Compare indicative premiums from 6 top health insurers — Star Health, Niva Bupa, HDFC ERGO, Care Health, ICICI Lombard & Bajaj Allianz. Individual, family floater & senior citizen plans. Zero GST from Sept 2025.
| Insurer & Plan | Annual Premium (No GST) | Claim CSR FY 2023–24 | Network Hospitals | Key Benefit |
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All premiums indicative for standard healthy profile. CSR = Claim Settlement Ratio (IRDAI Annual Report FY 2023–24). No GST on individual health insurance w.e.f. 22 Sept 2025. Verify on insurer's website before buying.
Health insurance (also called mediclaim) is a contract where the insurer pays for your hospitalisation and medical expenses in exchange for an annual premium. It covers room charges, doctor fees, surgery costs, ICU charges, pre and post-hospitalisation expenses, ambulance charges, and more — up to your Sum Insured limit. Without health insurance, a single hospitalisation can drain years of savings.
An Individual plan covers one person under a dedicated Sum Insured. A Family Floater plan covers your entire family (self, spouse, children) under a single shared Sum Insured — if one member makes a claim, the remaining SI is available for others. Floaters are 30–40% cheaper than buying separate individual policies. A Senior Citizen plan is designed specifically for people above 60, with higher premiums reflecting the greater medical risk, but often with features like domiciliary cover and day-care procedures.
A common rule of thumb: your Sum Insured should be at least 50–100% of your annual income. For individuals in metros, ₹10L–₹20L is the minimum recommended. For families, ₹20L–₹50L. Healthcare inflation in India runs at 10–14% p.a. — a ₹5L cover today will have the purchasing power of only ₹3L in 5 years. Factor in that a single cardiac procedure can cost ₹5L–₹15L and a cancer treatment can exceed ₹20L.
Following the 56th GST Council meeting, all individual health insurance premiums are fully GST-exempt from 22 September 2025. This applies to new policies and renewals — you now pay only the base premium. Only group health insurance (employer-sponsored) continues to attract 18% GST. This reform makes health insurance up to 18% more affordable than before September 2025.
Health insurance premiums qualify for deduction under Section 80D of the Income Tax Act. You can claim up to ₹25,000/year for premiums paid for yourself, spouse, and children. An additional ₹25,000 (or ₹50,000 if parents are senior citizens) is deductible for parents' health insurance. If you yourself are a senior citizen, the limit increases to ₹50,000. This means a family covering self and senior parents can claim up to ₹75,000 in 80D deductions annually.
Choose plans with no room rent limit or "single private room" cover so you aren't stuck with a shared ward.
If your SI gets exhausted in a claim, this resets it — sometimes multiple times in a year. Critical for families.
Your SI increases by 10–50% for every claim-free year — effectively more cover at the same premium.
All plans have a 2–4 year wait before PED is covered. Shorter waiting periods are better.
Covers 500+ procedures done in under 24 hrs (cataract, dialysis, chemotherapy). Ensure this is included.
Larger hospital networks mean easier cashless claims. Look for 10,000+ hospitals, especially in your city.
Avoid plans with a co-pay (e.g., "you pay 10% of every claim") — it means out-of-pocket cost even with insurance.
Has a 2–4 year waiting period. Include it if you're planning a family and buy early.
The Claim Settlement Ratio is the percentage of health insurance claims settled by the insurer in a financial year. A CSR of 95% means 95 out of 100 claims were paid. HDFC ERGO leads at 98.6% for FY 2023–24, followed by ICICI Lombard at 97.4% and Bajaj Allianz at 95.5%. While CSR is important, also consider the Incurred Claims Ratio (ICR) — a ratio between 50–80% indicates a healthy, sustainable insurer (too low = over-profitable, too high = financially stressed).
All health insurers impose a waiting period of 2–4 years before covering pre-existing diseases (PED) like diabetes, hypertension, thyroid conditions, asthma, or prior surgeries. During this period, claims related to the PED are rejected. However, once the waiting period ends, the PED is fully covered. Always disclose all pre-existing conditions honestly — concealment is the #1 reason for claim rejection and can even lead to policy cancellation.
Health insurance premiums vary by geography because healthcare costs differ significantly. Metro cities (Delhi, Mumbai, Bengaluru, Chennai, Hyderabad) attract a premium loading of 15–20% due to higher treatment costs. Tier-2 cities (Pune, Jaipur, Lucknow, Nagpur) use the base rate. Tier-3 cities and rural areas can be 5–10% cheaper. This calculator applies these loadings automatically based on your city selection.
Health insurance covers hospitalisation charges (room, ICU, nursing), doctor and surgeon fees, pre- and post-hospitalisation expenses (30–90 days), ambulance charges, day-care procedures like cataract and dialysis, and domiciliary hospitalisation. It does not cover OPD consultations (without a rider), cosmetic treatments, dental care, or spectacles.
For a single individual aged 25–35 in a metro, a minimum of ₹10L–₹15L is recommended; for a family of 3–4, ₹20L–₹30L floater cover is ideal. Healthcare inflation in India runs at 10–14% p.a., so buy more than you think you need. The Super Top-Up strategy — a ₹5L base plan plus a ₹20L super top-up — gives ₹25L total coverage at roughly the cost of a ₹10L plan.
A family floater plan covers your entire family (self, spouse, children) under a single shared Sum Insured. If one member claims ₹3L from a ₹10L floater, the remaining ₹7L is available for others. Floaters are 30–40% cheaper than separate individual policies; the premium is determined by the eldest member's age. Adding a restoration benefit protects the family if the eldest member makes a large claim.
No — not since 22 September 2025. The 56th GST Council granted a full exemption on all individual health insurance premiums, applicable to new policies and renewals. You now pay only the base premium. Only group health insurance (employer-sponsored corporate plans) continues to attract 18% GST.
If you make no claim in a policy year, most insurers increase your Sum Insured by 10–50% for free or reduce your next premium by 5–20%. For example, a ₹5L policy with 50% NCB after 5 claim-free years gives you ₹7.5L cover at no extra cost. Some insurers like Niva Bupa offer 'Lock the Clock' which freezes your premium at your entry age.
A Super Top-Up activates after your base plan's Sum Insured is exhausted. A ₹5L deductible + ₹20L super top-up costs roughly the same as a standalone ₹10L policy, but gives you ₹25L total coverage. This is the most cost-effective way to achieve high cover at low premium, and is especially recommended for people above 40.
Under Section 80D: premiums for self, spouse, and children qualify for up to ₹25,000 deduction (₹50,000 if you are a senior citizen). An additional ₹25,000–₹50,000 is deductible for parents' health insurance. A family covering self and senior parents can claim up to ₹75,000 annually. This benefit is available under the old tax regime only.
The younger and healthier you are, the lower and more stable your premium will be. Buying at 25 vs 35 can mean paying 40–50% less for the same cover. More importantly, any condition you develop after buying cannot trigger a premium increase for that specific condition. Buy health insurance immediately when you become independent of employer group coverage.
Three types apply: (1) Initial 30-day waiting period — no claims except for accidents. (2) Pre-existing disease (PED) waiting period of 2–4 years before PED claims are covered. (3) Specific illness waiting period of 1–2 years for conditions like hernia, cataract, or joint replacement. If you port to a new insurer, waiting period credits are carried forward.
Go beyond premium: check for room rent sub-limits (avoid them), co-payment clauses (avoid plans with co-pay), restoration benefit, network hospitals in your city, in-house vs TPA claim processing (in-house is faster), and the Claim Settlement Ratio. This calculator compares premiums across 6 leading insurers — but always read the full policy wording before buying.
