Gone are the days of one-size-fits-all health insurance. With skyrocketing health care costs, different lifestyles and different family structures, the right coverage needs to be as unique as you are. Enter add-ons (or riders) – additional coverage that you can tack onto a base policy that fills in coverage gaps without needing a whole new plan.
Here is how you can customise the best health insurance plan, when you should pay the extra premium and what to be cautious of.
Why Customise at All?
● Medical inflation in India hovers near double digits, quickly outpacing stagnant base sums insured.
● Newer treatments (robotic surgery, targeted cancer drugs, organ transplants) can exhaust a standard mediclaim policy long before recovery ends.
Add-ons allow you to:
● Expand scope (e.g., cover OPD visits that a basic medical insurance ignores).
● Remove cost caps (e.g., room rent sub-limits).
Popular Add-Ons at a Glance
Add-On
What It Does
Ideal For
Typical Cost Driver
Critical illness cover
Pays a one-time lump sum on diagnosis of listed life-threatening illnesses, irrespective of the actual hospital bill
Families with a history of cancer, heart disease or young breadwinners worried about income loss
Number of illnesses covered & sum assured
Room-rent waiver
Removes or raises per-day room cap so you can pick single AC or suite rooms without proportional deductions
Residents of metro cities
Hospital zone & chosen limit
Hospital daily cash
Fixed daily allowance (often 500–5,000₹) during hospitalisation to meet non-medical costs like food, attendant stay
People without salaried sick leave or freelancers
Daily cash amount & maximum days
Personal accident cover
Lump-sum for death or total/permanent disability; partial payout for partial disability
Frequent travellers, commuters, and high-risk professions
Sum assured & occupation risk class
OPD cover
Reimburses consultations, diagnostics and medicines without 24-hour admission
Families with chronic conditions requiring regular follow-up
Annual OPD limit
Co-pay waiver
Insurer bears the co-payment otherwise applicable in senior-citizen or budget plans
Parents above 60 or zones with high hospital tariffs
Age & co-pay percentage removed
AYUSH benefits
Covers Ayurveda, Yoga, Unani, Siddha, Homeopathy, and inpatient costs
Policyholders preferring alternative therapy
Sum insured for AYUSH
PED waiting-period reduction
Shortens 2–4-year lock-in for pre-existing diseases like diabetes or hypertension
Middle-aged buyers with known ailments
Years reduced & disease profile
How to Choose the Right Combination
1. Assess Risk and Life Stage
○ Newly married? Maternity rider may trump critical illness.
○ Travelling salesman? Accident and hospital cash add-ons matter more than OPD.
2. Check Existing Benefits
Some comprehensive family health insurance plans already bundle restoration, AYUSH or free health check-ups. Don’t duplicate benefits.
3. Compare the Marginal Premium vs. the Potential Savings
IRDAI caps add-on price at 30% of base premium, but even a 10% extra can feel steep if the rider rarely triggers.
4. Mind Waiting Periods and Exclusions
Riders follow their own clock. A critical illness payout may require a 90-day waiting period plus a 30-day survival; OPD covers usually carry sub-limits per visit.
5. Synchronise Tenure
Add-ons co-exist with the core policy. Renewing without them is allowed, but mid-term addition generally isn’t; plan ahead at purchase or renewal.
Suppose you hold a ₹10 lakh base mediclaim policy. A single hospitalisation for cardiac bypass in a metro can cost ₹5–6 lakh, eating half your sum insured. If the same event triggers heart failure again within the year, you’re underinsured. Two simple riders – Sum Insured Restoration (auto top-up after first claim) and Room-Rent Waiver – could have doubled the cover and prevented proportionate deductions for choosing a private room, all for maybe 12–15% extra premium.
Are Add-Ons Always Worth It?
Pros
● Targeted protection against specific financial threats.
● Cheaper than separate policies (no duplicate admin fees).
● Tax efficiency: Premium paid for riders counts under Section 80D, just like the core premium.
Cons
● Extra paperwork at claim time (insurers may require separate forms).
● Can create an illusion of unlimited cover, still subject to rider limits.
● Increasing costs: Stacking many riders may approach the cost of a larger base cover.
Rule of thumb: First, ensure an adequate base sum insured (at least 10–15 times monthly income for urban families). Then pick two or three riders who plug the biggest gaps.
HDFC ERGO’s Optima Secure plan doubles your base cover from day one, and restores 100% after a claim. Adding crucial add-ons to this plan can act as a one-stop solution for your healthcare needs.
Tips for Maximising Value
● Re-evaluate add-ons at every renewal; your needs evolve.
● Keep documentation – diagnosis reports, disability certificates – ready to speed lump-sum rider payouts.
● Use the insurer’s network hospital search before emergencies; cashless add-ons only work within accredited facilities.