Last Updated on September 9, 2022 at 11:18 am
The United India Insurance Family Medicare Policy has undergone a makeover. Here is a list of some new features introduced in the policy. These were intimated by my insurance agent when I applied for renewal. Our policies are close to 15 years old, with four claims paid. We hold both base and super top-up policies from United India (in addition to private insurer policies for my wife and son) . For full details, see: Why we purchased a 2nd set of base & super top-up health insurance policies.
Given these new features and in hindsight, I am glad that I did not port from United India and decided to retain it in addition to the additional cover mentioned above. I do not trust private health insurers. Their market share and therefore claims experience is much lower than the PSUs. The critical differentiator bet PSU and private insurers is the room rent sub-limits (see below), but there is no free lunch. For the volume of claims paid out by PSUs, sub-limits are a practical necessity. It is nice to see them relax these restrictions. Oriental Insurance has an option to remove all sub-limits for extra premium – those who prefer PSUs can consider this. Check out the post archive for more useful resources on selecting health insurance.
Please note, this is not a recommendation to buy United India Insurance Family Medicare Policy. Health insurance purchases are quite personal. Please read the full terms and conditions and policy wordings carefully to appreciate if this product will be suitable for you or not.
Revised United India Insurance Family Medicare Policy Wordings
In the following, unless explicitly specified, the features apply to the base policy and not the super top-up policy. Only the key changes have been highlighted here.
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Sum insured: The maximum sum insured has been revised from Rs. 10 lakhs to Rs. 25 lakhs. This is a welcome change.
Room Rent sub-limits:
- Rs. 5 Lacs and Above sum insured: 1% of Sum Insured (SI) or Single Occupancy Standard Air-conditioned room charges, whichever is higher. Earlier it was only 1% of the sum insured. This is obviously some distance away from the ideal of no sub-limits but offers more flexibility. For some hospitals, the 1% of SI can offer better than a standard AC room, and for some hospitals, the standard AC single occupancy can be a better deal.
- Rs. 5 Lacs and Above sum insured:: ICU charges will be paid as per actuals. This was earlier 2%. This is welcome news.
- I could not find the sub-limit wordings in the super-top up policy wordings. This usually means no sub-limits. I have to confirm that they have been removed.
Note: These changes apply only to Family Medicare policy and not their individual health policy. Please read all terms and conditions before purchase.
Why is this important? A room rent sub-limit restriction extends to (extract from policy wordings):
- “Nursing Care, RMO charges, IV Fluids/Blood Transfusion/Injection administration charges and similar expenses. Surgeon, Anaesthetist, Medical Practitioner, Consultants, Specialists Fees”.
- “Anaesthetist, Blood, Oxygen, Operation Theatre Charges, surgical appliances, Medicines & Drugs, Dialysis, Chemotherapy, Radiotherapy, Cost of Artificial Limbs, Cost of Prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory diagnostic tests, X-ray and such similar expenses that are medically necessary.”
- “Proportionate Deductions shall not be applied in respect of those hospitals where differential billing is not followed or for those expenses where differential billing is not adopted based on the room category.”
So practically everything else (aside from medicines and implants)!! See: Room rent sub-limits in health insurance: How I lost Rs. 24,000.
Day care procedures: The number of daycare procedures has been increased from about 60 to more than 200. Again a welcome move.
No claim discount: United does not offer any claim bonus or increase in sum insured. This benefit will go to zero after you claim. It instead offers a discount on the premium. The previous discount was 5% for every claim-free year. It has been hiked to 5% in the first year and 15% for every subsequent year.
Restoration of Sum Insured (optional)
This is not a key benefit as the probability that it comes into play is low. Yet many private players push this as a key benefit, and many buyers also get swayed by it. United has also joined the bandwagon.
If your sum insured is greater than Rs. 3 lakhs, and if it gets fully or partially exhausted in a policy year due to a claim, from illness X, for another claim made in the same year due to an illness different from X, the sum insured will be “restored” to the full amount. The benefit will not be carried forward, and if the age of entry is higher than 60, the extra benefit will come with a co-pay clause of 10% (that is, we pay 10%, the insurer will pay 90% of medical expenses).
Other changes
- Organ Donor Benefit- When Insured Person is the Donor: A lump-sum payment of 10% of the Sum Insured to take care of medical and other incidental expenses is payable to the Insured Person donating an organ
- Robotic Surgeries are now covered (with limitations)
- Ambulance coverage has been increased
- In-patient hospitalization for mental illnesses (with limitations) included
- Cataract coverage seems to have reduced. From 25% of sum insured to 10% of sum insured subject to a maximum of Rs. 50,000 per eye.
Source: United India Insurance.
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