Health insurance

A week in the ICU of a private hospital in a big city costs ₹3 lakh to ₹8 lakh. A bypass surgery is ₹4 lakh to ₹7 lakh. Cancer treatment runs well past ₹20 lakh. Medical costs in India rise faster than almost anything else, close to 10 to 14 percent a year, which means they double every six or seven years. Health insurance is the one policy every adult needs before any investment, and yet most families have either no cover of their own or only the policy their employer gives them.

A family of three or four in a metro should hold at least ₹10 lakh of cover, and more if they would choose a corporate hospital. In smaller cities ₹5 lakh to ₹7 lakh is a workable floor. Buy a base policy you can afford and raise the total with a super top-up, which is explained below. Remember the number you pick today has to cover a bill seven years from now.

Individual, floater, or both

• Individual policy: one person, one sum insuredSum insuredThe maximum the policy pays for hospital bills in one policy year.. Best for anyone with a known condition, and for parents.
• Family floaterFamily floaterOne policy with a single sum insured shared by all family members covered under it.: one shared sum insured for you, your spouse and children. Cheaper than separate policies, but a single large claim uses up the cover for everyone that year, so pick a higher amount or add a restoration benefit.
• Parents above 60: a separate policy, not your floater. The floater premium is priced on the oldest member, and their claims are the most likely, so mixing drains both the cover and your wallet.
• Employer policy: keep it as a bonus layer, never as the only layer.

The fine print that decides your claim

Top-ups, and why the office policy is not enough

A super top-up pays once your total hospital bills in a year cross a threshold called the deductibleDeductibleThe amount of bills you must bear, or cover from another policy, before a top-up starts paying.. A ₹20 lakh super top-up with a ₹5 lakh deductible costs a fraction of a ₹25 lakh base policy, because the insurer only pays for the rare big year. Pairing a ₹5 lakh base with a ₹20 lakh super top-up is the cheapest way most families can reach serious cover. Employer cover looks generous but has three flaws: it ends the day you leave, are laid off, or take a break; it is usually ₹3 lakh to ₹5 lakh and the company can shrink it; and you cannot take it with you. If you try to buy your own policy at 45 after a diagnosis, you will be refused or loaded with exclusions. Buy personal cover while you are young and healthy and let the office policy be the extra layer. In the old tax regime, premiums are deductible under Section 80D up to ₹25,000 for yourself and your family, with a separate, higher limit for senior-citizen parents.

At claim time, go cashless at a network hospital: show the policy card, inform the insurer or its TPA two to three days before a planned admission or within 24 hours of an emergency, and rules now require a decision on cashless requests within an hour and on final discharge within three hours. At a non-network hospital you pay first and claim later, so keep every bill, prescription, test report and the discharge summary; a missing paper is the usual cause of a cut. If a claim is refused, the letter will cite a waiting period, a sub-limit or non-disclosure, and you can appeal to the insurer's grievance officer and then the Insurance Ombudsman at no cost.