Top hospitalisation insurance plans in India: Comparison

Sunday, March 20, 2011, 11:03 by Business Editor

Explaining hospitalisation insurance policies, and comparing some of the best ones in India

Consider this: A guy is returning home late after a long day in office, and to his absolute horror, a drunken truck driver hits his bike right in the middle of the road. And the poor chap stays alone in a big city! Needless to say, the lack of adequate support systems in such situations can cause both financial and logistical inconvenience.

That’s where hospitalisation insurance plans can come in pretty handy. By spending as little as Rs. 900-odd per year, you can get yourself a Mediclaim/Hospitalisation cover that would cover a significant amount–if not the entire costs–of your hospital dues.

So what is a hospitalization plan after all? In simple terms, this is a policy wherein the insurer pays the policyholder a lump-sum amount for each day he or she requires treatment as an in-patient in a hospital–with regard to incidentals or miscellaneous expenses in case of hospitalisation. Thus, using this policy, one can meet the doctor’s consultation fees, surgery costs and/or any other overheads that are not covered by his current health insurance policy.
What options, then, are available in the market? Well, we have hand-picked four plans that, we believe, should be useful for you.

ICICI Pru Hospital Care

The ‘ICICI Pru Hospital Care’ hospitalisation plan offered by ICICI Prudential, one of the leading private-sector players in the Indian insurance market, is applicable for those aged between 1 to 60 years (age nearest birthday).

You can opt for either a 10-year, or 20-year policy term, with the maximum cover lapsing when the insured person turns 80.

Let’s look at some key features of this hospitalisation insurance plan.

1.    Under a cashless hospitalisation facility valid across ICICI Pru’s countrywide network of hospitals, the insurer reimburses directly to the hospital your dues up to the maximum benefit amount payable as per the product.

2.    The vendor claims that on submission of duplicates or photocopies of bills and certificates, it will give a lump-sum benefit amount – irrespective of the insured individual’s actual medical costs – on tops of the claims reimbursed by him from other medical insurers. So for example, if you have insured yourself with two Mediclaim policies from ICICI Pru and Birla Sun Life, then the ICICI Pru policy promises to pay a lump-sum benefit even if you’ve reimbursed expenses from the other vendor.

3.    A fixed amount of so-called “Daily Hospitalisation Cash Benefit” (referred to as DHCB from here on) amount – basically a daily allowance for the in-patient’s stay in a hospital – will be paid irrespective of actual hospitalisation expenses. For instance, if the actual daily hospitalisation expenses for an admitted patient come in at Rs. 800 per day and the DHCB figure is, say, Rs. 2,000, then the insured person will be entitled to a fixed DHCB of Rs, 2,000.

4.    ICU Cash – The insurer will pay a further 50% of DHCB amount per day if the concerned individual is admitted to an Intensive Care Unit (ICU)

5.    Surgery Expenses Benefit – For over 900 surgical procedures (categorized under four grades – 1, 2, 3, 4 – depending on the type and severity), a fixed lump-sum figure is paid, over and above the hospitalisation costs.

6.    Recuperating allowance/benefit – This is simply a post-hospitalisation benefit amount–typically equating to thrice the DHCB amount–awarded apart from other kinds of reimbursements, enabling the discharged patient to cover his rehabilitation costs (read medicines, follow-up consultations and tests, etc.).

So what options does one have when it comes to selecting his desired benefit cover? Well, the policy buyer can choose any one of the following four plans (each having fixed benefit amounts):

Benefit Plan A (Rs.) Plan B (Rs.) Plan C (Rs.) Plan D (Rs.)
Daily Hospitalisation Cash Benefit (per day) 1,000 2,000 3,000 4,000
ICU (Intensive Care Unit) Benefit (per day) 500 1,000 1,500 2,000
Recuperating Benefit 3,000 6,000 9,000 12,000
Surgery Benefit (Surgery Grade 1) 15,000 30,000 45,000 60,000
Surgery Benefit (Surgery Grade 2) 50,000 1,00,000 1,50,000 2,00,000
Surgery Benefit (Surgery Grade 3) 75,000 1,50,000 2,25,000 3,00,000
Surgery Benefit (Surgery Grade 4) 1,00,000 2,00,000 3,00,000 4,00,000

So in case somebody goes in for plan A and then has an 8-day hospitalisation, his cumulative benefit amount = DHCB + Recuperating benefit = (8 days x Rs. 1,000 per day) + Rs. 3,000 = Rs. 11,000.

