Wouldn’t it be great to have a DIY health insurance comparison chart that will immediately help you shortlist policies with most relevant and beneficial features? You could then read the policy wordings of these and choose one easily. Using the comparison feature at policybazaar, here is a health insurance policy comparison template with six policies filled in. You can easily add more. Plus we continue our policy wordings walk-through with Cigna TTK ProHealth Plus and Royal Sundaram Lifeline Supreme. We shall discuss their salient features and then compare them with the policies considered in previous wordings walk-throughs: Apollo Munich Optima Restore Benefit vs Max Bupa Re-fill Benefit and Star Health Comprehensive Insurance vs Religare Care Comprehensive Insurance. Let us first discuss three aspects that insurance buyers must be aware of.
1 Beware of insurance comparison portals
First things first. Last week and this week I used policy bazaar to compare the main features of these policies. I noticed that when I refresh the window without changing the products the featured items in the comparison vary. Also, the information provided is not accurate. So please do not use only these portals for buying your policy. Always, always read terms and conditions before buying. Lazy people will get what they deserve.
This is from the cover page of TTK Cigna Prohealth plus T&C document. How true is that! What is more, true to policy terms and conditions document, the font contrast is poor!!
2 Beware of room-type based sub-limits
Many of us are aware of how the PSUs – United India, Oriental, New India – have room rent sub-limits. The typical wording is 1% of sum insured (SI) for daily room rent and 2% of SI for daily ICU charges. This is a clear wording. If my SI is Rs. 5 lakh, then I should not stay in a room that costs more than Rs. 5000. Else I will not be reimbursed in full of most medical costs. Here is a snapshot of my policy United India Platinum Cover:
Now, this may seem restrictive to you. Yes, compared to a policy compared to no sub-limits, this is restrictive. However, many privates insurers also have room rent sub-limits with a different type of wording that you should pay close attention to.
For example, this is Star Health Comprehensive Health Cover
Room (Single Standard A/C room), Boarding and Nursing Expenses as provided by the Hospital / Nursing Home. Single Standard A/C Room means an individual air-conditioned room with attached wash room. This room may have a television, telephone and a
couch. This does not include deluxe room / suite or room with additional facilities other than those stated herein.
And this is TTK Cigna ProHealth Plus
Covered up to Single Private room.Single Private Room means a single Hospital room of any rating with/without air-conditioning facility where a single patient is accommodated and which has an attached toilet (lavatory and bath). The room should have the provision for accommodating an attendant. This excludes a suite.
Royal Sundaram Lifeline Supreme does not have any room rent conditions.
So what is my problem with this kind of room-rent policy wordings? I was treated as an in-patient in a deluxe room with my United India policy during my thymectomy surgery because it imposes a limit only on the room rent and not room type. Rs. 5000 could be the daily rent for a standard room in one hospital, deluxe room in another, suite room in another or general ward in another.
I think these private players are playing with words when they say “cover for a standard room or private room”. It “sounds” as if there is no room rent limit, but it could hurt you bad. If I had Star Health my claim for staying in a deluxe room may not have been paid in full. At least TTK Cigna says single private room. This fits the description of a non-ac room, ac room and a deluxe room in most hospitals. A suite will have more than one room.
This is an unnecessary play on words. If an insurer wants to impost sub-limits, they should simply do it on the daily room rent.
3 Beware of future co-payment clauses
Co-payment means for every Rs. 100 expense, the insurer will only pay Rs. 70 or Rs. 80 or Rs. 90 and you pay the rest for each hospitalization.
For Star Health comprehensive insurance:
This policy is subject to co-payment of 10% of each and every claim amount for fresh as well as renewal policies for insured persons
whose age at the time of proposing this insurance policy is above 60 years.
This means that 10% co-payment will apply if I buy the policy above 60 and not before (I earlier interpreted this for all ages, which is incorrect). However, if you have 5 lakh cover before 60 and buy an addition 1 Lakh cover after 60, the 10% co-payment will apply to the extra sum.
