Reviewed by Artha Research·Last updated 15 April 2026
Health Insurance Calculator India — Is Your Sum Insured Enough?
Is your health cover enough for a real Indian hospitalisation? Check sum insured vs metro costs, flag room-rent sub-limit risk. Free, 2026.
Cover profile
Hospitalisation costs in metros have outpaced general inflation for a decade. We size cover against that, not against a fixed multiple of income.
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Recommended total cover (base + super top-up)
₹78L
Fix this first
Hospitalisation in a tier-1 setting will outrun your current cover.
Add a super top-up first — it's the cheapest way to add ceiling.
Recommended base cover
₹19.5L
Recommended total (base + top-up)
₹78L
Cover gap
₹73L
Adequacy score
6.4%
Estimated annual premium
₹23,400
Cover needed in 10 years
₹2.9Cr
What today's recommendation looks like after medical inflation.
Breakdown
- Base cover₹19.5L25.0%
- Super top-up₹58.5L75.0%
Benchmarks
If you lived in a tier-2 city
+73.3%You
₹78L
Benchmark
₹45L
Tier-2 hospitals are cheaper; the benchmark drops with them.
Same cover, 10 years from now
-73.0%You
₹78L
Benchmark
₹2.9Cr
Medical inflation compounds — today's cover is tomorrow's gap.
Metro hospitalisation costs dwarf your current cover
A single ICU stay in a tier-1 city can run into lakhs. Your existing cover is less than half of the IRDAI-benchmark recommendation for this city.
Adequacy score
6.4%
A super top-up is the cheapest way to stretch your ceiling
Once the base cover is in place, a super top-up buys ₹25-50L of additional coverage for a fraction of the base premium.
Suggested super top-up
₹58.5L
Medical inflation will erode this cover within a decade
Healthcare costs in India are rising ~14% annually. What looks sufficient today can be half-enough in ten years — review and increase cover periodically.
Cover needed in 10 yrs
₹2.9Cr
Next best actions
The result hints at what to look at next. Each link carries your current numbers so you never re-enter them.
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At a glance
- What it does
- Checks your sum insured against metro or tier-2 treatment benchmarks, factors family-floater splits, and flags the room-rent sub-limit risk that pro-rates entire claims.
- Baseline cover
- ₹10L minimum in metros, ₹5L in tier-2 cities. Family floaters need 1.5× per-life cover to handle concurrent claims.
- The sub-limit trap
- Most policies cap room rent at 1-2% of sum insured/day. If your actual room charge exceeds that cap, the insurer pro-rates your entire bill — not just the room.
- Best used for
- Deciding whether to raise the base cover, add a super top-up (30-40% of fresh-policy cost), or switch out of an employer-only group plan.
How It Works
This is the drill-down layer. The flagship flow leads with a recommendation, and this page lets you inspect the underlying model.
- Effective cover (family floater) = sum insured / family size × 1.5.
- Adequacy score = min(100, effective cover / recommended minimum × 100).
- Room-rent risk flagged when daily room cap is below 1% of metro private-room rates (~₹8-25k/day).
Assumptions
The recommendation stays blunt, but the assumptions remain visible.
- Metro recommended minimum is ₹10L per adult; tier-2 is ₹5L. These are 2026 IRDAI-aligned benchmarks, not policy-specific minimums.
- Family-floater 1.5× multiplier reflects the probability of two concurrent claims in a household.
- Super top-up is assumed to be a deductible-stacked policy that activates after the base cover is exhausted in a policy year.
FAQ
The follow-up questions people usually ask after the main recommendation is already clear.
Do I need health insurance if my employer already covers me?
Yes. Employer group cover lapses the day you leave the job and has no portability credit — you lose the waiting-period clock you've accumulated. A personal policy alongside employer cover means you're continuously insured through job changes and can port waiting periods to better plans later.
What's the difference between base cover and a super top-up?
Base cover pays from the first rupee (after co-pay, if any). A super top-up only kicks in after the deductible is crossed within a policy year — and costs 30-40% of a fresh policy for the same cover. A base + super top-up stack (e.g., ₹10L base + ₹25L super top-up at ₹10L deductible) delivers ₹25L of usable cover at a fraction of the pure-base premium.
How much should I increase my cover each year for medical inflation?
Indian medical inflation is running at 12-14%/year, so cover that was adequate five years ago is already short. Rather than annual topping-up, size your sum insured for where costs will be in 10 years — or buy a super top-up that can be raised without full underwriting.
Sources & references
Every formula and assumption above is grounded in these authoritative sources.
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