Friday, May 19 2023
Source/Contribution by : NJ Publications

Having a basic health insurance policy is a great start to protect yourself from rising hospitalization costs and receive hassle-free, timely treatment at high-quality medical facilities. Standard health insurance plans, however, may not be sufficient on their own as it is not “one-size-fits-all” in terms of catering to the diverse healthcare needs of each individual and family. This is where health insurance add-ons or riders come into play!

What is Health Insurance Add-On?

Health insurance add-ons or riders are additional coverage options that you can purchase to extend the scope of your standard health insurance policy. You can buy add-ons to suit your needs at the time of buying the policy or when you renew it, by paying an additional premium. These covers will help cover medical expenses that aren't covered by the regular plan.

Types of Add-on Covers in Health Insurance

There are several add-on covers in the market that cater to the various needs of the policyholders. Here are some add-on covers you can choose to boost your health insurance coverage and maximise its benefits.

1. Room Rent Waiver: In a standard health insurance policy, hospital room rent is capped to a particular limit. If you include a room rent waiver add-on to such health insurance policies, it either raises that limit or imposes no limit. In the case of no cap, room rent can be as high as the sum insured.

For example, Mr Rahul buys a health insurance policy of Rs. 5 lakhs with a room rent cap of 1% of the sum insured. After a few years, he had to be hospitalized for bypass surgery. His insurance policy allowed him a room that cost Rs. 5,000 per day. His hospital stay was 5 days long and he chose to stay in a room costing Rs. 8,000 per day. Rahul’s total hospital bill was of Rs.3,00,000. Nows, the claim calculations however work on the principle of proportionate deductions, except on medicines, as it is a non-associated expense. As one can see from the details below, the insurance company finally pays Mr Rahul Rs.1,96,875 even though the hospital bill was Rs. 3,00,000 only because of the room rent cap.

Bill Particulars

Actual Expenses

Claim Amount

Claim Ratio

Room Rent Charges

Rs. 40,000

Rs. 25,000


Cost of Bypass Surgery

Rs. 1,75,000

Rs. 1,09,375


Doctor Visits

Rs. 30,000

Rs. 18,750



Rs. 30,000

Rs. 18,750



Rs. 25,000

Rs. 25,000



Rs. 3,00,000

Rs. 1,96,875


2. Unlimited Restoration: This add-on replenishes the sum insured upon exhaustion due to claim/s. With this add-on, the customer can claim multiple times without worrying about the risk cover exhausting. For example, you purchased a health insurance plan, with a cover of Rs. 5 lakhs. You had to undergo a heart surgery that uses up the whole sum insured. Let’s say, within the same year, you get hospitalised again for another ailment which requires a medical expense of Rs. 2.5 lakhs. Without the Restore Benefit, your health insurance plan will not cover the cost of second hospitalisation, and you’ll have to pay the bill from your own pocket. However, if you opt for the restoration benefit add-on, the cost of the second hospitalisation will get covered by your insurance plan up to the base sum insured, relieving you of any financial burden.

3. Consumables Coverage: Nebuliser kit, hand gloves, syringes, belts/braces, registration/admission charges, etc. are not covered under the standard policy. The customer has to bear the expense of such items out of the pocket. By purchasing an add-on/rider at an extra cost, customers can get coverage of non-payable items as well. 

4. Cumulative Bonus Booster: This add-on increases the sum insured by a fixed percentage if no claim is filed during a policy year. For eg; If your Sum Insured is Rs. 5 lacs and you have not registered any claim within the first policy year then your insurer gives 50% booster addition in base cover upon renewal. This means your sum insured becomes Rs. 7.5 lacs upon renewal without any increase in premium. So, with this add-on the insured need not worry even if the claim amount after renewal exceeds Rs. 5 lacs but up to Rs. 7.5 lacs.

5. OPD Care: OPD treatment is usually not included under the basic health insurance plan. The OPD care add-on covers costs associated with OPD visits, diagnostics, and medications. Please note that in order to claim this add-on benefit, the policyholder must submit a cashless or reimbursement claim.

6. Reduction in Waiting Period: Almost all health insurance policies include a waiting period for pre-existing diseases. By selecting this add-on, insured members can reduce or, in some cases, waive off the PED waiting period for an extra premium, thus allowing them to claim related expenses sooner than the stipulated time period.

Benefits of Buying Add-on Covers

On purchasing health insurance add-on covers, you will get:

- The ability to design or customise your policy to meet your specific medical needs.

- Less hassle during claims.

- Enhanced coverages and benefits.

- Tax benefits as per Section 80D of the Income Tax Act, 1961.


Buying add-ons is a cost-effective way to cover the specific risks that are not covered under your standard health insurance policy. Now that you know about the various add-on options, ensure that you assess your existing medical conditions, family’s medical history, lifestyle, etc. before deciding which add-ons would be appropriate for you. It is also advisable that you go through all the terms and conditions in detail before you make the final decision. 

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