Archive · 14 Sep 2026
Cashless Health Insurance Still Leaves Policyholders With Out-of-Pocket Costs
Health insurance helps pay medical bills, but it does not always pay the whole bill.
Cashless treatment usually means the insurer pays the eligible amount directly to a network hospital.
You may still need to pay for excluded items, expensive rooms, deductibles or co-payments.
A family floater policy also has one shared amount for the whole family.
Medical treatment has become more expensive, so an old policy may no longer be large enough.
The right amount depends on your family, city, health needs and preferred hospitals.
Experts suggest checking your policy every two or three years.
A super top-up can add protection, but its rules and deductible should be understood first.
Cashless hospitalisation does not cover expenses excluded by a policy or exceeding its limits and sub-limits.
Healthcare inflation in India averaged 10.8% from 2018 to 2024, including 14% in 2024, according to estimates cited in a Securities and Exchange Board of India report.
A policy’s adequacy depends on factors including age, health, family size, location, hospital preferences and whether coverage is shared through a family floater.
Room-rent limits, co-payments, deductibles, exclusions, disease-specific sub-limits and non-medical expenses can increase the patient’s bill.
Policybazaar’s Rohan Goel recommends reviewing cover every two to three years and considering super top-ups for additional protection.
- Who
- Health-insurance policyholders and their families, with guidance from Rohan Goel, Business Head of Health Insurance at Policybazaar, and the Insurance Regulatory and Development Authority of India.
- What
- The article explains why cashless health insurance can still leave patients with significant out-of-pocket expenses and how to assess whether coverage is adequate.
- When
- Healthcare inflation averaged 10.8% annually from 2018 to 2024; policyholders are advised to review coverage at least every two to three years.
- Where
- In India, with costs varying between metropolitan areas and smaller cities and between private and government hospitals.
- Why
- Hospital costs are rising, while policy limits, room-rent restrictions, co-payments, deductibles, exclusions and sub-limits can reduce the insurer’s payment.
- Healthcare inflation
- Average healthcare inflation was estimated at 10.8% between 2018 and 2024, including 14% in 2024.
- Coverage review
- Policyholders should review their health cover at least once every two to three years, or sooner after major changes in income, family size, location or medical needs.
- Suggested individual cover
- Rohan Goel says Rs 10 lakh can be a reasonable starting point for an individual in many cases.
- Family floater
- The sum insured is shared by all covered family members rather than being available separately to each person.
- Insurance coverage rates
- The National Statistical Office’s 80th Round survey found coverage of 47.4% of rural residents and 44.3% of urban residents.
- Cashless limitations
- Cashless treatment is generally available only at eligible network hospitals and does not cover expenses outside policy terms.
- Possible additional protection
- Super top-up policies may provide a larger financial cushion at a lower cost than substantially increasing the base policy, subject to their deductibles and conditions.