What about someone having plan D meeting with an unfortunate accident that warrants a 6-day hospitalisation, including 4 days in ICU and with a Grade 2 surgery?

His total benefit amount = DHCB + ICU cash + Recuperating benefit + Surgery Benefit (Surgery Grade 2) = (6 days x Rs. 4,000 per day) + (4 days x Rs. 2,000 per day) + Rs. 12,000 + Rs. 2,00,000 = Rs. 2,44,000.

Benefit limits- ICICI Pru has capped the total benefit amount that can be claimed during a given policy calendar year, as well as during the entire policy tenure (10 or 20 years), for each plan, as per the following table:-

Benefit limits Plan A (Rs.) Plan B (Rs.) Plan C (Rs.) Plan D (Rs.)
Yearly Limit 4,00,000 8,00,000 12,00,000 16,00,000
Surgical benefit (as part of Yearly Limit) 3,00,000 6,00,000 9,00,000 12,00,000
Policy Term Limit 20,00,000 40,00,000 60,00,000 80,00,000

So, as a case in point, suppose you have enrolled for plan A. That means you can claim a maximum of Rs.4 lakhs for multiple claims–including surgical benefit of as much as Rs.3 lakhs–per annum. But you are free to file several claims worth up to Rs.20 lakhs over the entire policy term.

Premium (same for both female/male)

Age (in years) Plan A (Rs.) Plan B (Rs.) Plan C (Rs.) Plan D (Rs.)
20 4,221 7,264 10,308 13,351
30 4,680 8,183 11,685 15,187
40 5,990 10,799 15,607 20,417
50 8,522 15,848 23,175 30,502

Note –
1.    The above premium figures (inclusive of service tax and education cess) are indicative only, and could change from person to person depending on his health history and present medical condition.
2.    The premiums are applicable for one year from the date of commencement of the policy, following which the insurer is within its powers to revise the premium – subject to clearance from the market regulator, the IRDA.

Premium frequency – Yearly, half yearly & monthly

Tax benefits – As our readers will be aware, section 80C of the Income Tax Act, 1961 allows us to save tax on earnings up to Rs 1 lakh. Similarly, one can claim tax savings for premium payments for medical insurance u/s 80D of the same Act, i.e. an individual can claim for a deduction in lieu of the Mediclaim premium paid up to Rs. 15,000 for himself and his spouse and dependent children.
The ‘ICICI Pru Hospital Care’ hospitalisation plan lets you capitalise on the aforesaid tax benefit.

Limitations – ‘Insurance is a subject matter of solicitation’–this line sounds quite familiar, doesn’t it? Safe to say we come across this advertisement at least once on TV every day. On a more serious note, though, the above line drives home the point that one needs to read the fine print carefully when deciding to purchase any insurance (life/general) policy. Because, as they say, the devil lies in the detail!

And the ICICI Pru Hospital Care plan is no different either. We have pulled out a few showstoppers, described below, that you need to watch out for as far as this hospitalisation policy is concerned.

1.    The payment of DHCB is conditional upon the in-patient being hospitalised for more than 24 hours, i.e. at least 2 successive nights and being charged for 2 days’ room expenses.
2.    Per policy year, the insurer will pay DHCB for hospitalisation up to 90 days, including the days spent in ICU.
3.    Per policy year, the insured individual can claim ICU benefit for ICU admission up to 30 days.
4.    The in-patient is entitled to the recuperating benefit only if he has been hospitalised continuously for at least 5 days.

5.    Don’t expect any maturity/death benefit, i.e. the insurer will neither return the premiums paid by you during the policy tenure at the end of the policy, nor will it pay any lump-sum figure upon the insured person’s demise.

6.    Zero reimbursement for any pre-existing illness, unless outlined in the policy proposal form and clearly accepted by the company and endorsed thereon.

7.    ICICI Pru won’t pay any benefit in lieu of any claim within 90 days of Policy Issue Date (barring for accident-related injuries).

AEGON Religare Health Plan

The ‘AEGON Religare Health Plan’ from AEGON Religare has an entry age of between 18-70 years for Primary & Secondary Life Insured, and 90 days to 7 years for an insured child. One can renew this hospitalisation insurance policy up to the age of 85.

Here too, the customary three benefits – DHCB, ICU Cash (in case of admission to the ICU for more than 8 hours) and Surgical Cash Benefit (SCB)–are included under the policy. It’s worth noting that the in-patient is also entitled to DHCB for the day on which he has been admitted to the ICU.

As far as the SCB goes, the vendor will reimburse the cost of surgeries clubbed under 6 categories, based on the type and severity (for each type of surgery, a fixed amount is paid).

