How an Indian health policy is priced and built, which features change what it pays, and the rules in force in 2026.
An Indian retail health insurance policy is priced mainly on the age of the oldest member, the sum insured, the city zone, the number of people covered and your health declarations. What it actually pays depends on features that rarely appear in the headline: room-rent limits and the proportionate deductions they trigger, co-pay, deductibles, disease-wise sub-limits and waiting periods.
Start with the overview of how health insurance works in India. It links to guides on individual versus family floater plans, room-rent limits, co-pay and sub-limits, waiting periods under the IRDAI 2024 rules, the removal of GST on individual health policies from 22 September 2025, Ayushman Bharat PM-JAY and how it sits alongside private cover, and group (employer) cover.
Rules are described as they stand in October 2026: the IRDAI Master Circular on Health Insurance Products of 29 May 2024, the GST exemption for individual policies, and the Income-tax Act, 2025 that replaced the 1961 Act from 1 April 2026. Rupee premiums used in examples are illustrative, not market prices. Always read the policy wording and Customer Information Sheet of the plan you are considering.
Premium Factors, Cover Features and 2026 Rules
What Ayushman Bharat PM-JAY covers, who is eligible including all citizens aged 70+ under Ayushman Vay Vandana, how to check, and how it fits with a private health policy.
Premium Factors, Cover Features and 2026 Rules
How co-pay, zone co-pay, deductibles and disease-wise sub-limits work in Indian health policies, the order they are applied in, and worked claim examples.
Premium Factors, Cover Features and 2026 Rules
How employer group health cover differs from a personal policy in India, what happens when you leave a job, migration to an individual policy, and when to buy your own.
Premium Factors, Cover Features and 2026 Rules
Individual and family floater health policies are GST-exempt from 22 September 2025. What the exemption covers, what still carries 18% GST, and how to check a renewal.
Premium Factors, Cover Features and 2026 Rules
How Indian health insurance premiums are priced, the clauses that decide a claim, and the IRDAI, tax and GST rules in force in 2026, with worked examples.
Premium Factors, Cover Features and 2026 Rules
How individual and family floater health policies differ in premium, cover and risk, with worked examples for young families, parents and mixed-age households.
Premium Factors, Cover Features and 2026 Rules
What room-rent capping means in Indian health policies, how proportionate deduction is calculated, which charges are excluded from it, and how to choose a room.
Premium Factors, Cover Features and 2026 Rules
Initial, pre-existing disease, specific-disease and maternity waiting periods under the IRDAI 2024 rules, the 5-year moratorium, removal of the age cap, with dated examples.
