
A CoverSure analysis of 1 lakh policyholders finds 63% locked out of better coverage by pre-existing conditions. Half of eligible policyholders still hold basic plans, raising concerns about underinsurance as healthcare costs rise.
More than 63% of Indian health insurance policyholders who wanted to switch to a better plan could not do so, largely because of pre-existing conditions, according to a new analysis by CoverSure. The platform examined data from over 100,000 policyholders and found that even among those with no medical barriers, nearly half hold basic, non-comprehensive plans despite being eligible for upgrades.
CoverSure's Policy Health Check report described the gap as one of awareness, not access. “The gap here is not one of access. It is one of awareness and engagement,” the report said. Many policyholders never revisit their coverage after buying it, so a plan that worked at age 32 can quietly become inadequate as circumstances change.
The analysis also flagged a specific exposure for older policyholders. A majority of those aged 50 and above carry less than ₹5 lakh in sum insured, far below the cost of a single hospitalisation in a tier-1 city. Among policyholders already living with chronic conditions, 17% hold less than ₹5 lakh in coverage. “These are individuals who are statistically more likely to be hospitalised, and yet hold coverage that a single admission in a tier-1 city can wipe out entirely,” the report noted.
Saurabh Vijayvergia, founder and CEO of CoverSure, warned that most policyholders discover these gaps only during a medical event. “Buying insurance is a starting point, not a destination. A policy that was right at 32 may leave someone dangerously underprotected at 35,” he said in the report.
A brighter note came from the younger cohort. Policyholders aged 30 to 40 made up 41% of those analysed, and those under 30 another 10%. The data showed younger policyholders engaging proactively with their existing coverage and questioning whether it is sufficient. The report described that shift as one that, if sustained, could meaningfully change how India's insured population relates to its policies over time.
Drafted by a large language model from the source reporting linked above, then screened by automated publishing checks. It is not read by a journalist before publication. Some articles cite our Alpha Score. Verify prices and figures against the original source. Educational coverage, not personalized advice.