Rajkumar Anguluri·Software Engineer · Founder, Artha Engine·Last reviewed 15 April 2026·Methodology
Independent decision-support tool. Artha Engine is not a financial services provider, does not sell loans or insurance, and has no commission relationships with banks or insurers.
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.
Related tools & decisions
Keep going from here — each link carries the same cluster context.
What to do next
Pick floater or individual policies
Family composition + oldest age decide the structure
Decide if employer cover is enough
Employer cover ends at job change or retirement — the math flips with PED and age
Find the cheapest structure for the same cover
Base + super top-up is almost always cheaper than a single high base
Comparison pages
Base vs Super Top-Up: What's the Cheapest Way to Reach ₹40L Health Cover?
Single high base policy or smaller base + super top-up stack — which is cheaper for the same total cover? Free Indian calculator with cumulative premium savings.
Floater vs Individual Health Insurance: Which Is Cheaper for Your Family?
One shared floater pool or separate individual policies per member — which costs less AND protects each member fully? Free Indian calculator for family health cover with coverage-parity comparison.
Employer Health Insurance vs Personal: Do You Need Both?
You already have employer group health cover. Do you still need personal insurance? Free Indian calculator that models total cost to life expectancy — not just this year's premium.
Related guides
Long-form explainers that put the math behind this tool in context.
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Cashless vs Reimbursement: The Real Claim Walkthrough for 2026
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Guide7 min
Health Insurance Portability in India: When It's Worth It
IRDAI lets you port a health insurance policy to a different insurer without losing waiting-period credits or no-claim bonus. That does not mean porting is always the right call. We map the specific triggers where porting wins, the traps where it costs money, and the 30-day process most people get wrong.
Calculations and decision frameworks, not personalised financial advice. The numbers on this page are based on the inputs you supplied and the regulatory rules in effect when this page was last reviewed. They are not a recommendation to buy, sell, hold, port, or surrender any specific financial product. Consult a SEBI-registered investment advisor, a qualified tax professional, or a licensed insurance broker before acting on a financial decision involving your money.
Artha Engine is an educational decision-support website. We do not offer loans, sell insurance, distribute mutual funds, provide regulated investment advice, collect loan applications, or receive commissions from banks, insurers, AMCs, brokers, or other financial providers. References to RBI, SEBI, IRDAI, Income Tax Department, or other authorities are source citations only. Artha Engine is not affiliated with, endorsed by, or sponsored by any government authority, regulator, bank, insurer, AMC, or broker. Artha Engine does not charge users fees for using calculators, comparison tools, articles, or financial health scoring. Mailing address: India.
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