Apart from these benefits, a so-called ‘Congenital benefit’ covers the listed Medically Necessary Surgical Procedures needed to rectify congenital defects in a child by a mother who is continuously covered for 9 months under the policy.

Here are some of the salient aspects of this hospitalisation insurance policy

1.    The premium stays fixed for the first 3 years, even if the insured has file for a claim in year 1 or 2.
2.    One can raise your coverage limit by 10% for every zero-claim year (the maximum increase is capped at 50%, though).
3.    Covers your family members under one policy, with an option provided for you to switch to higher level of coverage and to bring in more family members (spouse and children) at any point of time during the policy span.
4.    Offers guaranteed coverage for 10 critical illnesses such as Cancer, Stroke, Paralysis, Coma, Kidney Failure and Alzheimer’s Disease.
5.    Cashless facility in over 3,000 hospitals across India.
6.    For the bulk of operations, the usual 24-hours hospitalisation criterion is waived off.
7.    Healthy individuals below the age of 50 don’t have to undergo any medicals for sum assured up to Rs.3,00,000.
8.    Pays you a fixed lump-sum figure, independent of your hospital dues.

Benefit amounts

The ‘AEGON Religare Health Plan’ comes in four formats–Silver, Gold, Diamond and Platinum.
Consider the Gold plan for example. This scheme offers a DHCB of Rs. 3,000 with an annual limit of Rs. 1,80,000 (meaning coverage for up to 60 days of hospitalisation in a policy year).

You get an ICU Cash benefit of Rs. 3k per day in ICU (yearly cap of Rs. 1,80,000), while the SCB figure ranges from Rs. 3,00,000 for category 1 surgery to Rs. 15, 000 for category 6 surgery. The ‘Critical Illness’ benefit is set at Rs. 75,000.
And since all the afore-mentioned benefits can be claimed together within a policy year, you are therefore looking at a maximum total benefit of Rs. 7, 35,000 under the Gold plan. The Life Time Limit (SCB) is capped at Rs. 15, 00, 000.

Premium
For annual premium mode –

Age (Yrs.) Silver plan (Rs.) Gold plan (Rs.) Diamond plan (Rs.) Platinum plan (Rs.)
18-25 4,875 6,134 7,392 8.662
26-30 5,105 6,471 7,839 9,212
41-45 6,907 9,114 11,325 13,546

Premium frequency – Single, yearly and half yearly
Tax benefits – The policy holder can claim tax benefits on premiums paid under section 80 D of IT Act, 1961.
Limitations –
1.    In the event of the insured person being diagnosed with any critical illness, the AEGON Religare will pay a one-time fixed amount and then the policy will cease to exist for lifetime.
2.    Any claim arising out of pre-existing diseases or their consequent side-effects, unless described in the proposal form and categorically accepted by the vendor and endorsed thereon, will be rejected.

Bajaj Allianz HealthCare hospitalisation insurance policy

The ‘Bajaj Allianz HealthCare’ plan from Bajaj Allianz, a joint venture between Indian business conglomerate Bajaj Group and German insurance giant Allianz, is valid for those aged between 18 and 57 years.

The policy has a tenure of three years, and provides health protection alongside life insurance cover (a minimum Life Cover of Rs. 10,000 is paid out in the event of the death of the life assured).

The benefit-related commitments enshrined in the policy are honoured even if the policyholder has subscribed to Mediclaim plans from other vendors. Plus, one can make multiple claims in a policy year.

Benefit amounts

The ‘Bajaj Allianz HealthCare’ scheme defines DHCB and ICU Cash as ‘Hospital Cash’ (HC), with Recuperating Benefit being dubbed ‘Post Hospitalisation Benefit’.

The Hospital Cash amount is equal to room charges during the in-patient’s stay in hospital (capped at Rs. 500 per day), with the insured individual entitled to a claim for up to Rs. 1, 000 in lieu of every day spent in ICU. Overall, the HC figure–including both daily expenses and ICU stay–has an upper limit of Rs. 30,000 during a policy year, translating into coverage for as many as 60 days of hospitalisation.

Meanwhile, the ‘Post Hospitalisation Benefit’ is set at 50% of the claim amount settled for HC per day, with the insured person allowed to claim for a maximum of 5 days in a policy year.

For those having to undergo surgical procedures, Bajaj Allianz will pay a Surgical Benefit equaling the operation-related costs (maximum of Rs. 50,000 per policy year).

