Tips for buying best mediclaim insurance
India health insurance tips and tricks to choose the best medical insurance in India
Know more »
 Heartbeat |
Companion |
Go-Active |
 Medi Classic |
Comprehensive |
Family Health Optima |
Arogya Sanjeevani |
|---|---|---|---|---|---|---|
| In-patient Treatment | ||||||
| Covered up to sum insured | Covered up to sum insured | Covered up to sum insured | Covers hospitalisation expenses due to an disease/illness/injury | Covers hospitalisation expenses due to an disease/illness/injury | Covers hospitalisation expenses due to an disease/illness/injury | Covers hospitalisation expenses due to an disease/illness/injury |
| 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) |
Basic: 2% of base sum insured maximum up to Rs.5,000 Gold - 3 & 4 Lakhs: Rs.5,000 per day 5 to 25 Lakhs: Private single A/c Room |
Private single standard A/c Room | 3 & 4 Lakhs: Rs.5,000 per day 5 to 25 Lakhs: Single standard A/c room |
2% of sum insured subject to a 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 |
Covered | Actual | Covered | 5% of sum insured, max up to 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) | Incurred for a period not exceeding 30 days prior to the date of hospitalization,for the disease/illness/injury |
Up to 60 days | Up to 60 days | Up to 30 days |
| Post-hospitalization | ||||||
| 90 days(Covered upto sum insured) | 60 days after discharge from the hospital | 180 days (Covered up to Sum Insured) | Basic: 60 days from the date of discharge from the hospital (payble 7% of hospitalization expenses maximum of Rs.5,000 per hospitalization) Gold: 60 days from the date of discharge from the hospital |
Up to 90 days | Up to 90 days | 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 | All day care procedures are covered | All day care procedures are covered | All day care procedures are covered | All day care procedures are covered |
| Domiciliary Treatment | ||||||
| Covered up to sum insured | Covered up to sum insured | Covered up to sum insured | Covered | Covered | Not 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 | Up to Rs.750 per hospitalisation and overall limit of Rs.1,500 per policy period | Actual | Up to Rs.750 per hospitalisation and overall limit of Rs.1,500 per policy period | up to Rs.2,000 per hospitalisation |
| Dental Treatment | ||||||
| Not Covered | Covered except for inpatient hospitalization due to an Accident | Not Covered | Not Covered | 5 & 7.5 Lakhs: Rs.5,000 10 to 25 Lakhs: Rs.10,000 50 Lakhs to 1 Crore: Rs.15,000 |
Not Covered | Not Covered |
| Bariatric Surgery | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | 5 to 15 Lakhs: Rs.2,50,000 20 Lakhs to 1 Crore: Rs.500,000 |
Not Covered | Not Covered |
| Ayush Benefit | ||||||
| Covered | Covered upto Reasonable and Customary Charges | Covered Ayurveda, Unani, Sidha and Homeopathy | Not Covered | 5 to 15 Lakhs: Rs.15,000 per policy period 20 & 25 Lakhs: Rs.20,000 per policy periodbr>50 Lakhs to 1 Crore: Rs.30,000 per policy period |
3 & 4 Lakhs: Up to Rs.10,000 per policy period 5 to 15 Lakhs: Up to Rs.15,000 per policy period 20 lakhs & 25 Lakhs: Up to Rs.20,000 per policy period |
Covers in-patient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy up to sum insured |
| 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 | Not Covered | 5 Lakhs: Normal delivery - Rs.15,000 Caesarean - Rs.20,000 7.5 Lakhs: Normal delivery - Rs.25,000 Caesarean - Rs.40,000 10 to 25 Lakhs: Normal delivery - Rs.30,000 Caesarean - Rs.50,000 50 Lakhs to 1 Crore: Normal delivery - Rs.50,000 Caesarean - Rs.100,000 (24 months for first delivery from first inception of the policy) (24 months from claim under for next delivery) |
Not Covered | Not Covered |
| New Born baby cover | ||||||
| Covered upto Sum Insured | Not Covered | Not Covered | Not Covered | 5 to 25 Lakhs: Rs.100,000 50 Lakhs to 1 Crore: Rs.200,000 |
Up to 10% of sum insured or maximum of Rs.50,000 subject to availability of the sum insured (from 16th day to till the expiry of the policy) (provided if mother is insured for 12 months without break) |
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 | Not Covered | 5 to 25 Lakhs: Rs.5,000 50 Lakhs to 1 Crore: Rs. 10,000 |
Not Covered | Not Covered |
| Organ Donor Expenses | ||||||
| Covered up to sum insured | Covered up to sum insured | Covered up to sum insured | Basic: Not Covered Gold: Covered |
Covered | 10% of sum insured or Rs.100,000 | 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 | 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 | Up to 1% of the average basic sum insured subjected to max of Rs.5000 is payable (Sum insured 2 lakhs & above) |
5 Lakhs: Rs.2,000 7.5 Lakhs: Rs.2,500 10 Lakhs: Rs.3,000 15 Lakhs: Rs.4,000 20 & 25 Lakhs: Rs.4,500 50 Lakhs to 1 Crore: Rs.5,000 (Once in a block of every claim free years of continuous renewal) |
