Need of Health Insurance: Why You Can’t Ignore It in 2025
It was a rainy night in Mumbai in early 2025 when Ankit, a 31-year-old marketing manager, rushed his mother to a hospital after a sudden heart attack. Within hours, he had spent over ₹1.8 lakh just for the initial emergency treatment and ICU stay. He thought his company’s group insurance would be enough but was shocked to find it only covered a small part. According to India’s National Health Accounts 2024 report, over 65 percent of health costs are still out-of-pocket. Stories like Ankit’s are common, making one thing clear—health insurance isn’t just extra, it’s essential now.
Why Do You Need Health Insurance Today?
What is Health Insurance and What Does It Cover?
Health insurance is a contract where you pay a premium to an insurance company, and in return, they pay for your medical costs according to policy terms. It covers hospital stays, surgeries, doctor visits, medicines, and sometimes even regular checkups.
Expert Insight: Dr. Sneha Joshi, Health Economist, says: “With rising medical inflation over 12 percent yearly in India, even small illnesses can drain savings. Health insurance absorbs this shock.”
What’s Changed in 2025 That Makes It Urgent?
Many believe they’re healthy and young—so why rush? But 2025 presents new reasons:
- Hospital expenses jumped 15 percent after updated medical device rules in 2024.
- Lifestyle diseases are diagnosed in people as young as 27.
- Air pollution, new virus outbreaks, and erratic weather are increasing illness rates.
- Government data shows over 3 crore Indians pushed into poverty annually by medical bills.
Who Needs It the Most?
Everyone. But especially:
- Families with children or elderly parents
- People with family history of illness
- Self-employed or gig workers without corporate insurance
- Young, single professionals to lock low premium rates early
Tip: Don’t wait for marriage or children to buy. Young buyers get better deals and fewer exclusions.
How Does Health Insurance Protect You from Financial Disaster?
Is Medical Treatment Really That Expensive?
Yes. A simple appendix surgery can cost ₹70,000 to ₹1.5 lakh in a metro city. ICU care for three days? Over ₹1 lakh. Cancer can require ₹5 lakh plus in a few months.
Here’s a comparison table of average treatment costs in 2025:
| Treatment | Metro Hospital | Tier 2 City | Without Insurance Paid by Family |
|---|---|---|---|
| Heart Attack | ₹2.8 lakh | ₹1.7 lakh | 100 percent upfront |
| Covid or Flu ICU | ₹1.5 lakh | ₹75,000 | 100 percent upfront |
| Gall Bladder Surgery | ₹90,000 | ₹55,000 | 100 percent upfront |
What Does Insurance Actually Pay?
Depending on your plan, insurance can cover:
- Hospital room rent
- Doctor’s fees, OT charges
- Medicines
- Diagnostic tests
- Pre and post-hospitalization (usually 30 to 60 days before and after)
- Some plans include daycare, mental health, and preventive checkups
Expert Advice: Always check the ‘Sum Insured’ and what room category is covered to avoid payment surprises.
What Are Out Of Pocket Expenses and How Can You Avoid Them?
Even with insurance, some expenses may not be covered. These are called out-of-pocket expenses, such as:
- Items advised but not listed (e.g., expensive masks, diet food)
- Treatment beyond your policy limit
- Co payment portions, if any
To minimize, choose:
- No room rent capping
- Adequate sum insured (₹5 to ₹10 lakh minimum for urban families in 2025)
- Plans covering most major illnesses
“Medical bills aren’t predictable. Even a short hospital stay can surprise you,” says Priyanka Mehra, financial planner.
Can Health Insurance Help With Pre Existing Illnesses?
What If I Already Have Diabetes, Hypertension, or Asthma?
Many people think they can’t get insurance if they already have an illness. But it’s possible. Insurers now offer:
- Special plans for diabetics or heart patients
- Waiting periods (usually 2 to 4 years) after which pre-existing diseases are covered
How to improve your coverage:
- Disclose all illnesses honestly while buying
- Look for plans with short waiting periods
What About Senior Citizens or Parents?
It’s hard but not impossible to insure the elderly. In 2025:
- Many insurers offer senior citizen policies up to age 75 or even 80
- Higher premiums and more restrictions apply
- Some plans need health checkups before approval
Features for seniors:
- Critical illness riders for stroke, cancer, or kidney failure
- Cashless claim at network hospitals
“Buying early is best. But late is better than never,” shares Ramesh Khanna, insurance advisor.
How Do You Pick the Right Health Insurance Policy?
What Should I Look for When Buying?
Shopping for insurance can be confusing. Focus on:
- Sum insured amount
- Room rent limit (ideally, no cap)
- Waiting periods for diseases
- Cashless hospital network size
- Exclusions list
“Check claim settlement history. Companies with claims paid above 90 percent are preferable,” suggests insurance expert Neha Raj.
Individual vs Family Floater: What’s Better?
| Feature | Individual Plan | Family Floater |
|---|---|---|
| Covers | 1 person | Multiple family members |
| Sum Insured | Fixed per person | Shared among all members |
| Cost | Higher for many individuals | Cheaper for young small families |
- Individual plans are safer for elderly or sick parents
- Family floaters save money for young, healthy families
How Much Insurance Is Enough in 2025?
You need at least ₹5 lakh cover per person in cities. For families, pick ₹10 lakh to ₹15 lakh, or choose a base cover plus super top up plan.
