For individuals and families
Personal health insurance
How do I choose health insurance for myself, my family and my parents?
Most people buy health insurance the way they buy an umbrella — on the day it starts raining, whichever one is nearest. Then the hospital bill arrives, and a clause nobody read decides how much of it is theirs. This page is the conversation we have with friends and family before they buy: what to look for inside the policy, what to declare, how much cover is enough, how to build it when money is tight, what to do for parents, and what to ask the insurer before you pay.
If your company already covers you, keep it — it is priced better than anything you can buy on your own. It is just not permanent. That part is further down.
Last reviewed: .
20 minutes with an Ethika advisor on your family’s cover. No obligation.
Quick answer
Buy for the big bill, not the small one. Pick a policy with no room-rent cap, consumables and modern treatments covered up to the sum insured, and short waiting periods. Declare every illness. Build ₹1 crore of cover with a super top-up before you spend on frills. Insure parents separately, and look at the premium at 60, not only today’s.
The checklist — ten things to look at before you pay
| Look at | What good looks like | Why it matters |
|---|---|---|
| Room rent | No limit — or at least “single private AC room” | A room cap shrinks the whole bill, not just the room |
| Non-medical items (consumables) | Covered — built in, or as an add-on | Gloves, syringes, kits: paid from your pocket on every claim otherwise |
| Modern treatments | Up to the sum insured, no sub-limit | These are the cancer, heart and brain treatments that make the big bills |
| Home (domiciliary) treatment | Covered, without a small cap | Matters exactly when hospitals are full |
| Waiting periods | Pre-existing and specific diseases well under the 3-year legal maximum | Nothing is paid for those conditions until the clock runs out |
| Co-payment | None — or only one you chose to lower the premium | You pay a fixed share of every claim, for life |
| Disease-wise limits | None | Cataract, joint replacement, hernia are usually capped |
| Before and after hospital | 60 days before, 180 after is generous; 30/60 is basic | Tests and medicines happen outside the ward |
| Restore and bonus | Fine if included; do not pay extra for them | A super top-up does the job for less |
| The Customer Information Sheet | Ask for it before you pay | One compulsory page that lists everything above |
What are non-medical expenses, and why do they matter?
Non-medical expenses are the everyday items a hospital bills that a standard policy does not pay — gloves, masks, syringes, thermometers, admission kits. IRDAI’s standard list has 68 such items an insurer may cover only as an option. Left uncovered, they come out of your pocket on every claim, whatever your sum insured.
Each item is small. Together they are commonly estimated at 5–15% of a hospital bill — an industry estimate, not a regulator’s figure. On a ₹5 lakh bill that is ₹25,000 to ₹75,000 handed over at the discharge desk, on a claim that was otherwise approved in full. Around 80 more items on the same IRDAI list are meant to be bundled into room or procedure charges, and a hospital that bills them separately is one you can argue with.
Most insurers now sell a “consumables” or “non-medical expenses” cover as a small add-on; some newer plans build it in. The name changes from insurer to insurer, so ask the question in plain words: does this policy pay the items on the non-payable list? The answer belongs in the Customer Information Sheet, not in a salesperson’s nod.
Are modern treatments covered?
Since October 2019, every new health policy must cover twelve “modern treatment methods” — robotic surgery, oral chemotherapy, immunotherapy, stem-cell therapy, deep brain stimulation, intravitreal injections and six others. But insurers may cap them with a sub-limit. Look for cover up to the sum insured, not a percentage of it.
The twelve: uterine artery embolisation and HIFU; balloon sinuplasty; deep brain stimulation; oral chemotherapy; immunotherapy with monoclonal antibodies; intravitreal injections; robotic surgeries; stereotactic radiosurgery; bronchial thermoplasty; laser vaporisation of the prostate; intra-operative neuro-monitoring; and stem-cell therapy for bone-marrow transplant. Read that list again — it is cancer, Parkinson’s, eye disease, prostate and heart. The illnesses that produce the bills you bought insurance for.
