Health Insurance Adequacy Calculator

How the methodology works

The output is an educational estimate, derived in four steps from inputs that stay entirely in your browser:

1. Baseline by city tier. Metro hospitals charge measurably more than tier-2 hospitals for the same procedure. We use a metro baseline of ₹10 lakh per insured adult, ₹7 lakh for tier-1, and ₹5 lakh for tier-2.
2. Family-size multiplier. A floater pool needs to absorb claims from multiple members in the same year. For single → couple → couple+1 child → couple+2 children, the multiplier scales modestly because simultaneous large claims are rare in younger families.
3. Senior-citizen uplift. If the oldest insured is 60+, a 30% uplift accounts for higher per-claim cost (longer ICU stays, more comorbid procedures) and higher annual claim probability.
4. Employer-cover offset. 50% of any existing employer group cover is netted off — useful as a buffer, but not a full substitute (it ends with employment and is not personally portable under IRDAI rules).

The result is rounded to the nearest ₹5 lakh and shown alongside a 12%-medical-inflation projection so you can see what the number translates to in 10 / 20 / 30 years.

Frequently asked questions

How is the recommended cover computed?

The starting point is a city-tier baseline that approximates the cost of a tertiary-care hospitalisation in the highest-quality private hospital you might use. We then apply a family-size multiplier (a floater pool grows with family size), a senior-citizen uplift if the oldest insured is 60+ (medical claims at older ages are bigger and more frequent), and offset 50% of any existing employer cover (group cover is useful but ends when you leave the job and is not personally portable). The result is rounded to the nearest ₹5 lakh.

Why discount employer cover by 50%?

Employer-provided group health insurance is typically a useful supplement but has three structural weaknesses: (1) it ends the day you separate from the employer, (2) it is not portable to you individually under IRDAI rules, and (3) the sum insured is often modest (₹3-10 lakh) and shared across spouse, children, and sometimes parents at low caps. We treat it as a partial buffer rather than a full substitute.

What inflation rate is used?

We project medical inflation at 12% annually. Indian medical inflation has historically run higher than CPI inflation — published industry estimates are typically in the 10-14% range. The projection panel shows what your recommended cover today translates to in 10 / 20 / 30 years of equivalent purchasing power.

Is this a quote?

No. This is an indicative educational estimator. Actual premium depends on your insurer's underwriting, plan variant, sub-limits, co-pay structure, and your personal medical history. For an actual quote, please consult a licensed insurance advisor or visit an IRDAI-licensed comparison platform.

How should I use the senior-citizen flag?

Set it on if any member you plan to insure under this policy is 60 years or older. The senior-citizen multiplier reflects the higher per-claim cost and higher annual claim probability seen in older age bands. For families that include parents 60+, the standard structure is a separate senior-citizen plan for the parents plus a regular family floater for spouse and children — this calculator helps you size the floater portion and see whether to add a super top-up.

What about a super top-up?

If the recommended cover here is materially higher than your current base, the most cost-efficient way to reach it is usually a super top-up policy on top of your existing base, rather than buying a single large indemnity policy. Read the super top-up explainer linked below for the deductible mechanics.

Further reading

• What is health insurance in India? (pillar guide)
• Family floater vs individual
• Super top-up explainer
• Room rent limits and proportional deduction
• Sum insured — glossary
• Health insurance hub