Health insurance changed more in the last two years than in the decade before it: IRDAI's 2024 master circular rewrote the waiting periods and the moratorium, the GST Council made individual policies tax-free in September 2025 while leaving group policies taxed, and the cashless-everywhere framework went live in January 2024. Against that backdrop, the comparison that matters is not "which plan is best" — it is why the employer's free cover is the most expensive policy you own, and how to bridge out of it. This page does both, with the verified cells marked and the unverified ones labelled.
What the 2024 reset changed for every policyholder
The master circular on health insurance business (IRDAI, 29 May 2024, implementing the 2024 protection-of-policyholders regulations) reset the floor: pre-existing disease waiting periods capped at 36 months (down from 48), specific-procedure waiting periods capped at 24 months, and the moratorium cut from 96 to 60 months — after five years of continuous coverage, no claim can be contested on non-disclosure grounds except established fraud. The same circular hard-wires credit portability: sum insured, no-claim bonus, waiting-period credits and even the moratorium clock transfer when you port or migrate, including members moving out of group policies to the same insurer. And no claim can be repudiated without a committee's sign-off. Insurers implemented the new caps by October 2024.
GST just changed the math — unevenly
From 22 September 2025 (CBIC notification 16/2025, following the GST Council's 3 September recommendation), individual health insurance — including family floaters and senior-citizen policies — carries no GST. Employer-employee group policies are explicitly outside the exemption: the group master policy still carries 18%. Read together with the moratorium reform, the practical meaning is sharp: the company cover that "costs you nothing" is GST-loaded, portability-limited, and disappears with the job — while a personal policy bought young is now tax-free at purchase and becomes contest-proof after five continuous years. The same ₹25,000 premium buys more cover personally than it ever did.
Three plans, side by side
The three most-compared retail indemnity plans, from their official pages (October 2026): HDFC ERGO my:Optima Secure (sum insured ₹5L–₹1Cr+, base SI doubles from day one, no room-rent capping, no copay stated, automatic restoration), Niva Bupa ReAssure 2.0 (unused sum insured carries forward as a booster up to 10× at the top variant, unlimited reinstatements after the first claim, premium locked at entry age until a claim), and Care Supreme (₹7L–₹1Cr, cumulative bonus 50% a year up to 100% with no reduction on claim, unlimited automatic recharge, no zone-based copay). The marketing terms are not synonyms — restore refills after exhaustion, booster banks unused cover, recharge refills within the year — and the differences decide which policy pays the second hospitalisation of a bad year. The comparison table below the article carries the verified cells; the cells the official pages do not state (room-rent caps for two of the three) are marked, not guessed — the policy wording, not the brochure, is the binding text.
The comparison, verified cells only
Three retail indemnity plans from their official pages (October 2026). Cells the official pages do not state are marked rather than guessed — the policy wording is the binding document.
View the numbers as a table
| Axis | HDFC ERGO Optima Secure | Niva Bupa ReAssure 2.0 | Care Supreme |
|---|---|---|---|
| Sum insured | ₹5L-1Cr+ (base doubles day 1) | Variant ladder (SI list not stated on page) | ₹7L-1Cr |
| Room rent | No capping (official page) | UNVERIFIED from page | No sub-limits; modified variant exists |
| Copay | None stated | UNVERIFIED from page | No zone-based copay |
| Bonus / booster | Plus Benefit up to 4X total | Unused SI carries forward up to 10X | 50%/yr up to 100%, claim-proof (7X in 5y) |
| Recharge / restore | Automatic restore to base SI | Unlimited reinstatements after first claim | Unlimited automatic recharge per year |
| Waiting periods | 30d / 24m / 36m PED (official page) | Framework caps apply (not listed on page) | Framework caps (not listed on page) |
Not a recommendation. Plan terms change; UINs are on the insurers' pages. The restore/booster/recharge distinction is the row that decides the second hospitalisation of a bad year.
Why company cover fails exactly when you need it
- It ends with employment. Group master policies cover employees while employed; on exit or retirement the member drops out — no continuation right in the regulations.
- The credits do not follow automatically. The circular's migration clause lets group members carry waiting-period and moratorium credits to an individual policy with the same insurer; porting to a different insurer from group cover is the path advisers describe, commonly inside a 30–60 day window — the window's exact statutory basis should be checked before you rely on it.
- The corporate buffer vanishes. The extra sum insured employers buy on top of base cover is not yours and does not travel (reported by group-insurance intermediaries; not in the regulation text).
- The tax now runs the other way. Group premiums still carry 18% GST while your personal policy pays none.
- And the cover is sized for retention, not for catastrophe. Group sums insured are set by HR budgets; a ₹7.5 lakh hospitalisation against a ₹5 lakh group cover is the scenario the source video dramatised, and the mechanics behind it are real: after the group limit, the bill is yours, and the personal policy you never bought is the one that would have paid.
The employer-cover gap, itemised
What the group master policy gives, what it cannot give, and what the 2024-25 reforms changed about the trade. The last row is the new one: group cover is now the GST-loaded option.
View the numbers as a table
| Dimension | Employer group cover | Personal policy |
|---|---|---|
| Continuity | Ends with the job; no continuation right | Yours; renewal in grace protects credits |
| Waiting-period credits | Migrate only to the same insurer (§11) | Port across insurers (§12), credits carry |
| Moratorium clock | Runs on the master policy | Runs on yours from day one — 60 months to contest-proof |
| GST | 18% still applies | Exempt since 22 Sep 2025 |
| Sizing | HR budget (typically small base + buffer) | Sized to your household; add super top-up |
Mechanics per the IRDAI master circular and CBIC notification 16/2025; the 30-60 day porting window is adviser-reported and needs statutory verification before you rely on it.
The bridge: buy retail while you are healthy
The fix is sequencing, not shopping: hold a personal base policy (plus super top-up — the structure our ₹3-lakh audit page prices) from the first job, alongside the employer cover. The moratorium clock runs on your policy from day one, so by the time a job change, layoff or retirement arrives, your personal cover is contest-proof and its waiting periods are history. Porting or migrating later moves credits, but only a policy already owned buys you the five-year clock. The right moment to start it is the moment you stop needing it — which is also the moment it is cheapest.
What the claims data says
Scale context from the General Insurance Council's FY 2024-25 statistics (as reported February 2026): about 3.26 crore health claims registered and roughly ₹94,248 crore paid, with the settlement ratio cited between ~82.5% and ~87% depending on whether you count claims settled or use the IRDAI annual-report basis — pick one basis and attribute it; do not average them. The cashless-everywhere framework (live since 25 January 2024) lets you claim cashless at any eligible hospital with 15+ beds, provided intimation within 48 hours for emergencies — narrowing, though not closing, the network advantage. And the circular's claims-review committee requirement means a repudiation now needs institutional approval — a governance floor, not a guarantee.
Educational content, not financial advice. The master circular's waiting-period, moratorium and portability provisions are quoted from the circular text itself (29 May 2024); the GST position is from CBIC notification 16/2025 effective 22 September 2025 and the Finance Ministry's FAQ; plan details are from the insurers' own pages (October 2026) with unstated cells marked rather than guessed; GI Council statistics are via press reporting (February 2026). Plan terms change — the policy wording is the binding document, and the comparison is not a recommendation.