For TTK Cigna:
A mandatory co-payment will be applicable for insured’s aged 65 years and above
This is applicable whether you buy before 65 or above 65.
Royal Sundaram has no such clause and 100% will be paid at all ages. This is an important point while choosing policies (see full table below).
4 What is risk loading?
IRDA has mandated that insurers should not increase the premium after a claim. However, when they receive a proposal and find that covering a persona is a potential claim risk, they can increase the premium from day one whether you claim or not! So it is important to be aware of this. Many insurers do this and the premium could increase by anywhere from 100% to 200% depending on the insurer. This will be mentioned in the policy document. So watch out for it. Sometimes going through a broker could reduce this loading (because brokers provide insurers with business), but never hide anything from the proposal to reduce costs. That would be stupidity.
Not many insurers mention the exact amount of loading for each condition. I am happy to see Cigna TTK provide this list in their T &C. The following can be assumed to be close to what all insurers practice.
5 What is a personal permanent exclusion
In addition to the usual permanent exclusions that one sees, depending on our health condition, the insurer could permanently exclude certain conditions before issuing the policy. This means we cannot claim for any illness directly or indirectly related to that permanent exclusion! Tough luck!
6 No claim benefits for Cigna TTK ProHealth Plus and Royal Sundaram Lifeline Supreme
Cigna TTK Health Plus
Cumulative Bonus- We will provide a 10% (for Health Plus) increase in sum insured for every claim free year, subject to a maximum of 100% accumulation as per the Plan opted. The cumulative bonus will remain intact and not get reduced in case a claim is made during the policy.
Policy Bazaar mentions incorrectly that sum insured could reduce when there is a claim.
It is always good to have a policy that offers no claim benefits that will not be removed upon a claim. Usually, if the bonus is high (50%), it will be removed when there is a claim. Better to choose a smaller but permanent bonus.
Royal Sundaram Lifeline supreme
We will increase Your Sum Insured by 20% of Base Sum Insured per Policy Year up to a maximum of 100% of Base Sum Insured of renewed Policy for Supreme and Elite variant provided You understand and agree that the sub-limits applicable to various benefits will remain the same and shall not increase proportionately with the increase in total Sum Insured; Any earned No Claim Bonus will not be reduced for claims made in the future;
On this count, if there are no claims for a number of years, the no claim bonus for Royal Sundaram Elite will be twice as much as Cigna TTK Health Plus.
Both Cigna TTK and Royal Sundaram have a “re-load/restore”but thanks to Nitesh G Buddhadev in AIFW, I am not quite sure how they operate as the wording is confusing.
In Apollo Munich Restore option the restore will kick in after full exhaustion. In Max Bupa the re-fill up to sum insured for partial claims too
Now Royal Sundaram says
We will provide a 100% Re-load of Sum Insured once in a Policy Year, provided that: a) the Base Sum Insured and No Claim Bonus (if any) is insufficient as a result of previous claims in that Policy Year;
Cigna TTK Says
We will provide for a 100% restoration of Sum Insured once in a Policy Year, provided that: (a) The Sum Insured inclusive of earned Cumulative Bonus (if any) or Cumulative Bonus Booster (if opted & earned) is insufficient as a result of previous claims in that Policy Year
So this will work for partial exhaustion as well but consider this: I have 5L cover and make a claim for 2L. I get admitted again. The expense could be <= 3L (remaining cover) or it could be higher. If the second claim is <=3L then for a second claim the restore option in these policies will not kick in. If it is above 3L then I must be eligible for the restore. But how I will I know beforehand?! hmm…
7 Building a health insurance comparison chart
So as mentioned above, this is the chart based on policybazaar information (corrected where discrepancies were found). You can build one or add more entries to the file linked below.
I have marked desirable features in green. The more green boxes a policy has, the better it is. Build a shortlist of policies from this chart and read their policy wordings carefully before choosing.
- How to build a medical corpus and why it is important?
- base policy + super top vs single large cover?
- How much policy should I have anyways?
Let me know what other issues you would like compared. Please do not ask me which policy to buy. I will not respond.
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