Tips for buying best mediclaim insurance
India health insurance tips and tricks to choose the best medical insurance in India
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 Medi Classic |
Comprehensive plan |
Family Health Optima |
Arogya Sanjeevani |
 Mediclaim |
Premier Mediclaim |
Floater Mediclaim |
Arogya Sanjeevani |
|---|---|---|---|---|---|---|---|
| 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 | 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 | Not exceeding 1% of the sum insured per day | Covered | Not exceeding 1% of the sum insured per day | 2% of the sum insured subject to maximum of Rs.5,000 per day |
| ICU Charges | |||||||
| Covered | Actual | Covered | 5% of sum insured, maximum up to Rs.10,000 per day | Not exceeding 2% of the Sum Insured per day | Covered | Not exceeding 2% of the Sum Insured per day | 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 | 30 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 | 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 | 60 days after discharge from the hospital | 90 days after discharge from the hospital | 60 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 | 139 Day Care procedures are covered | Covered | Covered | Covered |
| Domiciliary Treatment | |||||||
| Covered | Covered | Not Covered | Covered | Not Covered | Not Covered | Not Covered | Not 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 | 1% of the Sum Insured | Covered | 1% of the Sum Insured | 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 | 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 | 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 |
Up to 25% of sum insured | Up to 20% of Sum Insured | Up to 25% of sum insured | Covered |
| 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 | 5 Lakhs and Above: 10% of the sum insured(Waiting period: 36 months) (Optional) |
Plan A: Up to Rs.50,000 Plan B: Up to Rs.100,000 |
5 Lakhs and Above: 10% of the sum insured(Waiting period: 36 months) (Optional) |
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 | Covered | Covered for any Illness or Injury | Covered | Not Covered |
| Organ Donor Expenses | |||||||
Basic: Not Covered Gold: Covered |
Covered | 10% of sum insured or Rs.100,000 | Not Covered | Covered | Covered hospitalisation expenses (excluding cost of organ) |
Covered hospitalisation expenses (excluding cost of organ) |
Not Covered |
| Vaccination (In case of post bite treatment) | |||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Daily Cash for Accompanying an Insured Child | |||||||
| Not Covered | 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 maximum 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 | Health check up for every 3 claim free years | Health check up for every 3 claim free years | Covered | 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 | 0.1% Sum Insured per day, up to a maximum of 1% Sum Insured | Plan A: Rs.2,000 per day Plan B: Rs.4,000 per day |
0.1% Sum Insured per day, up to a maximum of 1% Sum Insured | 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 | Option of Co-pay upto 20% on certain mediclaim plans | NIL Co-pay under this plan | NIL Co-pay under this plan | 5% Co pay applicable 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 | Covered after 4 years of continuous coverage | Covered after 3 years of continuous coverage | Covered after 4 years of continuous coverage | 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 | NIL Restoration benefit | NIL Restoration benefit | NIL Restoration benefit | NIL Restoration benefit |
| General waiting period | |||||||
| 30 days | 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% | 25% for every claim free year up to 50% of sum insured | Not Covered | 25% for every claim free year up to 50% of sum insured | 5% for every claim free year up to 50% of sum insured |
| 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 | Not Covered | Up to Rs. 1,00,000 for any one illness | 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 | 1 to 15 Lakhs | 15 Lakhs to 1 Crore | 2 to 15 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 | 1/2/3 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 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 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 | Renewal for whole life |
| Claims loading | |||||||
| No Loading | No Loading | No Loading | No Loading | No Loading | No Loading | No Loading | No Loading |
| Portablity(At the time of renewal) | |||||||
| Yes | 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 | Income tax benefit under section 80D |
| Star Health | New India Assurance | |
|---|---|---|
| Claims Settlement Ratio ** | 80.62% | 97.32% |
| Number of Lives Covered * | 1,16,17,000 | 8,75,61,000 |
| Network Hospitals | 9,900 + | 3,000 + |
| ||
India health insurance tips and tricks to choose the best medical insurance in India
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