Tips for buying best mediclaim insurance
India health insurance tips and tricks to choose the best medical insurance in India
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 Heartbeat |
Companion |
Go-Active |
 Health Suraksha |
Gold Smart |
Platinum Smart |
|
|---|---|---|---|---|---|---|
| In-patient Treatment | ||||||
| Covered up to sum insured | Covered up to sum insured | Covered up to sum insured | Covered | Covered | Covered | |
| Room Rent | ||||||
Gold: Covered up to Sum Insured (except for Suite or above room category) Platinum: Covered up to Sum Insured |
Covered up to Sum Insured (except for Suite or above room category) | 4 Lakhs: Up to 1% of base sum insured per day 5 to 25 Lakhs: No restriction (except suite or above room category)(Limit included in Inpatient Care sum insured) |
At Actual | capping on room rent | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day. | |
| ICU Charges | ||||||
| Covered up to sum insured | Covered | 4 Lakhs: Up to 2% of Base Sum Insured 5 to 25 Lakhs: Covered up to Sum Insured |
At Actuals | Covered | Up to 5% of sum insured subject to maximum of Rs.10,000 per day | |
| Pre-hospitalization | ||||||
| 60 days (Covered upto sum insured) | 30 days before the date of admission to the hospital | 90 days (Covered up to Sum Insured) | 60 days before the date of admission to the hospital | 60 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | |
| Post-hospitalization | ||||||
| 90 days (Covered upto sum insured) | 60 days after discharge from the hospital | 180 days (Covered up to Sum Insured) | 180 days after discharge from the hospital | 180 days after discharge from the hospital | 60 days after discharge from the hospital | |
| Day Care Procedures | ||||||
| Covered up to sum insured | Covered up to sum insured | Covered up to sum insured | Covered | Covered | Covered | |
| Domiciliary Treatment | ||||||
| Covered up to sum insured | Covered up to sum insured | Covered up to sum insured | Covered | Covered | Covered | |
| Emergency Ambulance | ||||||
| Network Hospital: Covered up to Sum Insured Non-network Hospital: Covered up to Rs.2,000 per event |
Up to Rs.3,000 per hospitalisation | Up to Rs.3,000 per hospitalisation | Silver Smart: Rs.2,000 Gold Smart: Rs.3,500 Platinum Smart: Sum insured 20 to 50 lakhs: Rs.3,500; Sum insured 50 & 75 lakhs : Rs.15,000 |
Covered | Maximum of Rs.2,000 per hospitalisation | |
| Dental Treatment | ||||||
| Not covered | Not covered | Not covered | Not Covered | Not Covered | Dental treatment, necessitated due to disease or injury | |
| Bariatric Surgery | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | |
| Ayush Benefit | ||||||
| Covered | Covered upto Reasonable and Customary Charges | Covered Ayurveda, Unani, Sidha and Homeopathy | Covered | Covered | Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. |
|
| Maternity Benefits | ||||||
Gold (5 Lakhs): Covered up to Rs.40,000 7.5 Lakhs: Covered up to Rs.60,000 10 Lakhs: Covered up to Rs.70,000 15 Lakhs: Covered up to Rs.75,000 20 Lakhs: Covered up to Rs.80,000 30 & 50 Lakhs: Covered up to Rs.1,00,000 Platinum - 15 Lakhs: Covered up to Rs.120,000 20 Lakhs: Covered up to Rs.160,000 50 lakhs & 1 crore: Covered up to Rs.200,000 (After continuous coverage of 24 months, up to 2 pregnancy) |
Not Covered | Not Covered | Covered(Optional) (Waiting period : 3 years) |
Not Covered | Not Covered | |
| New Born baby cover | ||||||
| Covered up to sum insured | Not Covered | Not Covered | Up to parent care sum insured(Optional) | Not Covered | Not Covered | |
| Vaccination of the new born baby | ||||||
Covered until new born baby completes one year vaccinations (as mentioned in the policy document) |
Not Covered | Not Covered | Silver Smart: Rs.5,000 Gold Smart: Rs.5,000 Platinum Smart: Sum insured 20 to 50 lakhs: Rs.5,000 Sum insured 50 & 75 lakhs: Rs.15,000 (Optional) |
Not Covered | Not Covered | |
| Organ Donor Expenses | ||||||
| Covered up to sum insured | Covered up to sum insured | Covered up to sum insured | Covered | Covered | Not Covered | |
| Vaccination (In case of post bite treatment) | ||||||
| Not Covered | Varient1 ( 2 to 4 Lakhs): Up to Rs.2,500 Varient2 ( 5 to 12.5 Lakhs): Up to Rs.5,000 Varient3 ( 15 to 100 Lakhs): Up to Rs.7,500(OPD benefit upto defined limit as part of overall limit) |
Not Covered | Not Covered | Not Covered | Not Covered | |
| Health Check-up | ||||||
Gold - 5 Lakhs: Annually covered up to Rs.1,250 per insured person 7.5 Lakhs: Annually covered up to Rs.1,875 per insured person 10 to 50 Lakhs: Annually covered up to Rs.2,500 per insured person Platinum - 15 Lakhs: Annually covered up to Rs.3,750 per insured person 20 Lakhs to 1 Crore: Annually covered upto Rs.5,000 per insured person |
Varient1 ( 2 to 4 Lakhs): once in every 2years Varient2 & Varient3: Once in every year |