The catch is the cap. A plan may pay modern treatments only up to 50% of the sum insured. Illustration only: on a ₹10 lakh policy, a ₹12 lakh robotic cancer surgery would then be paid to ₹5 lakh, leaving ₹7 lakh with the family — with the sum insured barely touched. Look in the Customer Information Sheet under sub-limits; if a percentage appears next to “modern treatments”, ask for the plan that does not have one.
What is domiciliary treatment, and should my policy cover it?
Domiciliary hospitalisation is treatment taken at home that would normally need a hospital — because the patient cannot be moved, or no hospital bed is available. Most policies cover it, usually for treatment lasting more than three days on a doctor’s advice; some cap it, and most exclude a list of chronic conditions. It matters in exactly the situations you cannot plan for.
Anyone who tried to find a hospital bed in the spring of 2021 knows why this clause exists. Three things to check: that it is covered at all; that any cap is a meaningful share of the sum insured rather than a token amount; and the exclusion list — asthma, hypertension, diabetes and other long-term conditions are commonly excluded from home treatment. Pre- and post-hospitalisation cover often does not apply to it either.
What is the room rent clause, and how does it cut my claim?
A room-rent limit caps the daily room charge the policy pays — ₹5,000 a day, or 1% of the sum insured, are typical shapes. Take a costlier room and the insurer cuts not only the room difference but, in the same proportion, the charges hospitals price by room category: doctor visits, surgeon and nursing fees. This “proportionate deduction” is the most common reason an approved claim comes back smaller than the bill.
Illustration only: your policy allows ₹5,000 a day; the hospital’s only free bed is a ₹10,000 room. You have used twice the allowance, so the room-linked charges may be paid at half. On a bill of a few lakh, that is a difference of tens of thousands — on a claim the insurer accepted.
Two protections you should know. Since 2020, IRDAI has barred insurers from applying the proportionate cut to pharmacy and consumables, implants and medical devices, diagnostics, or ICU charges, and from applying it at all in hospitals that do not bill by room category. And the regulator’s own numbers show the scale of the problem the rule addresses: in 2024-25, ₹18,521 crore — 13.98% of everything claimed — was disallowed from health claims “as per terms and conditions” of the policy, while the number of claims disallowed outright was zero. Paid claims, shaved bills. The clauses in this section and the next are the usual reasons.
What good looks like: no room-rent limit — the wording may say “any room” or “single private AC room”. Check the ICU limit separately; some plans cap the room but not the ICU, and a few do the reverse.
Co-payment, disease-wise limits and zone pricing — the other quiet cuts
A co-payment makes you pay a fixed share of every claim — 10% or 20% — and is common in policies for people over 60, or when you take treatment in a costlier city than the one your premium was priced for. Disease-wise sub-limits cap what the policy pays for cataract, joint replacement, hernia and a few other procedures regardless of your sum insured. Both are printed in the Customer Information Sheet.
A co-pay you chose, to lower the premium on cover you could partly self-fund, is a fair trade. A co-pay you did not notice — or one imposed by age — is a permanent 20% cut on the year you need the policy most. Zone pricing works the same way in disguise: some insurers price by city and apply a co-pay if you are treated in a costlier zone than you paid for. Buy for the city where you would actually be treated — for parents, that is usually the city they live in, not yours.
Disease-wise limits are older clauses that survive in cheaper plans. A ₹40,000 cap on cataract or a ₹1.5 lakh cap on a knee replacement is a number the hospital bill will exceed. Illustration only; check the actual figures on your sheet.
Waiting periods — what you cannot claim in the first years
Every policy runs three clocks. Thirty days from the start for any illness — accidents excepted. Up to 36 months for a list of specific diseases such as hernia, cataract and joint replacement. And up to 36 months for illnesses you already had when you bought. Since 1 April 2024, 36 months is the legal maximum for both long clocks — shorter is better, and some plans sell a shorter clock for a small extra premium. The clocks start once, so buy before you need it.
