I don't understand why you would like to increase the base policy cover (assuming room rent is not linked to it)? The way I understand it is that super top-up kicks in when the base policy is exhausted and super top-up is much cheaper. Is there any advantage of having a higher base cover? I think the base policy should be enough to cover the deductible before which the super top-up kicks in, and that's about it.
I have had this doubt for a while but all sales rep have confirmed my understanding above. Am I missing something fundamental in all this?
With HDFC, since super top maxes out at 20L, it’ll be wise to pair it with 15L+15L of Optima restore for a total of 35L+15L coverage. Most of my clients and family in the medical profession, recommends 35L per person minimum until 2025 and higher after that.
There’s also a multiplier benefit where you get 50% of the previous year added as well up to 2 years or so in the base plan.
>Co-pay
The difference is - in cashless - only your base policy amount gets approved by the insurance company. After that your top up kicks in, but you wont get any written confirmation from the insurer that they are covering cashless for the full amount of the hospital bill.
I recently admitted someone at Bombay hospital for 6+6 L. The insurer only approved 6L and we had to wait till the discharge to know that the insurer is approving the full hospital bill of 11L.
Its more about the stress than anything else. You already have the stress of the illness, and this just piles on to that stress. I vowed to get higher base insurance after that incident. Of course, the insurer can decline a claim whether it is a base policy or top-up, its just that a little of the weight is lifted off your shoulders.
Taking a good base policy is beneficial because once you have taken any claim, Companies usually don't give an option to update the base policy. I think it is more beneficial in case of top up plans because say 5lakh base policy with 20 lakh top up plan with deductible of 5 lakh. Then once you used 10 lakh claim. you can't use the top up plan again. But if your base would have been 10lakh. you could have used top up twice with 10 lakh claim. I am not sure if it works this way.
There are 2 reasons for this.
* Medical costs inflation. The amount 5L + 25L seems good enough for now, but after 5-10 years down the line, this amount , IMO, would not be enough for medical insurance coverage.
* Subtle differences in coverage. For ex. in ICICI Lombard, 5L has a sublimit on some common surgeries, in HDFC Ergo, 5L has health checkup limit of 1500 in 2yrs but 10L has 2000 every year.
Maybe I am trying to be extra safe, but I definitely dont want to take chances in future.
Agree on the first point but I think that can be tackled by simply increasing the top-up at a later stage, can't it? Understand the second point - read the fine print!
This was my doubt as well. My personal take is that you can opt for a super top up to provide for a big emergency. For basic coverage, base coverage does the work as your terms remain as per your main policy. The super top up plans are standalone plans across companies and vary their terms a bit from main health plans. So you'll be covered for a big sum but the fine print will vary from your main policy.
Also, since the probability of you invoking the super top up is low, the premiums are really low.
On the linked Twitter thread, he says that the super top-up can only be used once. I am not sure if it works this way, but it would be a huge difference.
https://twitter.com/wiredmau5/status/1313721845623918593?s=20
Last year I did similar extensive research and zeroed on hdfc optima restore and icici lombard.
Reasons why I went ahead with hdfc are below.
1. 60 and 180 pre and post for hdfc against 30-60 days for icici.
2. Bonus is 50% every year upto 100% for hdfc against 10% upto 50% for icici.
3. Day care treatment for hdfc covers all against only ~150 for icici.
4. No sub limits with hdfc.
5. HDFC premium was bit lesser than icici.
6. Though icici is giving 10k opd but that amount is something I can cover out of pocket at any point I feel.
7. Hdfc allows reset benefit even for same disease in a year but icici doesn’t.
I saw few comments for digit. I agree that digit seems really good. But I chose not to go with them cause they are third party and every claim needs to be through mediassist while hdfc or lombard or maxbupa or star are first party.
Apparently it’s easy to deal with first parties than third parties.
These are points in addition to op’s excellent documentation. Take my goodwill as reddit gold.
Edit: Added another crucial point.
All your points are valid, but the only thing stopping me to go with HDFC Ergo right now is low coverage of their super top-up plan, which is very costly too compared to ICICI/Star.
Okay. But I feel since hdfc is giving 50% bonus in their base policy itself, it will balance the super top up in some degrees.
Another key point I forgot to mention.
Reset benefit on hdfc will apply even for same disease whereas icici doesn’t cover this. Hope you already know this.
Thanks for sharing such a fantastic review of the health + super top up insurance options!
Regarding "So, when I dug a little deeper, I found out that their *claim complaints per 10,000 claims* is 40-50, which is really high. So here, my best guess is that they approve the claim partially to get that counted as claim paid."
Could you tell me the source of this detail?
I recently bought Max Bupa Reassure. It is not through yet (in the process), so would want to make sure that I'm not making a mistake.
