There are dozens of health insurers in India offering hundreds of plan variations. Looking only at the premium will lead you to the wrong policy. These are the things that actually matter when comparing health insurance — explained simply.
Start With the Claim Settlement Ratio
The claim settlement ratio (CSR) tells you what percentage of claims an insurer paid out in a given year. IRDAI publishes this data for all insurers every year. A CSR consistently above 95% means the insurer pays claims reliably. A lower number — or one that jumps around a lot from year to year — is worth investigating before you commit. When two plans look similar on price and coverage, the insurer’s CSR is often the most useful tiebreaker.
Sum Insured: Think About Where Healthcare Costs Are Heading
Medical inflation in India is running at about 11–14% annually — among the highest in Asia, according to ManipalCigna’s CFO in January 2026. A sum insured that feels comfortable today will cover less in five years. A major surgery at a private hospital in a metro city can cost ₹8–15 lakh or more. For families in metro cities, ₹10 lakh is a starting floor, not a ceiling. Super top-up plans — which kick in after your base coverage is used up — are a cost-effective way to extend your total coverage without a large jump in premium.
Check the Network Hospitals First
Cashless hospitalisation only works at network hospitals — where the insurer pays the hospital directly, without you having to pay first and claim later. Before buying any policy, check whether the hospitals you would actually go to in your city are in the insurer’s network. A policy with an excellent network in Mumbai but limited coverage in Pune may not work for you if you live between both cities. This is a simple check that often gets skipped.
Understand What the Waiting Periods Mean for You
Following IRDAI’s 2025 standardisation, pre-existing disease waiting periods are now capped at three years across all insurers. But specific disease waiting periods — for conditions like cataracts, knee replacement, or hernia — still apply and differ between plans. If you have a condition that’s likely to need treatment in the next few years, knowing exactly how long you’d need to wait for it to be covered is critical before you choose a plan.
Sub-Limits Can Catch You Off Guard
Some policies place sub-limits on specific expenses — room rent, for example, might be capped at ₹3,000 per day even if you have a ₹10 lakh sum insured. If a private hospital in your city charges ₹8,000 a night for a standard room, you’d pay the difference yourself. These sub-limits are buried in the policy document. A plan without room rent sub-limits is almost always a better choice for metro residents, even if the premium is slightly higher.
Draco Insurance gives you access to health plans from 15+ insurers, with honest advice on which one actually fits your needs — not whichever pays the highest commission. Compare options and get a quote at dracoinsurance.in, or call +91 7064106417 to speak with one of our advisers.
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