The most expensive health-insurance mistake is not a bad clause. It is buying at 46, the week after a scan shows something, and discovering that the condition sits behind a three-year wall. Every year you hold a policy is a year of those clocks already run. Buy at 30 for the person you will be at 50.
Maternity, where included, usually carries its own clock of two to four years — see the section on nice-to-have covers below.
Before and after the ward — pre- and post-hospitalisation, day-care, AYUSH
Bills start before admission and continue after discharge — tests, consultations, medicines. A policy pays for a window on each side: 30 days before and 60 after is basic; 60 and 180 is generous. Day-care procedures that need less than 24 hours in hospital, AYUSH treatment — which insurers must now cover at par with other treatment — and ambulance charges are standard; check each is actually there.
Network hospitals and cashless — will it work where I live?
Cashless works only at hospitals in your insurer’s network, so check the list for the hospitals you would actually use — near your home, and near your parents’. Since 2024, an insurer must decide a cashless request within one hour and a discharge authorisation within three hours. Outside the network you pay first and claim back; the industry’s “Cashless Everywhere” arrangement helps, but it is voluntary.
Cashless Everywhere, started by the General Insurance Council in January 2024, lets you seek cashless treatment at a hospital outside the network if it has 15 or more beds and is registered under the Clinical Establishments Act — you must inform the insurer 48 hours before a planned admission, or within 48 hours of an emergency one. Not every insurer and hospital takes part, so treat it as a fallback, not a plan.
Why must I declare pre-existing diseases — and what happens if I don’t?
A pre-existing disease is any condition diagnosed, or for which you took advice or treatment, in the 36 months before your policy started. Declare all of it — and your smoking, drinking and family history if the form asks. An undeclared condition is the insurer’s strongest ground to reject a claim or cancel the policy in the first five years. Declared, the worst case is a waiting period or a small loading on the premium.
Here is how it surfaces. You are admitted for a heart procedure at 52. The hospital’s admission note says “known case of hypertension, on medication for six years”. The insurer asks for your proposal form from four years ago, on which “hypertension” is ticked no. The claim is not paid, and the policy may be cancelled — with the premiums gone and a fresh policy now carrying a three-year wall on exactly that condition.
So: fill the proposal form yourself. Never let anyone tick “no” on your behalf to speed things up. Keep a copy. If you take a medicine every day, it goes on the form. People often ask us for the policy that suits their condition; the better question is which insurer will accept my condition in writing. Most will, with a waiting period or a loading. A few will decline — and a decline at proposal is a far smaller loss than a rejection at claim.
What is the moratorium clause?
After 60 months of continuous cover — ported years included — an insurer cannot question a claim or the policy on grounds of non-disclosure or misrepresentation. Only established fraud remains open. Before 60 months, everything you did not declare is fair game. If you raise the sum insured, the added portion runs its own 60 months.
This clock was eight years until 1 April 2024; it is now five. It is a protection for honest mistakes — the condition you genuinely forgot, the report you never saw. It is not a strategy: “hide it and wait five years” is fraud, and fraud has no moratorium. The clause is the strongest argument for continuity. Do not let a policy lapse. If you change insurers, port rather than buy fresh, so the months travel with you.
The one page to read — the Customer Information Sheet, free-look and renewal
Every policy now comes with a Customer Information Sheet — a compulsory one-page summary of the sum insured, waiting periods, sub-limits, co-pay, exclusions, and the claims and grievance contacts. If you read nothing else, read this. Ask for it before you pay, not with the policy bond.
Three more protections, in one breath. Free-look: you have 30 days from receiving the policy document to return it for a refund, less small costs, if it is not what you were told. Grace period: miss the renewal date and you have a short window to pay without losing continuity — but nothing that happens in the gap is covered, so set the reminder. Renewal: a health policy is renewable for life; an insurer cannot refuse to renew except for fraud or misrepresentation, and since April 2024 there is no upper age for buying one, though underwriting still applies.
When should I port my policy — and when should I leave it alone?
