consultations, senior citizens, heart patients, etc.
5. A good insurer should also be proactive in dealing with customer queries. In this regard, we generally find private insurance companies do better than public insurers.

Best Health Insurance Companies in India

Note that this isn’t an all-encompassing list. Instead, it’s expected to offer you some guidance.

Checklist of essential features in a good health insurance policy

• A good policy should have no room rent restrictions.
• It will not impose a co-payment clause.
• It should offer a no-claim bonus of atleast 50%.
• A good policy should extend a restoration benefit of atleast 100%.
• A good policy must have short waiting periods for pre-existing conditions.
• A good policy should offer pre and post-hospitalization care. Preferably 60 days before hospitalization and 90 days post hospitalization.
• It should also cover daycare treatments.
• A good policy should also offer a free health checkup every year.

Also, we have a dedicated page for Health Insurance checklist here. You can read about it in some more detail.

Once we have a checklist for insurers and the policies themselves we can make a list that includes the best health insurance policies for 2025 .

However, do note that the article so far describes how to pick a health insurance policy for generic cases. But if you’re reading this, you probably have a very specific use case. You could be looking to buy health insurance for a family. You could be a married couple looking to cover your newborn. You could be somebody looking to buy a policy at a bargain price. And in each case, there will be subtle differences in how you ought to approach health insurance.

So let's start with the most popular use case - Families.

How do you pick a health insurance policy for families?

The short answer is to pick a family floater plan.

The long answer is a bit more complicated. You see, a family floater policy is designed to cover you and your family under a single umbrella contract. You can include yourself and your dependents under the same plan and pay a single premium for combined coverage. However, most insurance providers have a rather narrow definition of what dependents actually mean. And they only let you include your spouse and kids alongside yourself when buying a family floater option. If you have parents and siblings, who you also intend to cover, you may not be able to do so under a family floater plan. But despite this restriction, it is an efficient and economical option if you’re looking to cover multiple members in your family and here’s why

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Benefits of a family floater option

1. It’s operationally less intensive - As opposed to buying and maintaining multiple policies for each individual, you can have a single policy that accounts for your entire family
2. It’s relatively inexpensive - If you’re picking an individual plan for each member of your family, then the premiums could be prohibitive. However, if you’re including them in a single plan, your premiums will be substantially lower
3. If you plan to insure your kids under the age of 18, you may not have many options besides including them in a family floater plan
4. It generally extends all the benefits that individual health policies extend.
5. Insurers generally extend a family floater option with most policies they market

Frequently looked policies for families:

HDFC ERGO

Optima Secure

Optima Secure is a great policy. There are no restrictions on the kind of room you can pick, you get a healthy loyalty benefit (50% increase in sum insured on every renewal until 100% of sum insured), and the heavily talked about Secure benefit. All things put together, you can get 3X the cover you originally paid for, once the loyalty benefit is fully accumulated. In many ways, this is a worthy successor to Optima Restore.

Largest Hospital Network

CARE

Care Supreme

Care Supreme is a bargain at the price at which it's selling and while it has a pre-existing disease waiting period of 3 years, you can cut this down to a mere 30 days for select conditions including Asthma, Hypertension, Diabetes, Hyperlipidimia. Similar to most plans from Care, you have to tag along add-ons to unleash its true potential.

ADITYA BIRLA

Activ One Max

Activ One Max is a variant within the Activ One policy series. This series allows customization over a base plan letting users pick and choose add-ons and Active One Max is the base plan. It includes several notable features, such as an exceptional bonus system and built-in consumable coverage. Additionally, it provides up to a 100% discount on renewal premiums, contingent upon adherence to a designated fitness regimen. If you are looking for an affordable plan with decent features, this could be a pretty good fit even without the customization.

NIVA BUPA

Reassure 2.0 Platinum+

Much like ReAssure, ReAssure 2.0 Platinum+ seems like it is the best policy in its class. Its economical. It covers most bases. It doesn't have outrageous conditions. And it offers a whole host of benefits including forever restoration (as described below), a better bonus cover package and age-lock feature (as described below once again). Unfortunately, the aggressive pricing means that Niva Bupa has the tough task of paying out ever larger claims while also managing to keep prices low. Can they do it? We don't know.

How to buy health insurance if you’re a couple planning for kids?

If you’re a couple planning for kids, you probably have your eyes set on childbirth. Unfortunately, maternity procedures are expensive. A normal delivery in a private hospital in Bangalore will cost you upwards of ₹50,000. A C-section will probably be much more expensive — ₹75,000 or more. If you’re in a more expensive facility then it will set you back a lakh or so. However if you’re planning to buy insurance, just to cover these costs, then you should know a few things.

First, insurers will increase your premiums considerably when you buy a plan with maternity benefits. A regular plan might cost you ₹9,000. But a plan with maternity will cost you ₹11,000 or more. Next, they’ll mandate something else. They’ll tell you that you can only buy a maternity plan if you have your spouse included in it as well. At this point, you have to remember that one of you is paying for the maternity benefit even though you won’t ever be making a claim yourself. Men don’t give birth to children and as such, the insurer is getting you to pay for something they know isn’t applicable to both of you. And finally, they’ll tell you that you can only make a maternity claim after 3 years of holding the policy, give or take. And they’ll also place sub-limits — ₹30,000 for normal childbirth and ₹50,000 for a C-section. So it’s entirely possible that you may pay more in premiums during a policy term compared to the actual costs associated with childbirth.

