How the cover calculator works
The model starts from a base sum insured determined by the city tier where you would most likely be hospitalised, because the same procedure costs very different amounts in a metro and in a smaller town. It then adds fixed, visible loadings rather than multiplying numbers together, so you can see exactly where each rupee of the estimate comes from.
The base is ₹15,00,000 for a metro, ₹12,00,000 for a tier-1 city and ₹10,00,000 elsewhere. A loading of ₹5,00,000 is added if you are 45 or older, another ₹5,00,000 if there is a moderate or major pre-existing condition in the family, and ₹5,00,000 for each member beyond the first two. The total is rounded to the nearest ₹5,00,000 and never falls below the base amount for your city.
This is deliberately a heuristic, not an actuarial model. It cannot know your hospital's tariff, your employer's group cover, or the room-rent sub-limits in the policy you are looking at. Use it to decide whether you are broadly under-insured, then compare actual policy wordings — the sum insured is only one of several things that decide whether a claim is paid in full.
The rule, written out
The calculation is a sum of labelled parts, then a rounding step.
Formula
Indicative cover = base(city) + age loading + condition loading + ₹5L × (family members − 2), rounded to the nearest ₹5L, never below the city base
- Where:
- base
- = ₹15,00,000 metro / ₹12,00,000 tier-1 / ₹10,00,000 other cities
- age
- = +₹5,00,000 if the eldest person covered is 45 or older
- condition
- = +₹5,00,000 if a moderate or major pre-existing condition applies
- family
- = +₹5,00,000 for every member beyond the first two
Because the total is rounded to the nearest ₹5 lakh, a raw figure of ₹32,00,000 becomes ₹30,00,000 and ₹17,00,000 becomes ₹15,00,000. The rounding keeps the output at the sum-insured steps that insurers actually offer.
Worked examples in rupees
Three households, run through the engine on this page.
- A family of four in a metro, eldest member 38, no significant conditions: ₹15,00,000 base + ₹10,00,000 for two extra members = ₹25,00,000 indicative cover
- A family of four in a tier-1 city, eldest member 48, one moderate condition: ₹12,00,000 + ₹5,00,000 age + ₹5,00,000 condition + ₹10,00,000 family = ₹32,00,000, rounded to ₹30,00,000
- A couple aged 30 in a smaller city, no conditions: ₹10,00,000 base, which is also the floor — ₹10,00,000 indicative cover
At the higher end, a family of five in a metro with a 52-year-old and a major condition reaches ₹15,00,000 + ₹5,00,000 + ₹5,00,000 + ₹15,00,000 = ₹40,00,000. At the lower end, a 29-year-old couple in a metro with no loadings sits at the ₹15,00,000 base.
Comparison: what changes the number
| Household | City tier | Loadings applied | Indicative cover |
|---|---|---|---|
| Couple, 29 | Metro | None | ₹15,00,000 |
| Family of 3, 35 | Tier-1 | 1 extra member | ₹15,00,000 |
| Family of 4, 38 | Metro | 2 extra members | ₹25,00,000 |
| Family of 3, 46 | Other | Age 45+, 1 extra member | ₹20,00,000 |
| Family of 4, 48 | Tier-1 | Age 45+, condition, 2 extra members | ₹30,00,000 |
| Family of 5, 52 | Metro | Age 45+, major condition, 3 extra members | ₹40,00,000 |
City tier and family size move the number most. Age and health conditions each add a single step of ₹5 lakh, which is a simplification: real medical inflation and real underwriting are far less tidy.
Reaching the cover without paying for it all at once
- Base plus super top-up: a smaller base policy with a super top-up above a deductible is often the cheaper route to a large total cover. Check how the deductible is applied — per claim or per year — before assuming it works the way you expect.
- Employer cover is not your cover: group health insurance ends when the job does, and the sum insured is usually modest. Treat it as a supplement, not a substitute.
- Family floater versus individual: a floater shares one sum insured across the family, which is efficient but exhausts faster when two members claim in the same year. Individual policies cost more and behave more predictably.
