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India health insurance tips and tricks to choose the best medical insurance in India
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| In-patient Treatment | ||||||
| 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 | Covered | Covered | Covered |
| Room Rent | ||||||
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 | 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 | Actual | Covered | 5% of sum insured, max up to Rs.10,000 per day | At Actuals | Covered | Up to 5% of sum insured subject to maximum of Rs.10,000 per day |
| Pre-hospitalization | ||||||
| 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 | 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 | ||||||
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 | 180 days after discharge from the hospital | 180 days after discharge from the hospital | 60 days after discharge from the hospital |
| Day Care Procedures | ||||||
| All day care procedures are covered | All day care procedures are covered | All day care procedures are covered | All day care procedures are covered | Covered | Covered | Covered |
| Domiciliary Treatment | ||||||
| Covered | Covered | Not Covered | Covered | Covered | Covered | Covered |
| Emergency Ambulance | ||||||
| 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 | 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 | 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 | Not Covered | Not Covered | Dental treatment, necessitated due to disease or injury |
| Bariatric Surgery | ||||||
| Not Covered | 5 to 15 Lakhs: Rs.2,50,000 20 Lakhs to 1 Crore: Rs.500,000 |
Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Ayush Benefit | ||||||
| Not Covered | 5 to 15 Lakhs: Rs.15,000 per policy period 20 & 25 Lakhs: Rs.20,000 per policy period 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 |
Covered | Covered | Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy. |
| Maternity Benefits | ||||||
| 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 | Covered(Optional) (Waiting period : 3 years) |
Not Covered | Not Covered |
| New Born baby cover | ||||||
| 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 | Up to parent care sum insured(Optional) | Not Covered | Not Covered |
| Vaccination of the new born baby | ||||||
| Not Covered | 5 to 25 Lakhs: Rs.5,000 50 Lakhs to 1 Crore: Rs. 10,000 |
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 | ||||||
Basic: Not Covered Gold: Covered |
Covered | 10% of sum insured or Rs.100,000 | Not Covered | Covered | Covered | Not Covered |
| Vaccination (In case of post bite treatment) | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Health Check-up | ||||||
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 | 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 | ||||||
| Not Covered | 5 Lakhs: Rs.500 7.5 & 10 Lakhs: Rs.750 15 & 20 Lakhs: Rs.1000 25 Lakhs: Rs.1,500 50 Lakhs & 1 Crore: Rs.2,500 (maximum 7 days/occurrence is payable) |
Not Covered | Not Covered | Covered up to Sum Insured | Covered up to Sum Insured | Not Covered |
| Daily Cash for Accompanying an Insured Child | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| 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 | 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 | ||||||
| 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 | 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 | ||||||
| 200% of Base Sum Insured for unrelated illness/diseases | 100% of Base Sum Insured for unrelated illness/diseases | Thrice up to 100% of Base sum insured for plans with sum insured 3 lakhs and above | Not applicable | 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 | 30 days |
| Renewal Benefit / Cumulative Bonus | ||||||
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% | 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 | ||||||
| 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 | Silver Smart:Not Covered; Gold Smart: Up to 2 lakhs; Platinum Smart : Up to 5 lakhs. |
Not Covered | Not Covered |
| Available sum insured options | ||||||
Basic plan: 1.5 to 15 Lakhs Gold plan: 3 to 25 Lakhs |
5 Lakhs to 1 Crore | 3 to 25 Lakhs | 1 to 5 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 year | 1 year | 1/2/3 Years | 1/2/3 Years | 1 Year |
| Eligibility criteria | ||||||
| 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) | 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 | Renewal for whole life |
| Claims loading | ||||||
| No Loading | No Loading | No Loading | No Loading | Loading | Loading | No Loading |
| Portablity(At the time of renewal) | ||||||
| Yes | 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 | Income tax benefit under section 80D |
| Star Health | HDFC Ergo | |
|---|---|---|
| Claims Settlement Ratio ** | 81.62% | 85.97% |
| Number of Lives Covered * | 1,16,17,000 | 96.05,000 |
| Network Hospitals | 9,900 + | 10,000 + |
| ||
India health insurance tips and tricks to choose the best medical insurance in India
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