Review of Health Insurance Policies

Written by Vidya Kumar

August 22, 2014

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We have analysed four health insurance policies in this article – 2 from the public sector and 2 from the private sector – Mediclaim 2012 Policy from New India Assurance Company Ltd, Happy Family Floater Policy from Oriental Insurance Company Ltd, Optima Restore Family Floater from Apollo Munich and Family Floater Heartbeat Gold plan from Max Bupa. You can opt for either of the public sector policies if you wish to take a lower Sum Assured. On the other hand, if you want a higher cover, you can opt for the private sector policies. Your specific needs determine the choice of the policy. Let’s look at some features of these 4 policies.

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Coverage: All policies cover the spouse and the dependent children of the policy holder. Oriental Insurance policy covers parents in laws too. The Heartbeat Family Floater variants allow coverage for self, spouse and upto 4 children in various combinations.

Entry age and age on renewal: The higher the maximum entry age and maximum age on renewal, the better it is for you, as this gives coverage in old age when the medical expenses are the highest. Of the plans compared, the maximum age is highest at 65 years for New India Assurance and Apollo Munich policies. However, 65 years is not very high. Nevertheless, a positive in New India Assurance policy is that there is no maximum age for renewal.

Sum Assured: In today’s age of rising medical expenses, a high cover is preferred by many families. Private players like Apollo Munich and Max Bupa offer a higher sum assured option. Max Bupa Family Floater Gold plan offers a sum assured as high as Rs. 50 lakhs. The maximum sum assured option is lowest for Mediclaim 2012 policy.

Premium per annum: For a lower sum assured option, the premium is lower for the public sector policies and higher for the other two policies. However, the benefits available in the Optima Restore policy and Family Floater Heartbeat policies are also higher.

Co-payment requirements: Lower the co-pay requirement; the better it is for you as this is the amount you will have to give from your pocket in case of a claim. This 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). Max Bupa’s plan has a tapering co-payment feature which provides an option of reduced and subsequently zero co-payment, subject to continuous renewal for a period of 4 years. Co-payment feature is absent in the Apollo Munich Plan and the Gold variant of the Happy Family Floater plan of Oriental Insurance.

No-Claim Benefits: The public sector policies we have analysed in this discussion come with no-claim discounts on premium with a ceiling of 15% for New India Assurance 20% for Oriental Insurance policies. Apollo Munich policy gives a 50% enhancement on the basic sum assured for every year you do not claim, upto 100%.   The Max Bupa plan offers a health relationship loyalty programme, wherein the policy holder can choose one of the two options – (a) Earn points worth 10% of the last paid annual premium on renewal of the policy (b) An increase of 10% of the Sum Insured every year of expiring base sum assured, accumulated upto 50% of renewal base sum insured. The loyalty program is irrespective of the claim.

Other Benefits: The pre and post hospitalization time periods are the highest for the Optima Restore policy by Apollo Munich. The Max Bupa policy (Gold variant) covers upto 20% of Base Sum Insured under this head. The Max Bupa policy offers maternity benefits, which is generally disallowed by most health insurance policies. Health check up benefits is another positive in Max Bupa. The two private sector policies also offer day care procedures as a part of the claim even though the hospitalization is for less than 24 hours and also cover organ transplant costs. The Apollo Munich policy has the benefit of automatic re-instatement of the basic sum insured, if the basic sum insured and multiplier benefit has been exhausted during the policy year, which is beneficial too. The extent of benefits is lower for the public sector policies.

Which policy should be chosen?

The most striking feature in the comparison below is that the premium for the 2 public sector policies for a lower sum assured is much lower than their private sector counterparts. So if you are concerned about paying a high premium, are not particular about extensive benefits and do not mind the co-pay clause, you can pick these two policies. However, remember that you cannot opt for a very high Sum Assured amount and the New India Assurance policy has an entry load if you are above 45 years.

Among the two private sector policies analysed, the premium as you can see if higher for the Family Floater Heartbeat plan of Max Bupa. You can take it if you want a high Sum Assured option or the extra benefits listed. The Apollo Munich plan does not have the co-pay clause and comes with restoration of Sum Assured and multiplier benefit as well. These can be positives in times of rising healthcare costs. Nevertheless, keep in mind the higher premium.

You can opt for either of the public sector policies if you wish to take a lower Sum Assured. On the other hand, if you want a higher cover, you can opt for the private sector policies. Your specific needs determine the choice of the policy.

A detailed comparison is available below. 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.

NA: Information Not Available

This article was originally published on Moneycontrol.
The author can be reached at [email protected]

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