Portability lets you move to another insurer at renewal and carry your waiting-period credit, your accumulated bonus (as sum insured) and your moratorium months with you. Apply 30 to 60 days before the renewal date. Port when your policy has aged badly or the premium has run away from the market. Do not port when someone on the policy is unwell or mid-claim, or before the new insurer has said yes in writing.
Port when: the old product carries the clauses on this page — a room cap, disease limits, no consumables — and the insurer will not move you to its newer plan (ask for that first; it is called migration and is simpler); or the premium has jumped well beyond what the age table explained; or claim service has failed you more than once.
Leave it alone when: someone on the policy is under treatment or freshly diagnosed — the new insurer underwrites afresh and can decline, load or exclude; when you want a higher sum insured at the same time — the extra portion starts every clock from zero; when the saving is small — the new insurer’s terms replace the old ones, and your bonus arrives as sum insured but grows on its rules from then on; or mid-year — porting works only at renewal.
How it works: apply to the new insurer with the portability form; your data moves through the Insurance Information Bureau’s portability portal; the old insurer must share it within 72 hours and the new one must decide within five days. Never let the old policy lapse until the new one is issued. If the new insurer declines, renew the old one on time and try again next year.
Maternity cover — nice to have, paid for every year
Maternity cover pays for delivery, usually after a waiting period of two to four years, and up to a sub-limit that is often below a private-hospital bill. If it is built into the plan, you pay its share of the premium every year for life, for a benefit most families use once or twice. Buy it only as a removable add-on, only for the years you plan to use it — or lean on your company’s group cover, which usually includes maternity from day one.
The arithmetic is simple even without numbers. A benefit used twice in forty years, capped, and priced into every one of those forty premiums, is a poor trade for most families — and an excellent one for the insurer. If you are planning a family, start the add-on’s clock early and switch it off afterwards. What you do want in the base plan is newborn cover from day one and cover for complications of pregnancy, which are treated differently from the delivery itself. Ask for both by name.
Restore, OPD, global cover, wellness — which extras are worth paying for?
Extras cost you every year, and most are pleasant rather than decisive. A “restore” or “refill” benefit reinstates your sum insured after it is used up — useful in a family floater, but a ₹1 crore super top-up does the same job better and for less. OPD cover tends to be priced close to what it pays out. Global treatment, air ambulance and wellness rewards are nice when free inside the plan. Do not pay a loading for any of them.
On restore specifically: it triggers only after the sum insured is exhausted; older versions work once a year and only for an unrelated illness; newer ones are unlimited. If it is included, good. If it costs extra, compare that cost with a super top-up sitting above the base — which pays for the same illness, in the same year, without conditions. The section below explains why that layer is where the money should go.
How much sum insured do I need?
Start from the bill you could not survive, not the one you could. Our rule of thumb: most families can raise ₹5–10 lakh in a crisis from savings, gold and borrowing — insurance is for everything above that. In a large private hospital today a heart bypass runs into several lakh, a course of cancer treatment can run into tens of lakh, and an advanced ICU bed costs up to a lakh a day. At 11–13% medical inflation those numbers double roughly every six years. For a family in a metro, plan for ₹1 crore of total cover.
Indicative published ranges for private hospitals, 2025–26: a bypass ₹2–7 lakh; an angioplasty ₹1.5–3 lakh or more; a knee replacement ₹1.5–6 lakh per knee; a full course of cancer treatment ₹3 lakh to ₹30 lakh or more; an ICU day ₹15,000 in a basic unit to ₹1 lakh in an advanced one. These are indicative, not quotes — your city and hospital decide.
Now the inflation line. Aon puts India’s medical inflation at 11.5% for 2026, down from 13% in 2025 — still well above the global figure of 9.8%. At those rates costs double in roughly six years. So ₹10 lakh of cover bought at 35 buys about ₹5 lakh worth of treatment at 41, and ₹2.5 lakh worth at 47 — if you never raise it. Two consequences: buy more than feels necessary today, and buy it in a structure whose top layer is cheap to hold, which is the super top-up.
