Last Updated : Sep 03, 2014 12:14 PM IST | Source:

Health insurance policies: Reviews & analysis

All policies cover the spouse and the dependent children of the policy holder. Oriental Insurance policy covers parents in laws too. Max Bupa policy does not specify of a ceiling in coverage on number of adults and children.

Smitha Hari

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. Let’s look at some features of these 4 policies.

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.

Insurer New India Assurance Company Ltd. Oriental Insurance Company Ltd Apollo Munich Max Bupa
Name of Policy Mediclaim 2012 Policy Happy Family Floater - Silver and Gold Variants Optima Restore Family Floater Family Floater Heartbeat Gold Plan
Coverage Self, Spouse, Children and Parents Self, Spouse, Children, Parents and Parents in laws. Self, spouse, children 2 Adults and 4 children in any of the following combinations:
·   1 Adult + 1Child
·   1 Adult + 2 Children
·   2 Adults
·   2 Adults + 1Child
·   2 Adults + 2Children
·   1 Adult + 3 Children
·   1 Adult + 4 Children
·   2 Adults + 3Children
·   2 Adults + 4Children
Maximum entry age 65 years 55 years 65 years NA
Maximum age on renewal No maximum age for renewal 65 years NA NA
Minimum Sum Assured Rs. 1 lakh Silver: Rs. 1 lakh Rs. 3 lakhs Rs. 5 lakhs
Gold: Rs. 6 lakhs
Maximum Sum Assured Rs. 8 lakhs (Rs. 3 lakhs for those aged over 55 at time of entry) Silver: Rs. 5 lakh Rs. 15 lakhs Rs. 50 lakhs
Gold: Rs. 10 lakhs
Premium per annum Rs. 6,067 Rs. 5,440 Rs. 10,736 NA (Silver Plan of offers a Sum Assured of Rs. 3 lakhs at an annual premium of Rs. 12,519)
(for a sum insured of Rs. 3 lakhs for a 35 year old, spouse and 2 children)
Premium per annum Rs. 11,820 (for maximum cover of Rs. 8 lakhs) Rs. 18,480 Rs. 17,608 Rs. 32,103
(for a sum insured of Rs. 10 lakhs for a 35 year old, spouse and 2 children)
Premium per annum Cover not available Cover not available Rs. 21,425 Rs. 35,489
(for a sum insured of Rs. 15 lakhs for a 35 year old, spouse and 2 children)
Pre-hospitalization time period 30 days NA 60 days 30 days
Post-hospitalization time period 60 days NA 180 days 60 days
Pre-existing diseases coverage After 48 months of policy commencement date After 4 consecutive renewals 4 years After 24 months of continuous coverage (Silver plans come at 48 months)
Co-Pay requirements 20% if the treatment is taken in a zone which is higher than zone for which premium is paid; 20% for persons above 55 years, until he has four years of claim free continuous coverage. Silver: 10% None 20% if the claimant is above 65 years. However this reduces by 5% for every year of continuous cover and subsequently become 0% after 4 years
Gold: Nil
No Claim Benefit For age above 60 years: 3% discount per year upto max of 15%; For others: 2% per year upto max of 10% (for SI < 3 lakhs) and 3% per year upto max of 15% (for SI =>3 lakhs) 5% of premium for every claim free year, subject to maximum of 20% Bonus of 50% of the basic sum insured for every claim free year, maximum upto 100%. There is a health relationship loyalty programme irrespective of the claim. One of the following two options can be chosen: , (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.
Major exclusions Pre-existing diseases within 48 months, Pregnancy related, Pre-existing diseases within 4 years Pre-existing diseases upto 4 years; Any disease within 30 days of start of policy; 2 year Waiting Period for Specific Illnesses; Non-allopathic treatment Pre-existing diseases within 24 months, Addictive conditions and disorders, Ageing and puberty, Artificial life maintenance, Circumcision, Dental/oral treatment, Conflict and disaster, Congenital conditions, Convalescence and Rehabilitation, Cosmetic surgery, Drugs and dressings for Out-patient or take-home use, Eyesight, Unproven/Experimental treatment, HIV, Obesity, alternative treatment, OPD treatment, reproductive medicine, sexual problems, speech disorders
Debility and General Run down Conditions, Sexually transmitted diseases, HIV (AIDS). Circumcision, Cosmetic surgery, Plastic surgery, Vaccination, War, Treatment outside India, Naturopathy, Domiciliary Treatment, Experimental or unproven treatment, external equipments, payments to Hospital like Service Charges, Surcharge, cost of external or durable medical equipments, non medical expenses
