Tips for buying best mediclaim insurance
India health insurance tips and tricks to choose the best medical insurance in India
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 Medicare Protect |
Medicare |
Medicare Premier |
 Medi Classic |
Comprehensive |
Family Health Optima |
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 | 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 | ||||||
| Shared Accommodation / 10% co pay for higher Room category | Shared Accommodation (with 10% co-pay)/ Single Private A/c Room | NIL Room Rent restrictions | 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 | Covered | Covered | Covered | Actual | Covered | 5% of sum insured, maximum up to Rs.10,000 per day |
| Pre-hospitalization | ||||||
| 30 days before the date of admission to the hospital | 60 days before the date of admission to the hospital | 60 days before the date of admission to the hospital | 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 | ||||||
| 60 days after discharge from the hospital | 90 days after discharge from the hospital | 90 days after discharge from the hospital | 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 | ||||||
| 540+ listed Day Care Treatment covered | 540+ listed Day Care Treatment covered | 540+ listed Day Care Treatment covered | 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 | ||||||
| Up to Rs.1,000 per hospitalisation | Up to Rs.3,000 per hospitalisation | Up to Rs.5,000 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 | Covers expenses incurred towards hospitalization for dental treatment under anesthesia necessitated due to an accident/injury/illness |
10,000 (OPD Dental) | 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 | Covered | 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 up to sum insured | Covered up to sum insured | Covered up to sum insured | 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 |
| Maternity Benefits | ||||||
| Not Covered | Not Covered | Up to Rs.50,000 (Rs.60,000 in case of girl child) per policy (Waiting period 4 years) |
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 | ||||||
| Not Covered | Not Covered | If a claim is admitted under the maternity benefit, then the company covers for medical expenses incurred on the treatment of new born baby up to Rs.10,000 for complications related to delivery |
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 | ||||||
| Not Covered | Not Covered | Up to Rs.10,000 (Rs.15,000 in case of girl child) up to one year after the birth of the child |
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 | Covered | Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Health Check-up | ||||||
| Up to 1% of previous sum insured subject to a maximum of Rs.10,000 per policy | Up to 1% of previous sum insured per policy | Up to 1% of sum insured subject to a maximum of Rs.10,000 per policy | Up to 1% of the average basic sum insured subjected to max of Rs.5,000 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 1Crore: 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 | ||||||
| Not Covered | If the insured is hospitalized in shared accommodation in a network hospital for more than 24 hours. Then the company pays 0.25% of base sum insured and maximum of Rs.2,000 per day |
If the insured is hospitalized in shared accommodation in a network hospital for more than 24 hours. Then the company pays 0.25% of base sum insured and maximum of Rs.2,000 per day |
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 | ||||||
| No co-pay | No co-pay | 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 4 years of continuous coverage | Pre-existing diseases covered after 3 years of continuous coverage | Pre-existing diseases covered after 2 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 48 months of continuous coverage without break |
| Restore Benefit | ||||||
| 100% of base sum insured for you and your family members | 100% of base sum insured for you and your family members | 100% of base sum insured for you and your family members | 200% of base sum insured for unrelated illness/diseases | 100% of base sum insured for unrelated illness/diseases | Thrice upto 100% of base sum insured 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% | 50% on base sum insured for every claim free year and up to 100%. Reduced by 50% and up to 100% in case of claim | 50% on base sum insured for every claim free year and up to 100%. Reduced by 50% and up to 100% in case of claim | 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 | ||||||
| Not Covered | Not Covered | 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 | ||||||
| Rs.2 to 5 Lakhs | Rs.3 to 20 Lakhs | Rs.5 to 50 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 /2/3 years | 1 /2/3 years | 1 /2/3 years | 1 /2 years | 1/2 years | 1 year | 1 year |
| Eligibility criteria | ||||||
| 5 years onwards, Dependent children between 91 days to 5 years can be covered only if both parents are covered under the policy | 5 years onwards, Dependent children between 91 days to 5 years can be covered only if both parents are covered under the policy | 5 years onwards, Dependent children between 91 days to 5 years can be covered only if both parents are covered under the policy | 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 |
| Claims 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 |
| 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 | ||||||
| Tata AIG | Star Health | |
|---|---|---|
| Claims Settlement Ratio** | 80.61% | 81.62% |
| Number of Lives Covered* | 22,48,000 | 1,16,17,000 |
| Network Hospitals | 4,000 + | 9,900 + |
| ||
India health insurance tips and tricks to choose the best medical insurance in India
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