Available | Covered | 1% of Sum Insured after every 4 consecutive and continuous claim free years with us (Subject to a maximum up to Rs.5,000) |
Not Covered | |
| Hospital daily allowance | ||||||
Gold: Rs.3,000 per day Platinum: Rs.6,000 per day |
Varient1: Rs.1,000 per day Varient2: Rs. 2,000 per day Varient3: Rs. 4,000 per day (Min 48hrs contineous hospitalisation required) (optional) |
Not covered | Covered up to Sum Insured | Covered up to Sum Insured | Not Covered | |
| Daily Cash for Accompanying an Insured Child | ||||||
| Not Covered | If an insured child aged 12 years or less is hospitalized. The company pays 0.25% of base sum insured and maximum of Rs.2,000 per day for one accompanying adult for 24 hours. | If an insured child aged 12 years or less is hospitalized. The company pays 0.25% of base sum insured and maximum of Rs.2,000 per day for one accompanying adult for 24 hours. | Not Covered | Not Covered | Not Covered | |
| Co-pay | ||||||
| Gold : a. If you select Zone 2, then 20% co-payment will apply for treatment in Mumbai (including Navi Mumbai & Thane), Delhi NCR, Kolkata & Gujarat State b. Options of 10% and 20% co-payment Paltinum : Options of 10% and 20% co-payment |
NIL co-pay for all inpatients, 10% for OPD treatment | No co-pay | Silver Smart: No co-pay for all treatment, Optional Co pay available between 10%/20%; Gold Smart : No co-pay for all treatment, Optional Co pay available between 15%/25%; Platinum Smart: No co-pay for all treatment, Optional Co pay available between 15%/25% |
NIL / co-pay applicable upto 20% for treatment in higher class cities | 5% co-pay on all claims | |
| Pre-existing diseases coverage | ||||||
| Pre-existing diseases covered after 2 years of continuous coverage | Pre-existing diseases for 2 to 4 Lakhs is covered after 4 years and for 5 to 100 Lakhs is covered after 3 years of continuous coverage | Pre-existing diseases covered after 3 years of continuous coverage | Pre-existing diseases covered after 3 years of continuous coverage | Pre-existing diseases covered after 4 years of continuous coverage | Pre-existing diseases covered after 4 years of continuous coverage | |
| Restore Benefit | ||||||
| Up to 100% of Base Sum Insured per year | Up to 100% of Base Sum Insured per year | Up to 100% of Base Sum Insured per year | Sum Insured Rebound upto 100% of Sum Insured per year | Not Covered | Not Covered | |
| General waiting period | ||||||
| 30 days | 30 days | 30 days | 30 days | 30 days | 30 days | |
| Renewal Benefit / Cumulative Bonus | ||||||
| 10% on base sum insured for every claim free year and up to 100% | 20% on base sum insured for every claim free year and up to 100% | Not Covered | Silver Smart & Gold Smart: 10% on base sum insured for every claim free year and up to 100%; Platinum Smart: 25% on base sum insured for every claim free year and up to 200% |
5% on base sum insured for every claim free year and up to 50% | 5% on base sum insured for every claim free year and up to 50% | |
| Emergency Air Ambulance | ||||||
Gold: Not Covered Platinum: Covered up to Sum Insured |
Not Covered | Not Covered | Silver Smart:Not Covered; Gold Smart: Up to 2 lakhs; Platinum Smart : Up to 5 lakhs. |
Not Covered | Not Covered | |
| Available sum insured options | ||||||
Gold: 5 to 50 Lakhs Platinum: 15 Lakhs to 1 Crore |
Varient1: 2 to 4 Lakhs Varient2: 5 to 12.5 Lakhs Varient3: 15 to 100 Lakhs |
Rs.4 to 25 Lakhs | Silver Smart: 3 to 5 Lakhs Gold Smart: 7.5 to 15 Lakhs Platinum Smart: 20 to 75 Lakhs |
3 to 50 Lakhs | 1 to 5 Lakhs | |
| Policy can be purchased for | ||||||
| 1/2 years | 1/2 years | 1/2/3 years | 1/2/3 Years | 1/2/3 Years | 1 Year | |
| Eligibility criteria | ||||||
| Adults from 18 to 99 years (dependents 91 days to 17 years) | Adults from 18 to 99 years (dependents 91 days to 17 years) | Entry age for Adults is 18 years - 65 Years (last birthday) and from 91 days to 21 years (last birthday) for children (dependent children) | Adults from 18 Years to lifetime entry (dependents 91 days to 25 years) | Adults from 18 Years to lifetime entry (dependents 91 days to 25 years) | Adults from 18 to 65 years (dependents 91 days to 25 years).If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals | |
| Renewability | ||||||
| Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | |
| Claims loading | ||||||
| No Loading | No Loading | No Loading | Loading | Loading | No Loading | |
| Portablity(At the time of renewal) | ||||||
| Yes | Yes | Yes | Yes | Yes | Yes | |
| Tax Benefits Limit | ||||||
| Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | |
| Useful Links | ||||||
| Niva Bupa | HDFC Ergo | |
|---|---|---|
| Claims Settlement Ratio ** | 85.96% | 85.97% |
| Number of Lives Covered * | 54,33,000 | 96.05,000 |
| Network Hospitals | 4,500 + | 10,000 + |
| ||
India health insurance tips and tricks to choose the best medical insurance in India
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