The ₹20 Lakh Question at 2 A.M.
Imagine this.
You have ₹2 crore invested across mutual funds, stocks and FDs. You own your home. Your income is comfortable. Financially, you would probably describe yourself as secure.
Then at 2 a.m., somebody in the family needs emergency hospitalisation.
The hospital asks for an initial deposit.
Tests begin. An ICU may be required. A procedure is discussed. Nobody yet knows whether the final bill will be ₹2 lakh, ₹7 lakh or ₹20 lakh.
At that moment, your net worth is almost irrelevant.
What matters is much simpler:
Can the treatment begin without the family first discussing money?
That, to me, is the real purpose of health insurance.
Not “saving tax”.
Not collecting a no-claim bonus.
Not getting your premium back somehow.
It is making sure that when health suddenly becomes the most important thing in the room, money can move into the background.
A Medical Bill Is Different From Most Other Expenses
If a car becomes too expensive, you can buy a smaller car.
If property prices rise, you can postpone the purchase.
If the stock market falls, you can wait.
Medical treatment gives you far less negotiating power.
A doctor saying, “We should do the angioplasty tomorrow,” is not the same as a broker saying, “This may be a good time to invest.”
Apollo Hospitals currently indicates that a coronary angioplasty in India can broadly cost around ₹1 lakh to ₹2.5 lakh, depending on complexity, stents, hospital and location. A coronary bypass can range around ₹2 lakh to ₹7 lakh, while a knee replacement at one of its centres is indicated at roughly ₹1.5 lakh to ₹3.5 lakh per knee.
Those are procedural estimates—not maximum hospital bills.
Add ICU care, complications, additional investigations, longer stays, medicines, specialist consultations or rehabilitation, and the final number can move materially higher.
Now change the situation slightly.
Suppose a family has a ₹5 lakh policy.
The hospital bill becomes ₹11 lakh.
The family technically has health insurance.
It still needs to arrange ₹6 lakh.
This is why the question is not:
“Do I have health insurance?”
It is:
“If a serious medical event happens today, is my cover actually large enough?”
Medical Care in India Has Changed Dramatically
There is another side to this story.
India today offers an unusual combination of specialist medical talent, sophisticated tertiary-care hospitals and relatively affordable treatment.
This is one reason people travel to India for healthcare.
Government data shows that India recorded around 6.44 lakh foreign arrivals for medical purposes in 2024. The Ministry of Tourism also points to NABH accreditation as part of India's framework for standardising quality across healthcare institutions.
India's long-standing advantage in medical tourism has been built around highly trained doctors, modern diagnostic and surgical technology, relatively short waiting periods for many procedures and treatment costs significantly below many developed markets.
I would not claim that every hospital in India is superior to every hospital overseas. Healthcare quality is provider- and procedure-specific.
But for many areas—cardiology, orthopaedics, oncology, transplantation, robotic surgery and complex tertiary care—India has institutions and specialists operating at very high levels.
That creates an interesting situation for Indian families and NRIs alike.
World-class treatment may be available nearby. But world-class treatment is no longer inexpensive.
The quality has moved up.
So has the bill.
“But I Already Have Insurance…”
Most problems do not arise because people have no policy whatsoever.
They arise because the policy was never reviewed.
Here are some of the objections I hear most often—and the way I would think about them:
Objection | What to consider |
|---|---|
“My company gives me health insurance.” | Excellent first layer. But employment can change, retirement eventually arrives, and corporate limits may be inadequate for a major hospitalisation. Personal cover creates continuity independent of your employer. |
“I am young and healthy.” | That is often the best time to buy. Insurance is easier to obtain before significant medical conditions appear, and waiting periods can begin running while you are healthy. |
“Premiums keep increasing.” | True. Medical inflation, age and claims experience affect pricing. But the relevant comparison is not premium versus zero; it is premium versus the potential cost of a large hospital event over decades. |
“Insurance companies may reject claims anyway.” | This is exactly why policy quality, agent and disclosure matter. Declare medical history completely, understand waiting periods, room-rent restrictions, co-pays and exclusions, and choose an insurer with a meaningful cashless network. |
“₹5 lakh was enough when I bought the policy.” | It may no longer be. A sensible structure can combine a meaningful base policy with a larger super top-up rather than trying to buy the entire cover as base insurance. |
One positive regulatory change is speed. IRDAI currently requires insurers to decide cashless pre-authorisation requests within one hour, and final cashless discharge authorisation within three hours of receiving the hospital's request.
The system is not perfect, but it is moving towards making health insurance more usable when it actually matters.
The NRI Question: “Why Do I Need Indian Health Insurance If I Live Abroad?”
This deserves far more attention.
NRIs can buy health insurance in India, subject to the insurer's underwriting and documentation requirements. Most ordinary Indian health policies primarily cover hospitalisation in India, so they should not normally be treated as replacements for health insurance in the country where the NRI lives.
But an Indian policy can still be extremely useful.
Consider an NRI living in Dubai, Singapore or London who:
spends several weeks or months each year in India,
has parents or family here,
expects to return to India eventually,
or would actively consider coming to India for a planned major procedure.
Buying Indian cover after deciding to return can create a problem: new policies can have waiting periods for pre-existing diseases and specified treatments.
Buying earlier allows those waiting periods to run while you are still abroad.
That can be valuable five years later.
There is also a broader strategic point.
An NRI may maintain local insurance abroad for emergencies where he or she lives and separately maintain Indian insurance for treatment in India.
They serve different purposes.
And given India's specialist depth and relative treatment costs, an NRI facing a planned procedure may sometimes actively choose India—not because treatment is “cheap”, but because the combination of doctor quality + hospital infrastructure + cost + access can be attractive.
A ₹2–7 lakh cardiac procedure in India, for example, can look very different when compared with the cost structure of private healthcare in several developed economies.
What Should You Actually Review?
You do not need 30 insurance features.
You need to know whether your policy will work when the hospital bill arrives.
For most families, I would review five things:
Total cover: Is the sum insured appropriate for the hospitals and city you would realistically use?
Room eligibility and sub-limits: Can seemingly small restrictions cause proportionate deductions from a much larger bill?
Waiting periods and existing illnesses: Have all health conditions been disclosed correctly?
Cashless network: Are the hospitals you would actually choose available?
Base + super top-up: Can you create substantially higher protection economically rather than relying on a small standalone policy?
And do not forget the parents.
A 35-year-old couple and 68-year-old parents are different risks. Combining everyone blindly under one family floater can be less effective than designing separate coverage.
Take 15 Minutes Today
Open your existing policy.
Don't look at the premium first.
Look at the sum insured, room conditions, co-pay, waiting periods, exclusions, cashless hospitals and restoration/top-up structure.
Then ask yourself one simple question:
“If somebody in my family needs ₹15–25 lakh of treatment tomorrow, what exactly happens?”
If you do not know the answer, your health insurance probably needs a review.
And if you are an NRI, add one more question:
“If I want—or need—to get treated in India five years from now, am I building that option today?”
Health insurance is one of the few financial products we should genuinely hope never to use.
But when we do need it, ₹5 lakh versus ₹25 lakh of correctly structured cover can matter far more than another 1% earned on the investment portfolio.
Review the cover before the medical event reviews it for you.