Other comments Entry load is applicable if the entry age is over 45 years; Benefits include 10% -18% Family discount depending on number of members and SI amount; SI can be enhanced on renewal if policyholder less than 65 years, 25% of SI is applicable for Ayurvedic and Homeopathic treatments, Hospital Cash allowance at 0.1% per day, free health check up benefits at the end of 3 claim free years Inbuilt cover daily cash allowance and attendant allowance up to limits specified for Gold Plan; Personal Accident add on cover; Cover of life hardship survival benefit for Gold Plan for diseases like Stage IV cancer, stroke leading to paralysis, end stage renal disease; Discount of 5% if TPA is not opted; Domiciliary Hospitalisation available up to limits specified, ambulance charges as per limits; Discount of 15% on Overseas Medical Policy premium if opted Automatic re-instatement of the basic sum insured, if the basic sum insured and multiplier benefit has been exhausted during the policy year; Emergency ambulance expenses up to Rs. 2000;Covers the cost of treatment for the organ donor at the time of organ transplant; Includes domiciliary hospitalization; covers 140 day-care procedures less than 24 hours of hospitalization Maternity benefits after 2 continuous years, all day care procedures not conducted in OPD department, , free health check every year, organ transplant costs, domiciliary hospitalization, emergency ambulance charges, Initial waiting period is 90 days, Pre and post hospitalization expenses capped at 20% of SI, Discount if 2 year option is chosen, Eligibility for Health Relationship Programme which can help you increase Sum Assured or earn and redeem points, Any age enrolment possible
VERDICT Positives: Maximum age for renewal is high, Sum Assured is high for people below 55 years entry, No claim bonus is available, discount if family members are included, hospital cash and free health check up benefits applicable Positives: Low premium, Option available for high Sum Assured in Gold plan, Domiciliary hospitalisation available, other optional covers available under Gold Plan, discount for Non TPA services and Overseas policy available Positives: Option of high Sum Assured, high pre and post hospitalisation period, No loading on renewal, no sub limits and co pay, restore benefit and multiplier benefit available, day care treatment, domiciliary hospitalisation and ambulance expenses available Positives: Option available for high Sum Assured, Maternity benefits, free health check-up and Domiciliary hospitalisation available, day-care procedures and ambulance charges covered, eligible for Health Relationship Programme
Negatives: Co-pay is very high, entry load if entry age is over 45 years Negatives: Co-pay applicable for Silver plans, No other benefits like day-care or maternity coverage, maximum age for entry and renewal is low    
    Negatives: Premium is high Negatives: Premium is highest among peers, Initial waiting period at 90 days is highest
Can be considered on the back of high renewal age; However, be aware of the high co-pay clause and entry load factor Can be considered for low premium and optional covers for lower sum assured; however be aware of the low renewal age and restrictions on the silver plan; Higher sum assured comes at a comparatively high premium    
    Can be considered if you want a higher sum assured option and multiple benefits available. However, lower slabs come   at a high premium and may not be suitable Can be considered for unique benefits, SI option is also high. This is a good option if you want a higher cover. However, be aware of the high premium
Reference Links ,
Reference Link for Premium Chart

NA :  Information not available

The author regularly writes on the Personal Finance. She is associated with Getting You Rich, a Mumbai based Financial Planning firm and blogs at

Disclaimer: This write up is for the information of the investors. They are advised to take their own informed decision before buying any insurance policy.

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First Published on Aug 7, 2014 01:11 pm
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