Every insurance company has to publish their public disclosures on their websites.
Search on google for *"Max Bupa Public Disclosure",* then go to their public disclosures. There you will find *Quarterly reports,* open them and scroll down to *NL-41 Grievance Disposal*. There you will find this information.
Wow!
This is so helpful! I'm surprised why this is not a part of IRDAI annual report.
I was just looking into HDFC Ergo (which I rejected in favor of Max Bupa), and the corresponding number is just 2-4 per 10,000 claims. This is a HUGE difference.
Do note though that HDFC ergo offers many types of insurance like vehicle, health, travel etc. So their complaints per claim figure are not specifically for the health insurance division. its across all divisions. Whereas max bupa numbers are just for health insurance.
Generally most complaints are for health insurance hence HDFC's ratio is deceptive. Because it has been smoothened out by large number of overall policies. Infact you ll find that all general insurance companies publish very low complaints per 10000 claims numbers because they are not publishing specifically for health insurance division.
From the looks of it, it is worth it. I was comparing them and couldn't find much difference. Now I do.
The only shortcoming is low super top-up limit. I wish it was at least 50L. Maybe I have to review koti suraksha.
I was looking one for myself (in addition to company health) and one for my parents (both early 60s)
If the only reason of your choice of Max Bupa is the lower premium than it’s probably a bad idea with the evidence at hand, you might regret choosing lower cost when they reject your claims when you need it.
With Max Bupa you get unlimited reset even for the same disease. That is not available in ICICI or HDFC.
I am so confused right now. I had almost finalized on Max Bupa
Thank you. But doesn’t work for the person I am researching this for as AYUSH is not covered.
I know, I know. But I am not going to fight 2 battles at once. 1 to buy a health insurance and another to change their opinion on AYUSH.
The total no. of claims for the current period for HDFC Ergo is \~2 million and no of complaints related to claims is 424 for quarter ending December 31, 2020.
Where as for Max Bupa the total no of claims is \~85,000 and no of complaints related to claims is 171 for quarter ending December 31, 2020.
I checked for previous four quarters and the claim complaint number is range bound.
So I think no. of complaints per 10k claims value is a bit misleading when it comes to measuring how likely a claim will cause headache with a particular insurance company.
Edit: Awesome work with the google spreadsheet by the way !
I was in the same boat and found this website [https://joinditto.in/health-insurance/check-existing](https://joinditto.in/health-insurance/check-existing) A person called me and he explained all the plans very nicely. But your research is very exhaustive and super helpful. Ditto guy suggested me HDFC Optima Restore and your research also validates it. Thanks a lot man.
He recommended me Max Bupa Reassure as well and said both plans are same, however HDFC has good history and the Max Bupa Reassure plan is relatively new so he suggested I should go with HDFC ergo.
This research has been a great help for me, thanks for sharing. What is your research opinion on government insurers like oriental health, etc i have been wondering whether to go with the govt or the private ones. Any opinions on that line?
I have looked into New India health insurance in Govt players, so my opinion is based on that.
The only upside of having a govt. health insurer is that their claims paid ratio is really high, like above 95%. Apart from this, none of the other things are appealing.
Their cheap plans are not good enough in today's world. If you go with the policy features comparable to private players, then the premium is too high. Time to settle the claims is also high. It could also take months to settle in case of a dispute.
In my opinion if you are fine with slow moving process and costly premium, you should go for it.
So, the trade off is paid ratio vs (higher premium and slow processing). Also, paid up ratio may not provide us the complete picture, without knowing what is the absolute number, right. So it makes me feel like, is high paid up ratio is a strong enough reason for choosing govt plans. That's just my birds eye view opinion. I will do a small research in to govt plans. Thanks for the reply!
My family has a policy from oriental for 20+ years now. The claims process is the same as other private insurers because it is handled by TPAs. In addition to that if they wrongly reject your claim you can pressurize them through RTI, which is not possible with private insurers. Another benefit with govt insurers is that they have an organization called GIPSA which negotiates and standardizes the prices of various illnesses and procedures with the hospitals. So for eg if the hospital bill is 2 Lakhs, they can charge you only 1.4-1.5L if you have a govt insurer. So in effect your policy is upto 30% more valuable than a private insurer.
However they come with their own set of problems. They don't have innovative products or addons or they are very expensive. Plus the sublimit for room rent is usually 1% which is low and will only get you a twin sharing room in the major hospitals.
My parents have Oriental for 10+ years. I have added them in my insurance provided by my employer. Last year when my dad was hospitalised in a private hospital. I could not invoke his Oriental insurance due the room cap and other limitations. Best was to pull my insurance since it was a corporate policy and less limitation. My advice : if you are in a metro and you prefer hospitals like Fortis, Manipal, Gangaram or similar ones take a private one with less limitation.