Steps to calculate:
- List family members’ ages and known health risks
- Check average costs for common emergencies in your area
- Add extra for inflation or special needs (like maternity, daycare procedures)
“Even Rs 1 crore health insurance is affordable if you take super top up plans,” says Rahul Suri, founder of a health startup.
What Are the Benefits Besides Hospital Bill Coverage?
Does Health Insurance Offer Preventive Health Benefits?
Yes. Many 2025 policies now include:
- Free annual health checkups
- Discounts on medicines and health services
- Wellness rewards (like premium discounts for gym or yoga classes)
Do You Get Tax Benefits on Health Insurance?
Absolutely. Under Section 80D of the Income Tax Act:
- Up to ₹25,000 deduction for self, spouse, and children
- Extra ₹25,000 for parents (₹50,000 if parents are senior citizens)
This reduces your overall taxable income.
“Tax savings are a bonus, but don’t buy just for that. Focus on real medical risks,” cautions C.A. Pravin Agrawal.
Can Insurance Help During Pandemics or New Health Scares?
After the Covid pandemic, most insurers have started covering:
- Hospitalization due to new viruses or outbreaks
- Cashless treatment for infectious diseases
- Telemedicine consultations
Some even include home care benefits for less severe cases.
How Do You Apply for Health Insurance in 2025?
Where Should I Start to Find the Best Policy?
The fastest and most accurate way is to use online health insurance comparison sites. Fincover.com lets you:
- Compare different plans from multiple insurers
- Filter by premium, sum insured, benefits, or exclusions
- Read verified user reviews
What Is the Application Process Step by Step?
- Visit fincover.com and select ‘Health Insurance’
- Enter details for yourself or family
- Compare top recommended plans
- Read all policy documents and check inclusions
- Click ‘Apply Now’ and fill out the proposal form
- Upload ID and health documents if needed
- Complete payment securely
- Get your policy instantly or after medical tests, if required
Benefits of applying online:
- Saves time, no paperwork
- Quick policy issuance
- Automated reminders for renewal
“Digital buying gives more transparency and helps avoid agent bias,” says digital insurance trainer Sunil Pandey.
Can You Switch Your Health Insurance Easily?
Thanks to new portability rules, you can:
- Switch to another insurer after one year of coverage
- Retain waiting periods already served
- Get better add ons or premium rates
Just avoid gaps in coverage during the switch.
What Should You Do When Making a Claim?
How Does Cashless Hospitalization Work?
In 2025, about 90 percent of big hospitals offer cashless claim facilities.
Here’s how it works:
- Select a hospital in your insurer’s network
- Show health card and ID at hospital desk
- Hospital contacts insurer for treatment approval
- After discharge, the insurer pays directly
- Only unpaid extras, if any, are settled by you
What If You Need to Pay First and Claim Later?
If you use a non network hospital, pay the bill yourself. Then:
- Submit all bills, test reports, prescriptions, and discharge summary to insurer
- Fill claim form online or offline
- Insurer reviews and pays into your bank account if approved
“Always keep copies and records. Digital apps can store all your documents safely,” recommends Aditya Shetty, health claims consultant.
What Issues Can Delay or Reject a Claim?
Claims may be delayed or denied if:
- You hid pre existing illness at purchase
- Treatment is for an excluded illness or cosmetic reason
- Hospital is not recognized by IRDAI
To avoid:
- Disclose full medical history when buying
- Choose reputed network hospitals
Are There Any Myths or Misunderstandings About Health Insurance?
Do Young People Really Need Health Insurance?
Some think insurance is just for old age. But:
- Accidents, dengue, or surgeries can happen at any time
- Buying early gives you full coverage and lower premiums
- Pre-existing diseases are less likely to be excluded if you never had them
“Healthy does not mean invincible. Early coverage builds a safety net,” shares Dr. Ashok Nair, family physician.
Is Employer Health Insurance Enough?
Group plans offered by companies are helpful but limited. Drawbacks:
- Only valid while you’re employed
- Often lower sum insured
- Coverage ends if you change or lose your job
Having a personal plan ensures:
- Full control on coverage
- Lifelong portability across jobs
Does Health Insurance Cover All Types of Treatment?
No. Most policies do NOT cover:
- Cosmetic surgeries
- Experimental treatments
- Infertility or conception treatments (unless in specific maternity covers)
Always check policy wordings and compare add ons for special needs.
Why Is Health Insurance More Than Just a Policy?
Beyond paperwork and premiums, health insurance in 2025 is confidence. It lets families focus on recovery, not bills, when emergencies happen.
Longer life expectancy, pollution, unpredictable disease outbreaks, and growing medical costs all make it a necessity, not a luxury.
“Financial safety and health go hand in hand today. Start small—but start now,” urges Gayathri Viswanath, a public health policy analyst.
Still Thinking? Here’s What To Do Next
If you don’t have a health plan:
- List your real needs, illnesses, and family size
- Research online using fincover.com to compare and apply
- Double check hospital networks and sum insured
If you already have one:
- Review sum insured and exclusions yearly
- Upgrade or add a super top up plan if needed
- Teach family members how to make a claim
Don’t wait for a crisis to realize it’s too late. Health insurance in 2025 is a basic household need. Taking action today can help you stay secure through whatever the future brings.