policies now offer several add-ons that can expand coverage beyond the basic hospitalisation benefits. These may include restoration of the sum insured, OPD cover, hospital cash, consumables cover and inflation protection. But each additional benefit can also push up the premium.
For consumers, the key question is whether the extra money is better spent on riders or on increasing the base sum insured.
Experts say the base cover should generally come first. Add-ons should be considered only after the core policy provides sufficient protection for the policyholder and their family.
“An adequate base sum insured should come first, as it protects against the overall cost of hospitalisation, while an add-on typically addresses a specific expense or situation,” said Amitabh Jain, COO, Star Health Insurance.
Shashi Kant Dahuja, Executive Director & Chief Underwriting Officer, Shriram General Insurance, said policyholders should first assess whether their existing base policy provides adequate coverage for their healthcare needs. Add-ons can then be considered for risks or expenses that the base policy does not sufficiently cover.
A higher base cover may matter more
A health policy with a low sum insured but several add-ons may still leave a policyholder exposed if the main hospitalisation bill exceeds the available cover.
This is why experts say consumers should not choose riders at the expense of adequate core coverage.
“Buying several riders while keeping the base sum insured too low may be insufficient while considering overall protection,” Dahuja said.
Gurmeet Singh, Vice President & Head – Health Underwriting, IFFCO-TOKIO General Insurance, said a sufficient base sum insured should generally be the starting point because it provides the foundation of protection against hospitalisation and medical costs.
Once that core cover is adequate, consumers can consider add-ons based on their specific needs and affordability.
Renuka Kanvinde, Vice President – Health Insurance, TATA AIG General Insurance, also said priority should be given to strengthening the foundational coverage before supplementary benefits are added.
When can an add-on be useful?
An add-on makes sense when it addresses a genuine gap in the base policy.
For instance, a policyholder may consider a benefit that provides additional protection against specific medical expenses or restores the sum insured after it has been used. OPD benefits could be relevant for families with recurring outpatient expenses, while hospital cash can provide a fixed benefit during hospitalisation.
But there is no universal list of add-ons that every policyholder needs.
“The decision should be based on individual health needs, age, family profile and likely medical expenses rather than simply adding every available benefit,” Singh said.
Jain said should also check whether the same protection is already available under their base policy or another insurance policy to avoid paying for overlapping benefits.
Check the fine print before paying extra
The additional premium is only one part of the calculation. Consumers should also examine what the add-on actually covers and the conditions attached to it.
Dahuja said policyholders should check waiting periods, exclusions, sub-limits and eligibility conditions before opting for an add-on.
Singh said consumers should compare the , coverage, exclusions, sub-limits, waiting periods, network hospitals and premium rather than choosing a policy simply because it offers more riders.
The same principle applies when choosing between a comprehensive policy with fewer add-ons and a lower-cost policy with several riders. The number of features alone does not determine the level of protection.
More add-ons do not necessarily mean better cover
A policyholder should therefore first determine how much base health cover is required for their own and their family’s healthcare needs. Only after that should the remaining budget be considered for specific add-ons.
“The objective should be meaningful financial protection, not maximum feature accumulation,” Jain said.
Ultimately, the right combination will depend on the policyholder’s age, family profile, healthcare requirements and budget. A rider is worth considering when it addresses a financial risk that matters to the policyholder and provides protection that the base policy does not adequately offer.