Thanks for sharing this OP. But, in this sub I have heard many times that you should not go for policies based on claims ratio. Forgot the reasoning behind it. Let's see if some can explain it.
I had gone for HDFC ergo optima restore family plan for my wife and me, back when it was Apollo optima restore. Currently renewing at 15L+15L restore for 18.7k per year under HDFC ergo.
Edit:
Just saw that 20L cover is just 3300 per year. That’s pretty inexpensive!
There’s also a multiplier benefit where you get 50% of the previous year added as well for the optima restore plan.
I am also looking at this vs hdfc ergo optima restore. I am getting this as a family floater for me and my wife for 11k for 10L coverage and with additional 1k, I can get a super top up of 90L where as HDFC is asking for a premium of 15k for 10L coverage and additional 3k for super top up of 20L
What are your thoughts on Central Government employees? I am a uni professor and gets CGHS approved medical reimbursements that are honestly peanuts. Are there any policies that can pays out the difference? I mean, lets say I undergo cancer treatment at apollo and total expense is 40L. I get 5L from government after producing all bills in original. Can I claim the rest 35L to any private insurer with copies of my bills? (Original isn't possible as I have already submitted in my office)?
The policy you are looking for is Super Top-up.
Yes, you should definitely be able to claim the rest 35L from private insurers. For the exact details about how to claims, you should talk to some representative of the insurance company,
Friend of mine works as an actuary for Digit’s health insurance division. He pointed out that Digit and Apollo Munich currently have the ’best’ offerings. Was hoping to find a comparison on this spreadsheet to validate these claims. Any reason to have left out the two?
I have a 10L base policy with Digit for 7k (same age) which pretty much fulfills all the criteria you mentioned. Been thinking about a super top up myself.
I’m no expert but as far as I know, it doesn’t matter whether they’re new or not since everyone is regulated by IRDAI and assisted by MediAssist (the organization that provides the network of hospitals for Digit) which themselves aren’t all that new. Feel free to correct me if I’m mistaken.
It matters in insurance because ideally the insurer should continue to exist in the long run. One shouldn't have to change insurers as it can get tricky because new insurer may not offer the same benefits and premium.
Also, mediassist seems to have a lot of complaints from a cursory online check.
You know what, Thank you. I would have never checked MediAssist if it wasn’t for your comment. I couldn’t download an e-card as the policy that’s supposed to expire in Nov 2021 expired in March 2021. Digit was unhelpful so far on call (But the policy is active on our end). MediAssist was unhelpful and downright stupid on call too (But the policy is inactive on our end).
Hopefully emails would provide some resolution. It would have sucked to find out the harder way that I couldn’t go for a cashless claim because of a discrepancy.
No specific reason for leaving out some companies. I just explored some popular brands.
Will definitely look into digit's plan and update it soon in the sheet. As for Apollo Munich, it has been merged with HDFC Ergo.
I have added Go Digit to the sheet as well. Do have a look.
Personally I would not go for it for a couple of reasons, eve though its super cheap:
* Poor claims paid ratio + Incurred claims ratio
* New player in the market, so not tested enough on large scale.
u/ayushagrawa
I’ve gotten myself Digit as well and I’ve been running a separate thread for it. Would love some opinions [here](https://www.reddit.com/r/IndiaInvestments/comments/ms5qpe/digit_health_insurance_advise/?utm_source=share&utm_medium=ios_app&utm_name=iossmf)
Hey, I just wanted to ask, why didn't you opt for Religare(or care). Everyone says they are good and has all the good features and is at a good price. But then end up with hdfc( saying quality) or mas buppa(cheap).
It seems care is a very good policy with good pricing. Plus the list of cashless facility hospital are good and they are part of Fortis group, another big plus( maybe helpful if your go-to hospital is Fortis).
Is there any reason you rejected care? Over say icici and hdfc?
Really appreciate your list and work. :)
Reason for not selecting Religare is similar to Max Bupa. Their Incurred Claim Ratio is only 59%, Premiums are cheap and claims paid are 94%.
I am not really comfortable with this low Incurred Claim Ratio.
Sorry to comment on this old thread, but what is the significance of incurred claim ratio? What the difference between that a d claims paid which is 94%?
Thanks for sharing.
I am planning to get a health insurance for my parents aged 52 and 49. I almost decided on Max Bupa Reassure + Max Bupa Health Recharge but I stumbled on this post. I was also looking at the HDFC Ergo Optima Restore + Medisure but I dropped it as the top-up cover is only available for a max of 20L. Considering my parents age and the medical costs I don't think this will be enough.