Two more inputs. In a family floater the sum insured is shared, so size it for the year two members fall ill together. And your city: a policy that is generous in a tier-2 town can be thin in a metro hospital.
Are “unlimited sum insured” policies worth it?
They exist, and they can make sense — if you read what “unlimited” means. In most plans it is one unlimited claim, once in the policy’s lifetime, or unlimited restoration for unrelated illnesses; room-rent rules, co-pays, waiting periods and sub-limits still apply, and some plans must be chosen in the first year or two. Price it against a ₹1 crore super top-up. The top-up usually wins.
Ask five questions before paying for unlimited: Does it apply to every claim, or one? To every illness, or a list? Does it survive if I port? What happens to the premium at 55 — these products are young and their price history is short? And what does the same money buy as a super top-up? If the answers are good, it is a fine product. If they are vague, you have your answer.
Base policy or super top-up — which do I buy first when money is tight?
Buy the super top-up first. A super top-up pays everything above a deductible you choose — say ₹5 lakh — up to its own sum insured, and because it skips the small, frequent bills it costs a fraction of a base policy with the same cover. Take at least ₹1 crore. Use your company’s policy, or savings, for the first ₹5 lakh. Add a base policy of your own when the budget allows.
Four things to get right:
- Super top-up, not top-up. A top-up pays only when a single bill crosses the deductible. A super top-up adds up all your admissible bills in the year and pays once the total crosses it. Two ₹4 lakh hospitalisations against a ₹5 lakh deductible: the top-up pays nothing; the super top-up pays ₹3 lakh. Always the super.
- It stands alone. You do not need a base policy to buy one. Without a base, the deductible is yours to pay — which is why the company policy is the natural first layer, with the deductible set at your company sum insured.
- It has its own clocks. Thirty days, and up to 36 months for specific and pre-existing diseases. Buy it while you are well and covered at work, not the year you need it.
- Only admissible expenses count towards the deductible. Non-payable items do not.
The most common personal-cover question our service desk gets from employees is a top-up over their company’s ₹5 lakh — and almost nobody has asked what happens to that top-up’s deductible the day they leave the company. The answer: the top-up stays, and the first ₹5 lakh becomes yours to pay. That is why a base policy of your own is step two, not never.
The stack, in plain form
| Layer | Pays for | Comes from |
|---|---|---|
| ₹0 – ₹5 lakh | Everyday hospitalisations | Company group policy today; your own base policy when you can; savings in between |
| ₹5 lakh – ₹1 crore | The bill that would otherwise mean selling something | Super top-up with a ₹5 lakh deductible — bought now, while the clocks can run |
Illustrative structure. The deductible should match your company’s sum insured; the top layer should be at least ₹1 crore.
Should I rely on my company’s health cover?
Keep it — but do not stop there. Group cover is priced better than anything you can buy alone: IRDAI’s latest annual report shows group health incurred ₹92 in claims for every ₹100 of premium, against ₹78 on individual policies, and a group policy covered a life for about ₹2,233 a year against ₹7,750 in retail. It also ends the day you leave, retire, or your employer trims it — and your own waiting periods start only when your own policy does.
The bridge is simple: buy your own layer — the super top-up at least — while you are employed and healthy, so its three-year clocks run under the shelter of the company policy. When you do leave, ask the insurer about migrating your group cover to its retail plan; the right to ask exists, the terms are the insurer’s, and it is far easier when you have your own policy already in place. The full picture is on What happens to my health cover when I leave?.
My parents are over 70 — what is the Ayushman Vay Vandana card?
Since October 2024, every Indian aged 70 or above can get ₹5 lakh a year of treatment per family, free at empanelled hospitals, under Ayushman Bharat PM-JAY — whatever their income. Families already in PM-JAY get an extra ₹5 lakh a year shared among their 70-plus members. Parents with private insurance can still enrol; those under CGHS, ECHS or CAPF schemes must choose one. All States and UTs have now signed on — West Bengal, the last, in June 2026.
