What is High Value health Insurance & How Much Coverage Do I Need?

In a World full of uncertainties one has to plan for the unplanned events like the medical emergencies, hospitalizations. People have become more aware of the health insurance and mediclaim insurance policies which is an encouraging sign. Recent Trend in the health insurance policy reveal that health insurers are offering high-value Health Insurance plans. What differentiates these plans from the regular plans is the Sum Assured. In these health insurance plans sum assured goes up from Rs 1 crore to Rs 6 Crores which is well above Rs 2 lakh to Rs 5 lakh. Let’s have a comparison of merits and demerits of such policies. Deciding on the health insurance coverage for the policyholder is an important factor.

Advantages of High-Value Health Insurance:

  1. They Provide Comprehensive Coverage:

With rapid advances in the field of science and medicine, healthcare has advanced by leap and bounds but so has the medical costs for the treatment. Certain medical cases like treatment of advanced stage of Cancer may cost over Rs 10, 00, 000. Basic Health Insurance Cover would not be able to cover this.

  1. International Treatment Are Covered:

Travelers who are on a foreign trip frequently could also find the high-value health insurance plans as the more suitable option. Medical Treatment costs are much higher in foreign countries as compared to India, therefore a regular plan would not be able to meet the medical expenses incurred on a foreign trip. In such cases, it is more advantageous to take High-Value Health Insurance Cover.

  1. No Sub-Limits:

High-Value Insurance Policies do not have sub-limits on the hospital room rents. However low category rooms may be allowed due to categorization scheme.

Drawbacks of High-Value Health Insurance:

  1. High Premium:

This comes as a no-brainer. High Sum Assured comes with a higher premium. Paying higher premiums for health insurance is completely out of bounds for middle-class people who are already underinsured. These plans are more suitable for the High Net worth Individuals who can pay higher premiums for higher sum assured.

  1. Despite High Premium, No respite from Waiting Period:

High-Value Health Insurance plans do not come with a rider to waive off the waiting period conditions. They still have this provision despite charging a higher premium. List of exclusion that applies to regular health plans also applies to these high-value health insurance plans. Pre-entrance Health checkup is required and any ailment detected would be included in the excluded list.

  1. Plans are Offered After Strict Underwriting:

All health insurance policies are issued only after strict underwriting but when the High-Value Health Insurance policy is taken up, even more stringent underwriting procedures are applied. A Co-Pay clause of 20% may be present for the senior citizen.

Should You Opt for a High-Value Health Insurance Policy?

We do need to take cognizance of the rising medical inflation and occurrence of dreadful diseases like Cancer, Tumor, Heart Attacks, and Stroke, a high-value health insurance policy seems to be beneficial. But the individual should take care of following factors.

  1. Your age

  2. Income

  3. Expenses & Liabilities

  4. Nature of Job

  5. Number of Dependents in Family

  6. Medical Facilities you desire

How Much Health Insurance Cover Do You Need?

Health insurance is the savior when it comes to rescue us from the monstrous expenses one incurs for the treatment of medical emergencies which include treatment of critical illnesses and also Out Patient charges. Factors that should go into thinking when deciding on the amount of Health Insurance You need are discussed below.

Ability to Pay Premium:

One of the first criteria to be used is the ability of the person to premiums regularly as the premium is directly proportional to the sum assured chosen. Not everyone can afford the premium for Rs 20 lakh cover, as it will be huge.

Percentage of Income:

One should have health insurance equal to 50 to 100% of your annual income and if you have spent over 3 lakh on medical expense over past 3 years then the person should add another 3 lakhs to the sum assured.

So if person annual income is R 4lakhs and medical expense over the last 3 years is 3 lakhs then the total sum assured to be chosen would be 7 lakhs.

Family History:

If the family of the person has a history of lifestyle diseases then the probability of it being passed on to the next generation is higher. Any person who falls in the genetically high-risk category, the person should buy wider health insurance coverage when the person is young and healthy.


A crucial factor in determining the amount of coverage is the age factor. If you are 25 years of age you can take up Rs 5 lakh to Rs 10 lakh of cover whereas for a middle-aged person close to 45 years, needs to buy high coverage as the options for buying health insurance decreases.

Keeping Specific Hospitals in Mind:

People can also decide on the sum assured for the health insurance policy depending on the specific hospital. For a similar treatment Hospital, A charges Rs X whereas for Hospital B charges are 2X. Depending on the type of hospital or grade of the hospital one could determine the amount of health cover required.

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