- Waiting periods decide claims: pre-existing conditions typically carry a waiting period, and specific illnesses have their own. Buying early is the only way to get past them before you need to claim.
- Watch the sub-limits: room-rent capping, disease-wise caps and co-payment clauses can reduce a claim even when the sum insured is large.
- Review after any life event: marriage, a child, a move to a metro, or a diagnosis in the family all change the right number.
One more practical point: the cheapest way to hold a large cover is to start it early and keep it running. Continuous renewal is what carries you past waiting periods, and most insurers add a cumulative bonus to the sum insured for every claim-free year, so a policy bought at 30 quietly grows into a larger cover by 40 without a new proposal or fresh underwriting. Lapsing a policy and buying a new one restarts every clock.
Tax treatment of health insurance premiums
Premiums paid for health insurance qualify for a deduction under Section 80D of the Income-tax Act — up to ₹25,000 for yourself, your spouse and dependent children, and a further ₹25,000 for parents, rising to ₹50,000 where the insured person is a senior citizen. The deduction is available under the old tax regime only; the new regime, which is the default, does not allow it.
That matters for how you frame the decision. Under the new regime there is no tax reason to buy health insurance, only a financial-protection reason — which is the better reason anyway. Run your own numbers on the Income Tax Calculator before assuming a premium will reduce your tax bill.
Frequently asked questions
How much health insurance cover do I need in India?
There is no single right answer. This calculator's indicative starting point is ₹10–15 lakh depending on city tier, plus ₹5 lakh steps for age 45+, for a moderate or major condition, and for each family member beyond two. Compare that with actual hospital costs in your city before deciding.
Why does the city change the cover?
Hospital tariffs differ sharply by city. The same procedure can cost several times more in a metro than in a smaller town, so the base sum insured is set at ₹15 lakh for metros, ₹12 lakh for tier-1 cities and ₹10 lakh elsewhere.
Is this figure a recommendation to buy a policy?
No. It is an indicative planning figure produced by a rule of thumb. It is not a recommendation to buy any product, and Two Plus Two Nine is an AMFI-registered Mutual Fund Distributor, not an insurance intermediary or adviser.
Is a family floater or individual cover better?
A floater shares one sum insured across the family and usually costs less; individual policies give each person their own cover and do not run out when someone else claims. Larger families and families with an older member often prefer a floater with a super top-up on top.
What is a super top-up and how does it help?
A super top-up pays once your total hospitalisation expenses in a policy year cross a deductible. Pairing a modest base policy with a super top-up is often a cheaper way to reach a large total cover than buying one very large policy — but read how the deductible is measured.
Does my employer's group policy count?
Only while you are employed there. Group cover typically ends with the job, may not travel with you to a new employer, and often has a modest sum insured. Keep a personal policy of your own so that a job change never leaves you uncovered.
How are pre-existing conditions treated?
Insurers generally apply a waiting period before conditions that existed when you bought the policy are covered, and they may load the premium. Disclose everything at proposal stage — non-disclosure is the most common reason claims are rejected.
Is the health insurance premium tax deductible?
Under the old tax regime, Section 80D allows up to ₹25,000 for self, spouse and dependent children and a further ₹25,000 for parents, rising to ₹50,000 where the insured is a senior citizen. The new regime does not allow this deduction.
Does the calculator estimate my premium?
No. It only estimates how much cover to plan for. Premiums depend on age, city, medical history, the insurer's underwriting and the exact plan — get quotes from the insurer or a licensed insurance intermediary.
How often should I increase my cover?
Review it after any change in family size, city, or health, and otherwise every few years, because medical costs have risen faster than general inflation. Increasing the sum insured is usually easier before a claim or a diagnosis, not after.
Should I buy health insurance before I start investing?
Protection generally comes before wealth-building: one uninsured hospitalisation can undo years of SIPs. Chapter 41 of our Learn series explains the sequence in more detail.