How to enrol a parent:
- Open beneficiary.nha.gov.in or the Ayushman App, and log in with a mobile number.
- Enter the parent’s Aadhaar number; the system checks age (70 or above) and completes e-KYC — by OTP to the Aadhaar-linked mobile, or face authentication on the app.
- Download the Ayushman Vay Vandana card. Keep a printed copy with their medicines.
- If the online route stalls, the Ayushman desk at any empanelled hospital or a Common Service Centre will do it in person. The national helpline is 14555.
Two honest caveats. Treatment is at empanelled hospitals — government hospitals and the private ones on the list — at fixed package rates; many large private hospitals are not on it, so check the hospitals near your parents on the same portal before you count on it. And the scheme’s own scale shows how few families have used it so far: about 97 lakh cards had been issued by the end of 2025, against a population of over-70s several times that. If your parents qualify, this is the first ₹5 lakh — free, and forty minutes of your time.
Why is a super top-up a must for parents?
Because a full base policy for someone in their seventies is expensive, rises with every age band, usually carries a co-payment — and over a handful of years can return a large part of its own sum insured to the insurer as premium. A super top-up with a ₹5 lakh deductible costs far less, because the insurer never sees the small bills. The ₹5 lakh below it can come from the Ayushman card, a modest base policy, or your own pocket.
The structure for a parent over 70, in order: the Ayushman card for the first ₹5 lakh at empanelled hospitals; a super top-up from ₹5 lakh to whatever the insurer will write at their age — ₹25 lakh to ₹1 crore; and a small base policy only if the budget allows and the premium makes sense against the cover. Under 70, replace the card with a base policy sized to the deductible.
Four rules that matter more for parents than for anyone else:
- One policy per parent. Never add parents to your family floater — the premium is priced on the eldest member, and one parent’s hospitalisation empties the sum insured for your children.
- Declare everything. Parents almost always have conditions. A waiting period on a declared condition is fine; a rejection on an undeclared one is a disaster.
- Watch the co-pay. Senior-citizen plans often impose 10–20%; some let you remove it for a higher premium. Know the number before you sign.
- The 10% rule. Since January 2025, an insurer cannot raise premiums for people aged 60 and above by more than 10% a year without consulting IRDAI first. If a parent’s renewal jumps more than that, ask why in writing.
Which discounts should I ask for?
Ask, in this order: a long-term discount for paying two or three years together — commonly 7.5% to 15%, and it locks the price; a loyalty discount if you already hold a policy with the insurer; a family discount for covering several members on individual policies; a credit-score discount, which a few insurers offer; wellness discounts at renewal for step or check-up targets, in some plans up to 30%; and a direct-purchase discount for buying on the insurer’s own website. Then check that the quote carries no GST.
On GST: the 18% tax on individual health and life premiums was removed on 22 September 2025. If a quote for an individual or family policy still shows GST, ask why. Company group policies still carry it.
On the direct-purchase discount — the honest note. Some insurers give a small discount when you buy on their own website. Check it; it is your money. Then decide what you are giving up for it: the person who reads the wording before you sign, and the person who argues with the insurer when a bill comes back short. We would rather you knew both sides than found out one of them at a discharge desk.
Discount percentages are product-specific and change; the figures above are what the market commonly shows at the time of writing, not a promise.
Does health insurance save tax?
A little, and only under the old tax regime. From 1 April 2026 the deduction sits in Section 126 of the Income-tax Act 2025 — the old Section 80D — with the same limits: up to ₹25,000 for premiums covering you, your spouse and children, ₹50,000 if any of you is 60 or above, and a further ₹25,000 or ₹50,000 for parents’ premiums, with ₹5,000 of preventive check-ups inside those limits. Under the new default regime there is no deduction at all. Buy for the hospital, not for the tax.
What if a claim is cut or rejected?