3 Lakhs: Rs.750 4 Lakhs: Rs.1,000 5 Lakhs: Rs.1,500 10 Lakhs: Rs.2,000 15 Lakhs: Rs.2,500 20 Lakhs: Rs.3,000 25 Lakhs: Rs.3,500 (available after every claim free year per policy) |
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 | Not covered | 5 Lakhs: Rs.500 7.5 & 10 Lakhs: Rs.750 15 & 20 Lakhs: Rs.1,000 25 Lakhs: Rs.1,500 50 Lakhs & 1 Crore: Rs. 2,500 (maximum 7 days/occurrence is payable) |
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 | No co-pay if entry age is below 60 years / 20% co-pay for ages above 60 years | No co-pay if entry age is below 60 years / 20% co-pay for ages above 60 years | No co-pay if entry age is below 60 years / 20% co-pay for ages above 60 years | 5% co-pay applicable 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 | Covered after a waiting period of 4 years | Covered after a waiting period of 4 years | Covered after a waiting period of 2 years | Covered after 4 years of continuous coverage without break |
| 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 | 200% of Base Sum Insured for unrelated illness/diseases |
100% of Base Sum Insured for unrelated illness/diseases |
Thrice up to 100% of Base SI for plans with sum insured 3 lakhs and above | Not applicable |
| General waiting period | ||||||
| 30 days | 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 | Basic: 5% of the basic sum insured for every claim free year subject to a maximum of 25% Gold: 25% of basic sum insured in the second year and additional 20% of the basic sum insured for each subsequent years subject to a maximum of 100% |
5 Lakhs: 50% on base sum insured for every claim free year and up to 100% 7.5 Lakhs to 1 Crore: 100% of the basic sum insured for every claim free year |
25% of Sum Insured after first year if claim free and additional 10% for the subsequent years (Maximum allowable bonus is 100%) |
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 | Not Covered | Up to Rs.2,50,000 per hospitalization, not exceeding Rs.5,00,000 per policy period | 3 to 5 Lakhs: Not Covered 5 to 25 Lakhs: Up to 10% of the sum insured |
Not Covered |
| Available sum insured options | ||||||
Gold: Rs.5 to 50 Lakhs Platinum: Rs.15 Lakhs to 1 Crore |
Varient1: Rs.2 to 4 Lakhs Varient2: Rs.5 to 12.5 Lakhs Varient3: Rs.15 to 100 Lakhs |
Rs.4 to 25 Lakhs | Basic plan: Rs.1.5 to 15 Lakhs Gold plan: Rs.3 to 25 Lakhs |
Rs.5 Lakhs to 1 Crore | Rs.3 to 25 Lakhs | Rs.1 to 5 Lakhs |
| Policy can be purchased for | ||||||
| 1/2 years | 1/2 years | 1/2/3 years | 1/2 years | 1/2 years | 1 year | 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) | 5 Months to 65 years. Therefore only renewals will be accepted without capping on the exit age | Adults from 18 to 65 years (dependents 3 months to less than 25 years) | Adults from 18 to 65 years (dependents 16 days to less than 25 years) | Adults from 18 to 65 years (dependents 3 months to less than 25 years) |
| 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 | Renewal for whole life |
| 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 | Not Covered |
| Portablity (At the time of renewal) | ||||||
| Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Claims loading | ||||||
| No Loading | No Loading | No Loading | No Loading | No Loading | No Loading | No Loading |
| 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 | Income tax benefit under section 80D |
| Useful Links | ||||||
| Niva Bupa | Star Health | |
|---|---|---|
| Claims Settlement Ratio** | 85.96% | 81.62% |
| Number of Lives Covered* | 54,33,000 | 1,16,17,000 |
| Network Hospitals | 4,500 + | 9,900 + |
| ||
India health insurance tips and tricks to choose the best medical insurance in India
Know more »Find out the different reasons why a medical insurance claim is rejected, Cashless hospitalization, Reimbursement.
Know more »Factors for medical insurance in India, How much is the premium and the coverage offered by India health insurance plans.
Know more »You can buy insurance online by using a credit/debit card, direct funds transfer using NEFT or RTGS or by using a cheque.
Know more »Insurance customers can quickly compare the details of benefits offered under Indian mediclaim insurance policies.
Know more »Compare Indian health insurance policies, Health insurance India comparison.
Know more »Health insurance blogs - Information on health or medical insurance coverage in India.
Know more »FAQ related to Indian health insurance. Get answers for any health insurance questions.
Know more »Every individual must buy insurance and for themselves and members of their family, based on their requirements.
Know more »Family floater is one single policy that takes care of the hospitalization expenses of your entire family.
Know more »A typical Top Up Health Insurance plan is an additional coverage for an individual who is already covered under an existing Health policy.
Know more »Accident, is an unexpected event, typically sudden in nature and associated with injury, loss, or bodily harm.
Know more »