Worked Examples and Buying Checklists
How to compare health insurance quotes in India: a worked example with three plans
Compare three health insurance quotes like for like using premium plus out-of-pocket on test bills, with room-rent, co-pay, sub-limits and waiting periods in the arithmetic.
To compare health insurance quotes properly, line them up on the same people, zone and sum insured, then calculate for each one premium + what you would pay yourself on two or three test bills: a moderate admission, a serious one, and a case that hits a sub-limit or waiting period. The plan with the lowest premium is often not the cheapest once a real bill is applied. This guide works through three illustrative quotes for one family, step by step, so you can repeat it with your own.
This guide is part of the health insurance buying checklist. Use the quote comparison tool for your numbers.
The family and the quotes
Illustrative. Couple aged 38 and 36 with one child, Hyderabad, ₹10 lakh floater. Neither adult has a declared condition. Three quotes:
| Feature | Plan A | Plan B | Plan C |
|---|---|---|---|
| Annual premium | ₹22,500 | ₹17,800 | ₹15,900 |
| Room rent | No limit | 1% of SI per day (₹10,000) | Single private room |
| Co-pay | None | None | 10% on all claims |
| Sub-limits | None for listed procedures | Cataract ₹40,000 per eye | None |
| Specific-disease wait | 24 months | 36 months | 24 months |
| Consumables | Covered by add-on (included) | Not covered | Not covered |
| Restoration | 100%, once a year | 100%, different illness only | None |
Test bill 1: a moderate admission
Illustrative. Three days for an infection, ₹1,20,000. Room ₹12,000 × 3 = ₹36,000; associated charges ₹50,000; medicines and tests ₹28,000; consumables (non-payable without add-on) ₹6,000.
| Plan A | Plan B | Plan C | |
|---|---|---|---|
| Non-payables | ₹0 (add-on) | ₹6,000 | ₹6,000 |
| Room-rent cut | ₹0 | Room: ₹36,000 → ₹30,000 = ₹6,000; associated ₹50,000 × 10/12 → cut ₹8,333 | ₹0 (single room) |
| Co-pay | ₹0 | ₹0 | 10% × ₹1,14,000 = ₹11,400 |
| You pay | ₹0 | ₹20,333 | ₹17,400 |
| Premium + you pay | ₹22,500 | ₹38,133 | ₹33,300 |
Plan B's deductions on the associated charges assume they are linked to the room category, as most wordings provide. Medicines and tests are not cut proportionately.
Test bill 2: a serious admission
Illustrative. Cardiac procedure, ₹5,50,000: room ₹15,000 × 6 = ₹90,000; associated (surgeon, OT, nursing) ₹2,20,000; stent and medicines ₹2,20,000; consumables ₹20,000.
| Plan A | Plan B | Plan C | |
|---|---|---|---|
| Non-payables | ₹0 | ₹20,000 | ₹20,000 |
| Room-rent cut | ₹0 | Room: ₹90,000 → ₹60,000 = ₹30,000; associated ₹2,20,000 × 10/15 → cut ₹73,333 | ₹0 |
| Co-pay | ₹0 | ₹0 | 10% × ₹5,30,000 = ₹53,000 |
| You pay | ₹0 | ₹1,23,333 | ₹73,000 |
| Premium + you pay | ₹22,500 | ₹1,41,133 | ₹88,900 |
Plan A is ₹4,700 more than Plan B in premium, but Plan B leaves the family paying ₹1.23 lakh on a single serious admission.
Test bill 3: a sub-limit case
Illustrative. The 36-year-old needs cataract surgery on one eye in the 30th month of cover; the bill is ₹70,000 with no non-payables. Plan B caps cataract at ₹40,000 per eye; the specific-disease wait in Plan B is 36 months, so at month 30 the claim is still inside the wait. Plans A and C have 24-month waits, so the claim is payable.
- Plan A: pays ₹70,000 (no sub-limit).
- Plan B: within 36 months, pays nothing. After the wait, pays ₹40,000.
- Plan C: pays 90% of ₹70,000 = ₹63,000.
Reading the results
| Scenario | Lowest total |
|---|---|
| No claim | Plan C (₹15,900) |
| Moderate claim | Plan A |
| Serious claim | Plan A |
| Sub-limit case | Plan A |
Decision rule. The premium gap between A and C is ₹6,600 a year. Plan C's 10% co-pay alone exceeds that on any admissible claim above ₹66,000. Unless this family is confident it will rarely claim and can absorb a 10% share of a large bill, Plan A is the better value. Plan B is the weakest because of the room-rent cap; it would only make sense if the family would accept a shared room or a hospital whose single rooms cost under ₹10,000 a day.
How to run this for your own quotes
- Get the Customer Information Sheet for each quote.
- Fill in the feature table above.
- Pick three test bills relevant to your family and city.
- Work out non-payables, room-rent cuts, sub-limits and co-pay for each, in that order. The co-pay calculator helps with the co-pay step.
- Enter premium, your share and sum insured in the quote comparison tool.
- Check waiting periods and exclusions separately; the tool cannot see them.
Related: how much sum insured do I need, super top-up maths, room-rent limits.
Frequently asked questions
Should I compare claim settlement ratios?
IRDAI publishes insurers' claims data in its annual report and insurers publish public disclosures. Ratios help as a broad signal but differ by how they are calculated and by portfolio. Use them alongside the wording, not instead of it.
Do network hospitals matter in a comparison?
Yes. Check whether the hospitals you would use are in each insurer's cashless network. A reimbursement claim is still payable but you fund the bill first.
How often should I re-compare?
At least every few years and before any portability decision, since products and prices change.
Sources and where to check
- IRDAI — annual reports and handbooks with claims data, product rules
- Bima Bharosa — complaints
- Council for Insurance Ombudsmen — annual reports on complaint types
