There is no ‘one size fits all’ when it comes to health insurance

Pooja Yadav, Chief Product Officer, Edelweiss General Insurance shares points to guide to select the right health insurance

The COVID pandemic has not only led to higher awareness about the need for health insurance among the public, but it has also brought sharp focus on rising treatment costs and need for higher sum insured. During COVID, many people opted for a basic health cover/COVID specific policy to tide over the pandemic. However, many of these policies were not renewed subsequently and has left customers with inadequate health cover.

Indians pay over 55 per cent of healthcare expenses out of their own pocket and medical inflation has also been consistently rising at rates higher than inflation. In India, in tier 1 & 2 cities, treatment for Heart ailments can cost upwards of 3-5 lakhs. It is therefore important to invest in a good health insurance policy. What is equally important is to have an optimal sum insured that takes care of your needs. One of the first steps to assess your health insurance needs is to assess your life stage, location, family’s medical history, existing health insurance cover, etc. Each stage of the life brings different health insurance needs whether young and single, couple, family, middle aged, retired. An underlying health issue, lifestyle disease, etc. further increases likeliness of other ailments and higher treatment costs.

Here are a few points to guide to select the right health insurance:

Age and lifestyle

Age and lifestyle are two of the primary factors that affect your health coverage. In 20s or 30s with an active lifestyle and no habits of drinking or smoking, the chances of any critical illness are low. A policy cover of Rs 5 to 7 lakh may prove enough; the insurance premium would also be lower.

Also, as one grow old, they need to start updating and increasing your health coverage, as ageing directly affects your health. The possibility of pre-existing diseases is also high for individuals aged above 40, which needs to be accounted for while purchasing a policy to avoid proposal or claim rejection. To cover these illnesses, one can look for additional coverage or benefits that come with a little extra cost but are likely to prove savior for family. In the end, changing lifestyle and increased family responsibility should reflect in the sum of health insurance policy.

The type of health policy

The type of health insurance policy you buy directly affects your coverage amount. For example, if opting for an individual policy in 20s, large sum to cover is not required. However, the dynamic changes if one is planning to purchase a family floater policy for spouse, child, and themselves in 40s. For the initial one, an Rs 2 to 5 lakh sum might be adequate, but for the latter, consider a policy of a minimum of Rs 7 to 10 lakh. One should also look for additional riders such as a claim bonus, unlimited recharge, and personal accident, to get monetary rewards and cover expenses.


Individual health policies constitute bulk of health insurance policies purchased in India. Customers must move beyond only insuring the primary breadwinner and including spouse and dependent children in their policy as any medical emergency in the family can wipe away years of household savings.

Family’s medical history and the chances of potential illnesses

If a family has a history of any diseases such as high blood pressure, heart ailments or diabetes, one should consider it as a genetic disease. One may not have any of those diseases at present, but a probability is always going to hover over the head. As a result, this is a crucial factor to decide on how much health coverage you will need and should opt for.

Additionally, one should research the cost of treatment for such potential illnesses at your preferred hospital. The health insurance policy you buy should cover that amount and should have the same or similar hospitals under their umbrella of network hospitals.

Affordability to pay a premium

While having higher health coverage is essential, it is equally important that your premium is well within the bounds of your income. In case you take high-value health insurance and fail to pay the premium within the grace period, the insurance company will deny your claim in case of emergency. The grace period tends to be around 30 days, after which your policy typically lapses. One also needs to know that no claims are admissible during the grace period. Thus, one must calculate the premium amount before deciding on a health insurance policy. One can also choose multiple frequencies to pay the premium, i.e., quarterly instead of annually.

Buy critical illness plans

There are many customised health coverages available nowadays that include specific critical illnesses such as coronary diseases, cancer, etc., and cover different sums based on the specific requirements, which depending on your age and financial responsibility, one should not miss. Above 40 years of age, the risk of critical illnesses increases significantly. Critical illnesses, apart from high treatment cost, also require major lifestyle changes and long-term treatment cost. Customers above 40 years of age should augment their health cover with critical illness policy which provide lump-sum sum insured to the customer.

Top-up the health insurance cover: While looking for a quick and easy way to enhance the health insurance coverage, one must consider super top-up plans. Super top-up health insurance plans offer high sum insured amounts at incredibly affordable prices. These policies provide an additional layer of protection once there is an exhaustion of base health plan. Ideally, pick a super top-up policy where the deductible equals the base health insurance coverage.

The claim under top-up policy becomes payable once the deductible limit is met. Customers have the flexibility to choose their deductible amounts under most health policies.

To conclude

There is no ‘one size fits all’ when it comes to health insurance cover. The size of cover required will be linked to income, lifestyle, family size, medical history, medical inflation, preference of healthcare facility, etc. There are enough and more options available today. In today’s digital age, one can research and compare different policy options available at convenience, and make a well-informed choice, after considering all impacting factors. So go ahead and choose wisely!


health coverageHealthcare affordabilityInsurance
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