Comparing Features in Base and Large Covers

Add-on difference

Applicability

Health insurers now prominently offer covers worth ₹1 crore or higher. The rising demand for private medical care, increasing disease burden, and technological advances in medical science alongside an evolving insurance industry, have nudged policyholders to consider covers ranging from the base policy of ₹5 lakh to ₹1 crore, or more.

Here, we analyse the differences in features of the two. We also analyse the suitability of a large or small cover to the policyholder.

Feature-wise

The first is obviously the cost difference. We considered a 35-year-old male living in a metro with no PED (pre-existing condition) to compare the policies.

A ₹5 lakh cover would cost around ₹7,000 per year in premiums compared to ₹16,000 per year for a ₹1 crore plan. While the cover increases by a factor of 20 times, the yearly premium increases by a factor of around 2–2.5 times. This is the primary factor driving the consideration for a large cover.

The basic features (against riders or add-ons) of a policy are largely similar across the two covers. An insurer offering a single private AC room or twin sharing for a ₹5 lakh cover offers the same for a ₹1 crore plan.

A ₹5 lakh policy offers restoration of cover for a second (or more) ailment in a policy year, for related or unrelated ailments.

This was largely absent for ₹1 crore covers a couple of years ago when policies were being introduced. Now, the same restoration of covers is available even in ₹1 crore plans.

Few differences exist in renewal bonus, which is no longer called no claim bonus because bonuses are allowed despite making claims.

A ₹5 lakh cover increases by a factor of 5-10 times in 5-10 years across policies. But some policies limit renewal bonuses in a ₹1 crore policy to 3-5 times. The other base features of a policy including outpatient consultations, PED waiting periods, pre- and post-hospitalization period are similar across covers, ₹5 lakh or ₹1 crore. Few insurers offer a better maternity plan in larger covers but with 3-year waiting period included in them.

Add-ons across covers

Differences exist in add-on riders that are purchased on top of a base policy. Day one riders or PED reduction riders, which reduce the waiting periods for existing ailments are costlier in ₹1 crore policies. For instance, Niva Bupa offers day one cover for diabetes at ₹1,900 in a ₹5 lakh policy; but it costs ₹4,900 in a ₹1 crore policy.

Deductible and Co-pay, which reduce premiums if policyholder shoulders a fixed amount (deductible) or a percentage (Co-pay) of the claim, are also different. HDFC Ergo Optima Secure offers a ₹2,600 reduction in premium for a ₹25,000 deductible but a ₹3,135 reduction for the same deductible in a ₹1 crore policy.

Super top-ups, which expand coverage in an affordable way, are largely absent for ₹1 crore covers. Some add-ons are cheaper in ₹1 crore policies as well. For instance, ICICI Lombard’s Elevate policy offers unlimited claim for a single ailment in a policy lifetime at ₹900 in a ₹5 lakh policy. But, the feature costs only ₹142 in a ₹1 crore policy.

There are some insurers offering features exclusively for covers of ₹1 crore or above. Tata AIG offers Medicare Premium which is not available in lower covers. One feature the policy offers is worldwide treatment if the diagnosis occurs in India. The worldwide treatment feature is available in Manipal Cigna as well, only if the cover is of a large value such as ₹1 crore or above.

Policy applicability

A large cover does not indicate high premium offering in a traditional sense. It serves in the same manner as a ₹5 lakh cover would, sans the price difference. Policyholders concerned about genetic pre-disposition to cancer, cardiological ailments, and others who are willing to spend the higher amount for peace of mind, can consider a ₹1 crore cover.

With the PED reduction rider, the policyholder can be covered for any ailment with a 1-3 year waiting period.

Policyholders with ₹5 or ₹10 lakh plans can also generate a large protection net over time with renewal bonus, restoration of cover, critical illness riders, or super top-up riders. But as noted, the large protection is built up over time which implies a consistent policy upkeep.

Published on January 17, 2026