Clipped from: https://www.thehindubusinessline.com/portfolio/personal-finance/insurance-query-matters-of-the-heart/article70655893.ece
Should you opt for plan with unlimited sum insured?
Q: My wife, Aaruhi (35), was recently diagnosed with a chronic heart condition. As a family of three, we’ve always relied on my corporate insurance, but this diagnosis has been a wake-up call. I want to secure a personal plan that ensures she gets the best treatment. Given her condition, would a ₹30 lakh health plan be enough, or should I opt for plan with unlimited sum insured? With a chronic heart ailment, which structure is better for recurring hospitalisations? Also, what mandatory checks should I look for regarding pre-existing disease (PED) waivers and consumables coverage to minimise out-of-pocket costs? – Sam
A. Hi Sam,this is a valid question, and you are right to reassess your health cover after a diagnosis like this. A medical condition in the family often changes how one looks at insurance, moving it from being a routine benefit to a critical part of long-term financial planning.
With a chronic heart condition, one can never be certain about the scale, frequency, or timing of future medical expenses. Cardiac care is rarely a one-time event. It often involves repeated hospitalisations, interventional procedures, diagnostics, medications, and long-term follow-ups. Over time, the cumulative cost of care can be significant, especially as medical inflation continues to push up treatment expenses in quality hospitals.
In this context, for complete peace of mind, an unlimited sum insured is the more prudent choice. It removes the uncertainty around how large a claim might be in any given year and protects you from the risk of exhausting your cover due to multiple or high-value hospitalisations. Unlike traditional fixed-sum plans, unlimited sum insured policies reduce reliance on restoration clauses and typically allow the effective cover to increase year after year. This ensures that treatment decisions are driven by medical need rather than financial limits.
An unlimited structure also ensures that access to treatment is not constrained even if multiple claims occur within the same policy year. For families managing chronic conditions, this continuity of coverage is critical, as hospitalisations may not always be predictable or neatly spaced out over time.
When evaluating pre-existing disease coverage, it is important to carefully check the waiting period. This should be clearly defined and as short as possible. Equally important is ensuring that once the waiting period is completed, there are no sub-limits on cardiac procedures, room rents, or related complications. Hidden caps can significantly reduce the real value of a policy at the time of claim.
Consumables cover becomes especially critical in cardiac care. Items such as stents, catheters, syringes, gloves, and other disposables are widely used in heart-related procedures and are often excluded or capped in standard policies. Ensuring comprehensive consumables coverage can meaningfully reduce out-of-pocket expenses during hospitalisations.
The author is Joint Group CEO, PB Fintech
Published on February 28, 2026
aniltikotekar4sme.com 