Ask for the reason in writing — the insurer must give it. Then, in order: the insurer’s grievance officer; IRDAI’s Bima Bharosa portal if that fails; then the Insurance Ombudsman, which is free. In 2024-25 the Ombudsman disposed of 81% of complaints within 90 days and ruled for the policyholder in 76% of health cases decided on merit. Most families never get that far: roughly one denied health claim in ninety is ever contested.
Two pages on this site walk through it step by step: How do I claim health insurance in India? and What to do if a health claim is rejected. Read them before you need them.
How it works with Ethika
You do not need a broker to buy a health policy. You need one when the choice is not obvious: a condition to declare, parents to cover, a company policy to build around, or a claim that came back short. By law a broker works for you, not the insurer. The insurer pays us; the premium you pay is the insurer’s filed rate either way — except where an insurer offers a direct-purchase discount, which we have already told you to check.
| Step | What happens |
|---|---|
| 1. Twenty minutes | Family, city, budget, existing conditions, and what your company policy already covers. |
| 2. The structure on paper | Base or super top-up first; the deductible; individual or floater; parents separately. Decided before any product enters the room. |
| 3. The comparison | Plans compared on the ten checklist items — room rent, consumables, modern treatments, waiting periods, co-pay, sub-limits — not on the brochure. |
| 4. The proposal form | Filled with you, every condition declared, a copy in your hands. |
| 5. Every year after | The renewal premium checked against the age table, discounts re-asked, and the plan re-read when the insurer changes it. |
| 6. When you claim | Our claims team stays with you until it is settled. We promise the fight, never the outcome. |
20 minutes with an Ethika advisor. No obligation.
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Ethika-wide figures, per Fixed Facts as at 21 August 2026.
Common questions
Is there an upper age limit for buying health insurance?
No. Since 1 April 2024, insurers must offer products for all ages. Underwriting still applies — an older buyer may face a loading, a co-pay or a decline — but age alone is no longer a bar.
Individual policies or a family floater?
A floater for you, your spouse and children; separate individual policies for each parent. Never mix the generations on one sum insured.
Can I hold more than one health policy?
Yes. Declare each to the other. You choose which policy to claim from first; if the bill exceeds it, the second pays the balance on its own terms.
Will my premium go up because I claimed?
No. An insurer may revise a product’s premium for everyone who holds it, but cannot single you out for claiming. What you may lose is that year’s cumulative bonus.
What is a cumulative bonus?
An increase in sum insured for each claim-free year, up to a cap. It travels with you when you port, as sum insured.
Does a super top-up need medical tests?
The same underwriting as a base policy — it depends on age and declared conditions. Pre-existing conditions must be declared exactly as on the base.
Top-up or super top-up?
Super. A top-up needs a single bill to cross the deductible; a super top-up adds up all your bills in the year.
Can my parents be on my company’s policy?
Many employers allow it, often with a co-pay or a lower sum insured, and it ends when you leave. Use it if offered — and still buy each parent their own super top-up.
Can I move my company policy to my own name when I leave?
That is migration, not portability: at exit you may ask the same insurer to move you to its retail plan, usually with underwriting. It is far easier when you already hold a policy of your own. See What happens to my health cover when I leave?.
What happens if I miss the renewal date?
A grace period lets you pay late and keep continuity — but nothing that happens in the gap is covered. Set a reminder a month before.
Should I buy through an app, an agent, a broker, or directly from the insurer?
The policy is the same, and so is the filed premium, except where the insurer offers a direct discount. What differs is who fills the form with you, who reads the wording, and who picks up the phone at claim time. Choose on that.
My parent is 72 and has diabetes and a stent. Will anyone insure them?
Often yes, with a waiting period and possibly a loading or co-pay — and the Ayushman card needs no underwriting at all. Declare everything; let the insurer decide in writing.
Key terms
- Sum insured
- The maximum the policy pays in a year. In a floater, shared by everyone on it.
- Deductible
- The amount you (or another policy) pay before a super top-up starts paying.
- Super top-up
- A policy that pays above a deductible, counting all admissible bills in the year together.
- Proportionate deduction
- The cut applied to room-linked charges when you take a costlier room than the policy allows.
