A parliamentary committee is considering caps on hospital room rents, linked to local three-star hotel rates, as well as limits on surgery costs. The proposal aims to contain medical inflation, which has accelerated since the post-Covid period. To examine the issue from an insurance and claims perspective, we look at data released by Policybazaar.com. The insurance aggregator and composite broker analysed 8.7 lakh health insurance claims filed between 2021 and 2026. The study highlights how age, region and gender influence claims, and points to the growing burden of chronic conditions.Age factorClaims rise steadily with age. As the figure shows, the average claim for the 60-plus cohort is 170 per cent higher than that of the youngest cohort, aged 0–25 years. The study notes that younger policyholders typically claim for infections, injuries and maternity-related expenses, while older policyholders are more likely to claim for cardiac, cancer, kidney and other chronic illnesses.The first takeaway is that health insurance should not be viewed as a product only for older people. Although claim amounts are lower among younger policyholders, the study reports that 56 per cent of claims came from the 26–45 age group. With more than half of claims arising from this younger cohort, health insurance is better seen as an age-agnostic form of protection.This also matters because pre-existing disease, or PED, is the most common reason for claim rejection. Entering the health insurance net early helps policyholders complete the three-year PED waiting period and the five-year moratorium period sooner, after which claim rejections should be minimal.The second takeaway is that insurance for the elderly, though expensive, may still be necessary. Annual premiums can range from ₹70,000 to ₹1 lakh, putting such cover out of reach for many households. However, the risk of remaining uninsured is also significantly higher, with the average claim for older policyholders at ₹1.8 lakh.Rising impact of lifestyle conditionsThe study also underlines the rising burden of chronic conditions in healthcare. These conditions persist for more than a year and may require lifelong care from the point of diagnosis. They include diabetes, cardiac ailments and kidney disease, many of which are also linked to lifestyle choices. For policyholders, this makes chronic illness a key financial risk to plan for.The average claim amount for chronic conditions is ₹2.66 lakh, four times the average for non-chronic claims. As economies develop, healthcare demand typically shifts from acute, non-chronic care to long-term chronic care, and India appears to be following that pattern. Although chronic conditions accounted for only 27 per cent of claims by number, they made up 42 per cent by value. Within this category, cancer and heart conditions together accounted for 22 per cent of claims by value.Medical inflation is also highest in the chronic category. Cancer recorded annual claim inflation of 10–14 per cent, while heart and bone-related treatments saw annual inflation of 6–10 per cent., over the five-year period. Given the high claim amounts and rising disease burden, policyholders need adequate cover with the PED period completed to ensure effective financial protection.Women-centric careThe study also focuses on women’s health and high-risk areas beyond maternity care. Breast cancer claims averaged ₹7.5 lakh, and Policybazaar.com reports that the condition accounted for ₹99 crore in claims over the last five years. Reproductive health, maternity and benign breast tumours reported average claim amounts of ₹1.12 lakh, ₹50,000 and ₹86,000, respectively. These numbers underscore the need to prioritise women’s healthcare, an area where several insurers already offer women-centric plans.Regional impactRegional differences further shape claim costs. The study finds that the average hospitalisation claim in Tier-1 cities is 44 per cent higher than in Tier-3 cities. For instance, Mumbai reported an average claim of ₹1.92 lakh, compared with ₹1.5 lakh in Faridabad. This helps explain why insurance pricing is pincode-dependent and why policyholders should accurately report their place of residence when buying a policy. Higher land and personnel costs in Tier-1 cities push up healthcare expenses, making higher cover more important in these regions.The study also breaks down the components of a claim. In high-cost ailments, surgery accounts for 32–43 per cent of the claim, followed by medicines at 10–16 per cent.. Room and nursing charges account for 7–10 per cent, while consumables account for 7–8 per cent. For policyholders, the key takeaways are to check the room-rent clause at the time of admission and to consider a consumables cover, since these expenses may otherwise have to be paid out of pocket.Siddharth Singhal, Head of Health Insurance at Policybazaar, says, “Healthcare costs in India are increasingly being shaped by two parallel trends — the rising incidence of complex illnesses and the growing cost intensity of treatment.” Medical inflation of 14–16 per cent remains a concern, driven not only by general price inflation but also by advances in healthcare delivery, including robotics, pharmaceuticals, biologics, instruments and procedures.Taken together, the claims data show that health insurance is no longer optional across age groups. Adequate cover, bought early and maintained consistently, remains one of the most effective ways to protect households from rising healthcare costs.Published on August 22, 2026