However, that doesn’t mean there is absolutely no utility here either. For instance, if your newborn has complications that require urgent medical attention, you’d be well served to have a plan that covers maternity expenses, since most plans cover your newborn with Day 1.

Frequently looked policies for couples planning a kid:

ADITYA BIRLA

Activ Fit+

This plan is specially curated for young audiences who are into fitness. It has special discounts on both first-year premiums and renewal premiums based on medical evaluations or a fitness regime matrix. It also offers online consultations for mental illnesses based on medical evaluation. All in all, it is a good plan with good features, no outrageous conditions, so long as you're under 45.

NIVA BUPA

Aspire Titanium +

Aspire Titanium+ is the most premium variant within Niva Bupa's Aspire stable. It's has some very cool features like age lock, Fast Forward, Future Protect, and Cashbag (as described below). And some of these benefits are slightly more comprehensive than Platinum+. The only problem here is that the aggressive pricing will mean that Niva Bupa has the tough task of paying out ever larger claims while also managing to keep prices low. Can they do it? We don't know.

ICICI LOMBARD

Elevate

ICICI Lombard Elevate is perhaps the most comprehensive plan on paper. Sure, it doesn't offer all the benefits in the base variant, but it offers you almost unlimited customization options (through add-ons) that you can then use to craft a plan of your liking. You can pick unlimited coverage, you can choose to cut waiting periods for pre existing diseases, you can opt for OPD and Maternity cover and you get some really unique perks like coverage for surrogate mother and Oocyte donor expenses up to ₹5 lakhs. The only caveat is that ICICI Lombard's claim settlement ratio isn't exactly stellar.

STAR HEALTH

Super Star

The Super Star plan from the stable of Star Health Insurance is a great pick (the only issue being its insurer). The plan offers a unique feature of “freeze your age,” under which your plan's premiums stay the same until your 1st claim. When you file your 1st claim, the premium starts varying from the next policy year based on your age. However, the plan’s perks extend beyond this—this policy is quite possibly one of the most heavily customisable plans in the market, with 21 add-ons, making it an interesting product to cater to your tailored requirements. Now, while the policy of Super Star doesn’t have any pitfalls, one consideration is that there have been recent online customer feedback regarding Star's claims experience, suggesting there may be room for improvement in this area.

TATA AIG

Medicare Premier

Tata Medicare Premier is a great policy considering it covers most bases and then goes beyond the traditional feature set to offer dental cover, to offer coverage for international treatments and even pay for outpatient consultations. All of these are subject to certain conditions of course, but if you are looking for comprehensive coverage very few policies can beat this. The only caveat - It is an expensive policy.

How to buy a health insurance policy if you’re a salaried individual?

If you’re a salaried individual, you likely have a corporate health insurance policy. However, bear in mind that corporate health insurance policies come with their own caveats. For one, your employer may not be particularly inclined to extend a plan with extensive benefits. And they routinely impose restrictions on these plans. The most popular restrictions include restrictions on room rent. So if you want to upgrade your room when you’re being treated for an illness, you may have to pay extra. Then there’s the fact that corporate health insurance plans only cover your expenses when you’re employed with the same company. If you quit, you will also have to let go of the benefits associated with the plan.

Meaning, all things considered, it makes sense to have a separate health insurance plan that doesn’t impose these restrictions. What plans should a salaried individual consider you ask?

Frequently looked policies for people with Diabetes:

HDFC ERGO

Energy Silver

If you're diabetic or suffering from Hypertension, then Energy is for you, considering the fact that the insurer covers all complication arising out of these chronic diseases from Day 1. However, if you aren't diabetic maybe you could look at the other options since this policy is fairly expensive.

CARE

Care Supreme

Care Supreme is a bargain at the price at which it's selling and while it has a pre-existing disease waiting period of 3 years, you can cut this down to a mere 30 days for select conditions including Asthma, Hypertension, Diabetes, Hyperlipidimia. Similar to most plans from Care, you have to tag along add-ons to unleash its true potential.

ADITYA BIRLA

Activ One Max

Activ One Max is a variant within the Activ One policy series. This series allows customization over a base plan letting users pick and choose add-ons and Active One Max is the base plan. It includes several notable features, such as an exceptional bonus system and built-in consumable coverage. Additionally, it provides up to a 100% discount on renewal premiums, contingent upon adherence to a designated fitness regimen. If you are looking for an affordable plan with decent features, this could be a pretty good fit even without the customization.

NIVA BUPA

Reassure 2.0 Platinum+

Much like ReAssure, ReAssure 2.0 Platinum+ seems like it is the best policy in its class. Its economical. It covers most bases. It doesn't have outrageous conditions. And it offers a whole host of benefits including forever restoration (as described below), a better bonus cover package and age-lock feature (as described below once again). Unfortunately, the aggressive pricing means that Niva Bupa has the tough task of paying out ever larger claims while also managing to keep prices low. Can they do it? We don't know.