- Pre-existing disease (PED)
- A condition diagnosed, or advised or treated, in the 36 months before your first policy.
- Moratorium
- After 60 months of continuous cover, the insurer cannot contest a claim for non-disclosure, except for proven fraud.
- Waiting period
- The time after purchase during which listed conditions are not covered: 30 days initial, up to 36 months for specific and pre-existing diseases.
- Co-payment
- A fixed share of every claim you must pay yourself.
- Sub-limit
- A cap on what the policy pays for a particular item or procedure, regardless of sum insured.
- Cumulative bonus
- Extra sum insured earned for each claim-free year.
- Restore / refill
- Reinstatement of the sum insured within the year after it is used up, on the plan’s conditions.
- Portability
- Moving to another insurer at renewal with your waiting-period credit, bonus and moratorium months intact.
- Migration
- Moving to another product of the same insurer, including from a group policy to a retail one.
- Customer Information Sheet (CIS)
- The compulsory one-page summary of your policy’s key terms.
- Cashless
- The insurer pays the network hospital directly; you pay only what the policy does not cover.
- Domiciliary hospitalisation
- Treatment at home that would otherwise need a hospital, when the patient cannot be moved or no bed is available.
- Day-care treatment
- A procedure that needs less than 24 hours in hospital because of medical advances.
- AYUSH
- Ayurveda, Yoga, Unani, Siddha and Homoeopathy; insurers must now cover it at par with other treatment.
- Ayushman Vay Vandana card
- The PM-JAY card for citizens aged 70 and above: ₹5 lakh a year per family at empanelled hospitals, regardless of income.
The policy you buy at 32 is the one that pays at 62
Everything above is how health insurance works in general. What it means for your family turns on your city, your company’s policy, the conditions on your form, your parents’ ages, and what you can set aside this year — a short conversation, not a form filled in blind.
What happens when you talk to us. A 20-minute call. We look at what your company already covers and where it ends; whether the super top-up or the base comes first for you; how to structure cover for parents, Ayushman card included; and which plans clear the ten checklist items at your budget. You leave with a structure on paper and a straight answer on whether you need us at all.
20 minutes with an Ethika advisor. No obligation.
· 4,000+ Google reviewsA note on this page. General information to help you read a health policy — not medical, tax or legal advice, and not an offer of a specific product. No insurer or product is named or recommended; Ethika is insurer-agnostic. Illustrations are arithmetic, not quotes. Rules and figures are as at the review date above and change by regulation; treatment costs and discount ranges are indicative published figures, not Ethika’s data. Your policy’s Customer Information Sheet and wording decide what is covered.
IRDAI (Insurance Products) Regulations 2024 and Master Circular on Health Insurance Products, 29 May 2024 (waiting periods, moratorium, pre-existing disease definition, free-look, cashless timelines, AYUSH, all-ages cover, Customer Information Sheet). IRDAI Master Circular on Protection of Policyholders’ Interests, 5 September 2024 (portability window and timelines, prospectus on website). IRDAI circular of 30 January 2025 on premium revisions for senior citizens. IRDAI Guidelines on Standardisation of Exclusions, 27 September 2019 (modern treatments); Master Circular on Standardisation in Health Insurance, 22 July 2020 (non-medical items list); circular of 11 June 2020 on proportionate deductions. IRDAI Annual Report 2024-25, Tables I.26, I.27 and I.29. Council for Insurance Ombudsmen Annual Report 2024-25. General Insurance Council, Cashless Everywhere, 24 January 2024. Notification 16/2025-Central Tax (Rate), 17 September 2025, and Department of Financial Services explanation (GST exemption). National Health Authority and PIB releases on AB PM-JAY for senior citizens aged 70+, October 2024 to June 2026. Income-tax Act 2025, Section 126. Aon Global Medical Trend Rates Report 2026. Published private-hospital cost ranges and product discount ranges, 2025–26, indicative. Ethika-wide figures per Fixed Facts, 21 August 2026. Verified 20 September 2026.