Wealth · Protection

Health Insurance Gap Calculator

Under or over covered? Recommended minimum family cover benchmarked on IBAI cost estimates (ICU ₹18,000/day and room ₹8,000/day in metros), with an employer-cover risk flag and a super top-up recommendation when the gap is large.

Family profile

Your age

Annual income

₹

Family members covered (1–6)

City tier

Any pre-existing conditions in the family (diabetes, BP, heart, etc.)

Existing cover & premium

Individual policies (total sum assured)

₹

Family floater sum assured

₹

Employer group health cover(lapses when you change jobs)

₹

Annual premium you pay (all policies)

₹

Cover verdict

ADEQUATELY COVERED

You have ₹50,000 more than the recommended minimum of ₹34.50 L

IBAI cost benchmarks (Metro — base)

ICU / day

₹18,000

Room / day

₹8,000

Major surgery

₹4.00 L

Minor surgery

₹60,000

Maternity

₹80,000

Income-based floor (50% of income)

₹7.50 L

3 × major surgery cost

₹12.00 L

30 days ICU exposure

₹5.40 L

Base recommendation (max of above)

₹12.00 L

Adjusted for age, pre-existing, family

×1.15 age · ×1 pre-existing · ×2.5 family

₹34.50 L

Your total existing cover

₹35.00 L

Employer-cover risk: 86% of your cover is employer-provided. Group health cover lapses on job change, and a new employer's policy usually excludes pre-existing conditions for the first 1–2 years. Buy a personal base policy before you need it.

Premium sanity check: You pay 0.43% of your cover as premium. Very low ratios usually mean sub-limits (room rent caps, disease-wise limits, co-pay) — verify what the policy actually pays.

Statutory basis

IRDAI (Standardisation in Health Insurance) Regulations 2016: standardisation of individual health insurance covers — including portability so you can switch insurers without losing continuity benefits.

s.64VB, Insurance Act 1938: no risk attaches to the policy until the premium is paid — a lapsed policy means zero cover during the gap.

This tool is informational. IBAI cost benchmarks are planning estimates, not guarantees of claim payout. Consult a licenced insurance broker for a policy that matches your family's actual risk profile.

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