Health insurance cover
Assumptions
When the room rent exceeds the cap, the base policy pays the bill in the ratio cap ÷ actual rent (proportionate deduction), then co-pay is removed. The base policy pays up to its cover; a super top-up pays the amount above its aggregate deductible up to its cover. Cover needed ahead inflates the bill at medical inflation. Section 80D allows ₹25,000 for self and family (₹50,000 when any insured member is 60 or over) and the same again for parents, old regime only; the saving uses your marginal rate. Individual health premiums carry no GST since 22 September 2025. Waiting periods, sub-limits and exclusions vary by policy and are not modelled.
Rules: Section 80D for tax year 2026–27 and IRDAI 2024 circular, reviewed 2026-09-11.
TaxGarden · Section 80D limits AY 2026–27
IRDAI health insurance master circular, May 2024 (summary)
Estimates are not personalised financial advice. Review assumptions before use.
Out of pocket on the illustrative claim
Based on your inputs. Not guaranteed.
From hospital bill to your share
A room above the cap reduces the whole payable bill in proportion, not only the room charge.- Hospital bill₹8 lakh
- Room-rent proportionate deduction-₹0
- Co-pay-₹0
- Base policy pays−₹8 lakh
- Super top-up pays-₹0
- You pay₹0
A room above the cap reduces the whole payable bill in proportion, not only the room charge.
View detailed breakdown
- Base policy
- ₹8 lakh
- Super top-up
- ₹0
- Out of pocket
- ₹0
Why does the room rent matter so much?
Under a proportionate deduction the whole bill is scaled by cap ÷ actual rent, not only the room charge.
Detailed results
| Result | Value |
|---|---|
| Out of pocket on the illustrative claim | ₹0 |
| Proportionate deduction for room rent above the cap | ₹0 |
| Co-pay | ₹0 |
| Paid by the base policy | ₹8 lakh |
| Paid by the super top-up | ₹0 |
| The same treatment in 10 years at medical inflation | ₹17.27 lakh |
| Total cover today (base plus top-up above deductible) | ₹30 lakh |
| Section 80D deduction (old regime) | ₹24,000 |
| Tax saved by 80D | ₹7,200 |
| Total annual premium | ₹24,000 |
Room-rent cap ₹10,000 per day against ₹8,000 in the bill. Pre-existing-disease waiting periods are at most 36 months and the moratorium 60 months under the IRDAI 2024 circular; individual health premiums carry 0% GST.