Frequently looked policies for parents who are about to retire:

HDFC ERGO

Optima Secure

Optima Secure is a great policy. There are no restrictions on the kind of room you can pick, you get a healthy loyalty benefit (50% increase in sum insured on every renewal until 100% of sum insured), and the heavily talked about Secure benefit. All things put together, you can get 3X the cover you originally paid for, once the loyalty benefit is fully accumulated. In many ways, this is a worthy successor to Optima Restore.

Largest Hospital Network

CARE

Care Supreme

Care Supreme is a bargain at the price at which it's selling and while it has a pre-existing disease waiting period of 3 years, you can cut this down to a mere 30 days for select conditions including Asthma, Hypertension, Diabetes, Hyperlipidimia. Similar to most plans from Care, you have to tag along add-ons to unleash its true potential.

ADITYA BIRLA

Activ One Max

Activ One Max is a variant within the Activ One policy series. This series allows customization over a base plan letting users pick and choose add-ons and Active One Max is the base plan. It includes several notable features, such as an exceptional bonus system and built-in consumable coverage. Additionally, it provides up to a 100% discount on renewal premiums, contingent upon adherence to a designated fitness regimen. If you are looking for an affordable plan with decent features, this could be a pretty good fit even without the customization.

NIVA BUPA

Health Companion

Health companion is one of Niva Bupa (Max Bupa)'s most popular product. And for good reason. It covers most bases. It's economical. It doesn't have any unsavoury conditions. And it offers a whole host of benefits that are particularly useful. The only downside - Niva Bupa (Max Bupa) might just have a better product now and its called ReAssure. You might want to check that out.

STAR HEALTH

Super Star

The Super Star plan from the stable of Star Health Insurance is a great pick (the only issue being its insurer). The plan offers a unique feature of “freeze your age,” under which your plan's premiums stay the same until your 1st claim. When you file your 1st claim, the premium starts varying from the next policy year based on your age. However, the plan’s perks extend beyond this—this policy is quite possibly one of the most heavily customisable plans in the market, with 21 add-ons, making it an interesting product to cater to your tailored requirements. Now, while the policy of Super Star doesn’t have any pitfalls, one consideration is that there have been recent online customer feedback regarding Star's claims experience, suggesting there may be room for improvement in this area.

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How to make a claim if you have a health insurance policy?

1. In the case of emergency hospitalization, you have to intimate the insurer or make the claim as soon as you get the patient admitted. In the event that isn’t possible, you must intimate the insurer within 48 hours of hospitalization.
2. In the case of planned treatment, you have to intimate the insurer 3 days before admission. But if you can do it sooner, you should probably consider doing that as insurance companies may take a while to investigate the veracity of your request.
3. Check for partnered hospitals — Each insurer will have a dedicated network of hospitals they’ll have partnered with. Once you find a partner hospital of your liking, you can try to make the claim on a cashless basis. That is to say that the hospital will directly communicate with the insurer and bill them without asking you to pay anything out of pocket
4. If you try to make a cashless claim, you will have to fill a Pre-Authorization Request Form.
5. The form will be made available to you once you intimate the insurer that you will be making a cashless claim. You’ll have to fill in your personal details and the hospital will fill out the rest. Once complete, you can ask the hospital to submit this form back to the insurer.
6. Upon receipt of this form, the insurer will validate your claim and approve a sum that will be paid out on a fully cashless basis. In the event the treatment costs exceed this sum, then you’ll have to pay the difference and seek reimbursement once you’re discharged.
7. If you don’t find a network hospital of your liking or if the cashless claim doesn’t pass, then you may have to file for reimbursement — wherein you pay the full cost of treatment and ask the insurer to reimburse you afterwards

How to file for reimbursement?

1. Oftentimes insurance companies may be tentative to settle a claim on a cashless basis but will gladly do so once you’ve paid the bill in full. This process is called reimbursement.
2. To file a claim, you will need to download the claim form from the insurer's website. Some insurers will also have an online portal for submission.
3. The claim form is divided into two parts — Part A & Part B. You’ll have to fill out Part A and the hospital personnel will fill out part B. They’ll also have to sign and seal the document.
4. In the meantime, you have to collect and collate all the investigation and medical reports associated with your prognosis.
5. And finally, you will have to mail the original reports to the insurance company and wait for them to process your claim.

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What documents do you need while making a claim with a family floater plan?

1. Investigation and Medical reports: You will need investigation reports signed by your physician and approved by the hospital.
2. Discharge Summary: A discharge summary will include further details about your diagnosis, treatments extended and the protocols followed to effectively treat your condition. The discharge summary must be printed on hospital letterhead and include all relevant data, such as the hospital’s address, license number, and contact specifics.
3. The final bill: An itemized bill that includes expenses incurred across the board. It must have specific breakdowns, detailed statements and also include consultation charges.
4. Invoice details: Medical implants and other consumables must be supported by the invoice associated with the products.