Introduction
Choosing the right sum insured in health insurance is critical — too low, and you risk out-of-pocket expenses; too high, and you may overpay premiums. In 2026, with rising medical inflation and lifestyle diseases, it’s more important than ever to match your coverage to real-world hospital costs and family needs.
🧠 What Is Sum Insured?
- The maximum amount your insurer will pay for medical expenses in a policy year.
- It includes hospitalization, surgery, daycare, and sometimes pre/post-hospital expenses.
- Once exhausted, you pay the rest unless you have restoration benefit.
🏥 Factors to Consider in 2026
1. Family Size & Age
- Individual: ₹5–10 lakh may suffice
- Family of 4: ₹10–25 lakh recommended
- Senior citizens: ₹15–50 lakh due to higher risk
2. City of Residence
- Metro cities (Chennai, Mumbai, Delhi): higher treatment costs
- Tier 2/3 cities: lower average hospitalization bills
👉 Example: ICU in Chennai may cost ₹25,000/day vs ₹12,000/day in Coimbatore
3. Hospital Type
- Corporate hospitals charge more than government or mid-tier hospitals
- Room rent, specialist fees, and surgical packages vary widely
4. Medical Inflation
- Healthcare inflation in India is ~12–15% annually
- A ₹5 lakh cover today may feel like ₹3 lakh in 5 years
👉 Choose a sum insured that stays relevant for the next 5–10 years
5. Lifestyle & Risk Profile
- Smokers, diabetics, heart patients → higher risk
- Frequent travelers or adventure sports → consider accident cover
📊 Recommended Sum Insured Table
| Family Type | Recommended Sum Insured | Notes |
|---|---|---|
| Individual (Age <35) | ₹5–10 lakh | Add riders for OPD, accident |
| Couple (Age 30–45) | ₹10–15 lakh | Consider maternity + room rent rider |
| Family of 4 | ₹15–25 lakh | Opt for floater + restoration |
| Senior Citizens | ₹15–50 lakh | Needs higher cover + critical illness |
💡 Tips to Choose Smartly
- Go Floater for Families: One sum insured shared across members
- Add Restoration Benefit: Auto-refills sum insured if exhausted
- Check Room Rent Limits: Avoid sub-limits that restrict room choice
- Review Disease-Specific Caps: Some policies cap expenses for cancer, heart, etc.
- Use Premium vs Coverage Calculator: Compare plans across insurers
Conclusion
In 2026, choosing the right sum insured is about balancing affordability with real-world medical costs. For most families, ₹15–25 lakh with restoration and riders offers solid protection. Always factor in age, city, hospital type, and inflation — and review your coverage every 2–3 years.