The policy covers 11 defined critical illnesses (Paralysis, Major Organ Transplantation, First Heart Attack, etc.) and reimburses for claims up to Rs. 50,000 during the policy term of three years.

Finally, a “Accidental Permanent Total / Partial Disability” clause in the plan gives you Rs. 50,000 on total disability and Rs. 25,000 in event of partial disability.

Premium

Age For Minimum Cover (Male) For Minimum Cover (Female)
20 917 972
30 1011 1091
40 1445 1347
45 1887 1604
50 2454 1937

N.B. The above premium figures are indicative only, and don’t include the Service Tax applicable as per the prevailing rates.

Premium frequency – Yearly (minimum payment of Rs. 1,000) and monthly (minimum payment of Rs. 100)
Tax benefits – The ‘Bajaj Allianz HealthCare’ plan lets the policyholder claim tax benefits under Section 80D of the Income Tax Act, 1961 with regard to premium paid for health cover (Hospital Cash + Post Hospitalisation benefit + Surgical Benefit + Critical Illness cover).

And for the premium paid on account of Life Cover and Accidental Permanent Total / Partial Disability benefit, one is entitled to apply for tax benefits under Section 80C of the Income Tax Act, 1961.

Limitations –
1.    The aggregate benefits payable for all policies under the Bajaj Allianz HealthCare plan can’t be more than the maximum amount of cover allowed under Bajaj Allianz Health Care.
2.    The insured person can claim surgical benefit only if the disease covered is diagnosed at least 180 days following the date of commencement of risk or reinstatement of risk.
3.    Critical Illness Cover can only be applied for if the illness has been diagnosed at least 180 days after the date of commencement or reinstatement of risk.

Max New York Life LifeLine – MediCash Plan

The ‘LifeLine – MediCash Plan’ from Max New York Life has a policy term of 10 years, and is applicable for those aged between 18 years to 55 years (age as per last birthday). The plan lapses when the insured individual turns 65.

Here are some of the salient features of this hospitalisation insurance policy –
1.    If you don’t file any claim during first 5 years of the policy, then the insurer will give you a Premium discount for the remaining five years.
2.    Premium costs are fixed for the first five years of the policy, following which Max New York Life–subject to approval from IRDA–can decide to hike the premiums.
3.    Cashless hospitalisation facility available in more than 4000 network hospitals across the country.
4.    Benefits– Daily Hospitalisation Cash Benefit, ICU Cash benefit and recuperating cash benefit–are payable on top of any other Mediclaim cover that you may have with Max New York Life or any other insurer.
5.    A fixed daily hospitalisation benefit will be reimbursed irrespective of the amount of actual billing by the hospital.

Benefit amounts –

The ‘LifeLine – MediCash Plan’ defines benefits in terms of “Units”, which represent the collective array of benefits that the policyholder seeks to avail of.

Benefits 1 unit 2 Units 3 Units 4 Units 5 Units
Daily Hospitalisation Cash Benefit (Rs. per day) 1,000 2,000 3,000 4,000 5,000
ICU (Intensive Care Unit) Cash benefit (per day) 2,000 4,000 6,000 8,000 10,000
Recuperating cash benefit (lump-sum) 3,000 6,000 9,000 12,000 15,000

Premium (for Unit 3, as an example)

Age (years) Male Female
20 4824 4179
30 5082 4638
40 6105 6288
50 8652 8562

N.B. These Premiums are exclusive of Service Tax and Education Cess
Premium frequency – Half Yearly and Yearly

Tax benefits – The policy owner can claim tax benefit on the premium paid up to Rs.15, 000 under section 80 D of the Income Tax Act.

Limitations

1.    You cannot change the “Unit” once the insurance policy comes into force.
2.    All kinds of benefits, in aggregate, shall be payable for a maximum of 50 days of hospitalisation of the life insured during a policy year. The remaining days, if not claimed, cannot be carried forward to the next policy year.
3.    During the policy term, the insurer will pay all types of benefits in aggregate for a maximum of 250 days of hospitalisation of the concerned individual. In the event of those 250 days having been claimed, the policy will cease to exist.
4.    The lump-sum amount in lieu of Recuperating cash benefit is given only if the in-patient has been hospitalised for at least 7 days and been advised by doctor.
5.    The fixed daily Hospitalisation Cash Benefit is reimbursed only if the patient is hospitalised for a continuous period of at least 48 hours, but excluding the first 24 hours of such hospitalisation.
6.    The ICU cash Benefit is awarded only if the insured individual is admitted to ICU for at least 8 hours continuously, during a hospital stay for a continuous period of at least 24 hours.

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