There are four public sector players in the country with health insurance policies – United India Insurance Co Ltd, National Insurance Co Ltd, New India Assurance Company Ltd and Oriental Insurance Company Ltd. The greatest benefit of taking a policy with these players is the cost benefit, as you will need to pay lower premium for the same coverage when compared to a private sector player. However, there are some drawbacks also, like a co-payment clause in many policies and also limited option of choosing a high cover. ​

Our earlier analyses on health insurance policies have received positive feedback from our readers. We have discussed health policies offered by Nationalized Banks, those offered by top players in the private sector and policies offered exclusively for senior citizens. Today, we look at health coverage offered by public sector players only.  

We have analyzed the Family Medicare Policy from United India Insurance Co Ltd, Parivar Mediclaim Policy from National Insurance Co Ltd, Family Floater Mediclaim Policy from New India Assurance Company Ltd and Happy Family Floater Policy from Oriental Insurance Company Ltd. Let’s look at some features of these 4 policies.

Coverage: All policies cover the policy holder, spouse and dependent children. However, parents are covered only by New India Assurance and Oriental Insurance policies. Further, parents in laws are also covered by the Oriental Insurance policy.

Entry age and age on renewal: This becomes critical when you consider health cover for old age. National Insurance and Oriental Insurance score poorly on these counts. The policies by United India Insurance and New India Assurance are better, as the maximum age on renewal is very high, thus making it ideal if you look at the long term.
Sum Assured: This is a weak point in general, for most public sector health policies, with that offered by National Insurance Company being the poorest at maximum Rs. 5 lakh. Others have the maximum Sum Assured option up to Rs. 10 lakhs. But Oriental Insurance has come up with a variant which has a maximum sum assured of Rs. 20 lakhs. However, there are some private sector policies which offer up to Rs. 50 lakhs coverage also. The amount of coverage you need depends on your needs, family size etc. If you feel you need a higher overall cover, you can also consider splitting across 2 policies or looking at a top up cover option also.

Premium per annum: This is a positive feature for public sector policies, as the premium is lower when compared to private policies for the same amount of cover. The amounts are almost comparable across all the 4 policies analyzed.
Co-payment requirements: This is the amount the policy holder will have to shed from his pocket in case of a claim. It is the highest in the New India Assurance policy, with co-pay clause applicable on age as well as location specifications (Refer the table below). The other plans have co-pay requirement of 10%. The Gold variant of the Happy Family Floater plan of Oriental Insurance does not come with this condition.
Benefits: No claim discount works out to be the best for the Oriental Insurance policy, ranging up to 20%. Further, there is a discount of 5% in TPA services are not opted and 15% on Overseas Medical Policies. There is also a discount if you purchase the policy online. Again, this policy comes with additional covers like daily cash allowance, attendant allowance, personal accident cover and cover of life hardship survival benefit, albeit at a cost. Domiciliary hospitalization is also possible. Some other policies have a no-claim discount up to 15%, subject to certain conditions. Free health check up benefits is available under United India Insurance. The latter also offers discount on family members’ premium. . The National Insurance policy seems to be restrictive in terms of extra benefits offered. Refer the table below for other benefits of the policies.
Claim Settlement Ratio: The higher the claims settled, the better it is for the policy holder. In this respect,all the companies have done pretty well. Most are above 100% indicating that they are clearing the backlog of claims. The ratios for all of them have improved over the last few years.
Other features: Pre and post hospitalization time period is 30 days and 60 days respectively for all policies, except the National Insurance policy, where it is 15 days and 30 days respectively. This is again restrictive. Pre-existing diseases are covered only after 4 years of the policy for all the policies analyzed. The exclusions are also pretty standard across all the policies.

​Which policy should be chosen?
Each policy has both benefits and drawbacks and you should choose based on your unique requirements. The policy by United India Insurance comes with high age and sum assured options. However, there are not many extra benefits available in this policy and claim settlement ratio is also low. The policy by New India Assurance can be considered for high settlement ratios and also high renewal age. But again, you should consider the co-pay clause and entry load for higher age brackets. The Oriental Insurance policy can also be considered for high settlement ratios and the gold and diamond plan variants comes with higher sum assured option and more benefits. But this may not be suitable for higher age brackets as the maximum age for entry is comparatively lesser. You can avoid the policy by National Insurance Company although the premium is comparable, if you wish to take a higher sum assured or are in the higher age bracket. There is also a restriction on total expenses payable for one illness.
As mentioned earlier, your specific needs determine the choice of the policy. Go by the benefits you can get, as the premium charged is almost comparable across all the four policies.

A detailed comparison is available below. If you prefer to download the excel file, please click here. For more details, refer to individual company’s prospectus. Kindly note that this analysis covers major offerings from the insurers only & this is not an all-product comprehensive comparison. The analysis is valid on the date being published.

This article was originally published on Moneycontrol

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