But the right sum insured is not the same for every policyholder.
Age, location, family size, medical history, choice of hospital and existing employer-provided insurance can all influence how much cover a person needs. Industry experts also point to rising treatment costs and the growing expense of complex procedures as reasons for reassessing health insurance regularly.
Medical inflation in India is estimated at around 12-14% annually by several industry experts. At that pace, even a policy that appears adequate today can provide less protection against healthcare costs several years from now.
“₹5-10 lakh was a fair number five years back. It isn’t anymore,” said Gaurav Dubey, Founder and CEO at LivLong, an Indian health-tech and insurance platform backed by the IIFL Group.
For consumers in metros, he suggested viewing ₹15-20 lakh as a starting point rather than a ceiling.
Rajendra Upadhyaya, Chief Growth Officer at Choice Insurance Broking India, a licensed direct insurance broker, suggested ₹15-25 lakh for individuals in metros and ₹25-50 lakh for families with senior parents, depending on factors such as age, health history, location and risk tolerance.
Siddharth Singhal, Head of Health Insurance at Policybazaar, an online insurance aggregator and financial tech platform, suggested a base cover of at least ₹20-25 lakh for many households, with a super top-up used to extend protection.
These are broad industry benchmarks, not prescribed amounts. A young individual living in a smaller city may have a different requirement from a family in a metro with elderly dependants and a preference for private hospitals.
What can push a medical claim higher?
The concern is not simply how often a person is hospitalised, but how expensive a serious hospitalisation can become.
Cancer, cardiac procedures, organ transplants, neurological treatment, complex trauma and prolonged ICU stays are among the situations associated with high-value claims, according to the insurance executives.
Singhal said high-value claims remain a relatively small proportion of total claims but can account for a disproportionately large share of payouts. Multiple procedures, expensive implants, advanced diagnostics and extended post-operative care can add significantly to the final bill.
Dubey said advanced-stage cancer treatment involving extended chemotherapy or immunotherapy can push costs into the ₹20-30 lakh range and sometimes higher at private Tier-I hospitals. Cardiac surgeries, transplants and prolonged ICU treatment can also result in substantial expenses.
“Claims exceeding ₹25 lakh or ₹50 lakh are still not the norm, but they are certainly becoming more frequent than they were a few years ago,” said Vaibhav Kathju, Founder of Inka Insurance,an Indian insurtech platform.
Kathju cited prolonged ICU admissions, complex trauma, cancer treatment, organ transplants and neurological procedures among the drivers of high-value claims.
The implication for consumers is that health insurance needs to account for the financial impact of a severe event, not just the cost of a routine hospitalisation.
A large sum insured is not the whole story
Consumers often focus on the headline number when comparing policies. But the features attached to that cover can determine how much protection is actually available during a claim.
Restoration benefits are one such feature. They can reinstate the sum insured after it has been exhausted, subject to the policy’s conditions. This can be useful when a policyholder or family member requires more than one hospitalisation in the same policy year.
A super top-up is another way to increase overall protection. It can allow consumers to take a relatively large additional cover after a specified deductible, potentially at a lower premium than buying the entire amount as a base policy.
Room-rent restrictions also deserve attention. Depending on the policy wording, a room-rent cap can lead to proportionate deductions in the claim, increasing the policyholder’s share of the hospital bill.
No-claim or cumulative bonuses can increase the available cover over claim-free years. However, consumers should check the maximum bonus, applicable conditions and how the benefit changes after a claim.
“Room rent flexibility is critical because room rent restrictions can proportionately reduce payouts across the entire claim,” Singhal said.
He also advised consumers to examine cashless hospital networks, sub-limits, waiting periods for pre-existing diseases and coverage for day-care and modern treatments.
Upadhyaya similarly highlighted co-payment clauses and waiting periods for pre-existing conditions as features that consumers should understand before buying a policy.
The role of a super top-up
For households that want higher protection without paying the premium associated with an equally large base policy, a super top-up can be one option.
The important distinction is the deductible. A super top-up starts paying once eligible expenses cross the specified threshold, subject to the policy terms. Consumers therefore need to understand how the deductible is calculated and whether the existing base policy provides enough protection below that threshold.
For example, a consumer could combine a base health policy with a higher-value super top-up rather than buying the entire desired amount as a base cover. The exact structure will depend on the individual’s budget and risk exposure.
This approach can also be useful for families that already have employer-sponsored health insurance but want an additional layer of protection outside the workplace.
A ₹72 lakh claim shared by Inka Insurance
Inka Insurance shared the case of a 26-year-old customer who suffered a serious road accident in Jammu and Kashmir in June 2026. According to the intermediary, the customer required air evacuation to a specialised hospital in Hyderabad and subsequently incurred a medical bill of around ₹72 lakh.
Inka said the customer had a ₹10 lakh base policy and had also opted for an additional cover. The intermediary said the claim required additional scrutiny because the policy had been purchased only a few months before the accident.
Cashless approvals were subsequently issued progressively and that around 99% of the ₹72 lakh bill was covered.
The case is a company-reported example rather than evidence of the typical size of health insurance claims. Its relevance is that a major medical expense can arise even for a young policyholder, and the eventual financial exposure depends on the structure and terms of the policy rather than the headline sum insured alone.
What consumers should check before buying or renewing
Instead of choosing a policy solely on premium or sum insured, consumers can assess their cover across four areas:
- Adequacy of cover: Consider age, city, family size, medical history and the cost of treatment at hospitals you are likely to use.
- Additional protection: Check whether restoration and a super top-up could improve the overall structure of your cover.
- Policy restrictions: Examine room-rent limits, co-payments, sub-limits, exclusions and waiting periods.
- Claim usability: Check the cashless hospital network and the conditions attached to restoration, bonuses and additional covers.
The sum insured should also be reviewed when circumstances change.
Marriage, having children, adding elderly dependants, moving to a more expensive city or losing employer-sponsored insurance can all alter the level of protection required.
The objective is not to buy the biggest possible policy. It is to ensure that a serious medical event does not turn into a financial setback because the policy was too small or carried restrictions that the policyholder had not accounted for.
