Health Insurance Calculator

Family Floater: One policy covers entire family (spouse + kids), shared sum insured, cheaper premiums. Example: ₹10L floater costs ₹20k vs ₹35k for 3 individual policies. BEST for: Young families with kids under 25 years. Drawback: If two members hospitalized simultaneously, sum shared. Individual: Separate sum insured per person, higher premiums but isolated claims. BEST for: Elderly parents (60+), couples with pre-existing diseases, families with high medical risk. Recommendation: Floater for spouse + kids, separate super top-up for parents above 60.

Minimum recommended (Tier 1 cities): Individual ₹5-10L, Family ₹15-20L. Tier 2/3 cities: ₹5L individual, ₹10L family. However, medical inflation is 12-15% annually. A ₹5L policy becomes ₹5L worth only ₹3L in 5 years. Better approach: Base Policy ₹10L + Super Top-Up ₹40L (costs ₹3-4k extra) = ₹50L total coverage for ₹25-30k premium. Rule of thumb: Cover should be 50-100% of annual income OR ₹10L minimum, whichever is higher.

Section 80D allows income tax deduction on health insurance premiums: (1) ₹25,000 for self + spouse + kids, (2) Additional ₹25,000 for parents (under 60 years), (3) ₹50,000 for parents (60+ years). Maximum deduction: ₹75,000 (self ₹25k + senior parents ₹50k). Tax saving at 30% bracket: ₹22,500 annually. Example: Pay ₹40k premium (₹20k self + ₹20k parents) → Save ₹12k in taxes → Effective cost ₹28k. CRITICAL: Deduction on premium paid, not claim amount.

Claim Settlement Ratio (CSR) = % of claims settled vs rejected. Example: Company received 10,000 claims, settled 9,500 → CSR = 95%. Top performers (2023): HDFC Ergo 98.5%, ICICI Lombard 97.9%, Max Bupa 97.5%. Avoid companies under 90% CSR. However, CSR alone misleading—check: (1) Claim settlement time (14-30 days average), (2) Cashless hospital network (400+ hospitals good), (3) Rejection reasons (pre-existing, document issues). A 98% CSR with 300 hospitals is worse than 95% CSR with 5000 hospitals in your city.

Pre-Existing Disease (PED): Any illness you had BEFORE buying policy (diabetes, BP, thyroid, asthma). Waiting period: 2-4 years (typically 2-3 years). Example: Have diabetes, buy policy today → Claims for diabetes-related hospitalization covered only AFTER 2 years. Other illnesses covered immediately. CRITICAL: Declare ALL pre-existing conditions truthfully—hiding leads to claim rejection + fraud charges. Some insurers offer 1-year waiting for extra premium (₹3-5k more). After waiting period, ALL future claims fully covered. Portability resets waiting period—switch carefully.

Direct from Company: Slightly cheaper (no commission), but claim support depends on company helpline, renewal reminders may be missed. Broker (PolicyBazaar, Turtlemint): Helps compare 20+ policies, free claim assistance, renewal reminders, but may push high-commission plans. Recommendation: (1) Research on aggregator, shortlist 3-4 policies, (2) Check CSR, hospital network, exclusions yourself, (3) Buy directly from shortlisted company OR via aggregator if claim support package included. NEVER rely solely on broker advice—they earn 15-20% commission on premium.

Common Exclusions: (1) Cosmetic surgeries (nose job, liposuction), (2) Dental treatment (unless accident-related), (3) Eyeglasses, contact lenses, LASIK, (4) Infertility treatment, IVF (some newer plans cover ₹2-3L), (5) Alternative treatments (Ayurveda, naturopathy unless specialized plan), (6) Self-inflicted injuries, substance abuse, (7) Pre-existing for 2-4 years, (8) First 30 days waiting for most illnesses (except accident). CRITICAL: Read Policy Wording Document (30+ pages)—marketing brochures hide exclusions. Check specific disease exclusions list.

Buy YOUNG (25-30 years). Why? (1) Lower premiums: ₹5k at 25 vs ₹15k at 45 for same ₹10L cover (₹10k saved annually), (2) No pre-existing: Escape 2-4 year waiting, (3) Lifelong renewability: Most policies guarantee renewal till 65+, easier if bought young, (4) No medical tests: At 25, instant approval. At 45+, medical checkup mandatory. Example: ₹5L policy bought at 25 costs ₹1.5L over 30 years. Same policy bought at 45 costs ₹6L over 20 years. Start early, upgrade coverage as income grows.

YES, premiums increase 5-15% annually due to: (1) Medical inflation, (2) Age increase (major jumps at 35, 45, 60), (3) Claim history (if multiple claims, 15-25% hike), (4) Company-wide losses. Example: ₹10k premium at 30 → ₹18k at 40 → ₹35k at 50. Mitigation: (1) Lifetime renewal policies (premium capped at 10% annual increase), (2) No-claim bonus (5-50% discount for claim-free years), (3) Compare during renewal—switch if hike greater than 20% and better options available. Budget 10% annual increase when planning long-term.