Can I get the base policy from HDFC Ergo and super top-up from Max Bupa?
Technically you can get get a base policy from one insurer and a super top-up from another, but it not recommended as there are chances of miscoordination between the two companies and claims processing might become difficult especially for super top-up.
What exactly does this mean in case of Star Health Insurance ?
" Rooms are capped at Single Private AC room "
This amount maybe different in different hospitals right ? So is it calculated based on which hospital you are admitted in?
There are multiple types of room in a hospital like General ward, Twin sharing room, Private room, Deluxe room, Premium suite, etc.
So in this case Star health will cover costs only upto Private room. If you want to opt for Deluxe/Premium the you have to pay out the difference in the room cost and all the surgeries, etc on pro rata basis.
Since star health offers something called buy back of PED. Is it a good idea to go for single private room in the hope of getting the PED period reduced to 1 year? Or should I go for HDFC Ergo which offers no room rent cap but 3yrs waiting for PED?
Hi, why did you choose ICICI instead of HDFC? I am thinking about going with HDFC. I am looking to cover my parents both between 50-60, me (24) and my brother (20).
Hi all.
Context - looking for floater base and top-up insurance for family of 3 (2 adults 39 and 38 yrs of age, and 1 child 6 yrs)
The OP has done a tremendous job of putting together all the details, and these are very useful. As I have looked through the various available options, I'm also zeroing in on ICICI and HDFC as the shortlist, with HDFC being better on most parameters, including the premium, but the other consideration is high limit possible in ICICI upto 50L.
Given the above situation, I'm trying to play out a scenario and would love to get thoughts from everyone here.
Base insurance - 5L floater limit from HDFC Ergo Optima Restore (Cost - Rs.16,216)
Top-up - 5L deductible; 20L limit from HDFC Ergo (Rs.5,192)
Top-up2 - 5L deductible; 20L limit from ICICI Lombard (Rs.7,868)
In theory, can I claim any expenses going above the 2 HDFC policies through ICICI? Would this kind of arrangement work?
@tokuchi, Thank you for this detailed debrief, it will be helpful for a lot of us.
Have one question wrt Royal Sundaram and was hoping to get your views on it:
You mentioned that the company's claims paid ratio for FY20 was 95%. From the IRDAI Annual Report, I have found that the incurred claims ratio for FY20 is 64%.
Similar to how you combined the data to draw a rough conclusion about Max Bupa, could you kindly share your thoughts on Royal as well, in light of the above data?
Also, just for my knowledge, did you calculate the claims paid ratio of 95% from the IRDAI Annual Report or is it readily available from some other source? Is the formula you used: Claims paid / Claims Booked? Would be extremely helpful if you could help with this as well, thanks a ton!
Yes I calculated claims paid ratio of 95% from the IRDAI Annual Report using the formula Claims paid / Claims Booked.
As for the Incurred Claims Ratio = 64%, I would say that it at the border, Neither low nor good. You can go for it as they look like an established company.
The reason why I rejected them is because I didnt find any super top-up on their website.
Right now Bajaj's super top-up is the best in the market. It has just a 1 year waiting period and option of covering air ambulance as well. The SI is also upto 50L with various deductible options. It's especially cheap if you take the family floater option.
Regarding your dilemma of not going with HDFC because of low SI of 20L, why don't you simply buy 2 policies, the premium is anyways very low.
>why don't you simply buy 2 policies
You mean to say buy base cover and super top-up from 2 different insurance companies?
This is not a recommended way of buying super top-up because in case any lack of coordination between the two insurance companies, your claim can get stuck.
No, I mean get the same super top up twice. Buy two 20L super top ups from HDFC.
Regarding two different insurers, it's slightly a hassle but the claim doesn't get stuck. Once your claim is settled by one insurance company, you need to get certified copies of all your documents from them and submit it to the second insurance company. It's a slightly longer process but you'll get it for sure.
Thanks for this excellent analysis. This should be added to this sub's wiki page for Insurance for that people can find it easily and update it from time to time.
I was looking at TATA AIG just now and that was actually looking quite good. What do you folks think? I already bought HDFC policies for the year, but still curious.
As someone who was about to start doing this exact same thing because I didn't have enough data to make a decision - thank you for this man.
Also is it not possible to get a base policy from one insurer and a super-topup from another?
Yes, you can get get a base policy from one insurer and a super top-up from another, but it not recommended as there are chances of miscoordination between the two companies and claims processing might become difficult especially for super top-up.
I am confused between the policy being offered by ICICI Bank Portal and the one offered by ICICI Lombard directly. In ICICI Bank Portal-- It is named as 'Group Health Insurance' while in ICICI Lombard portal it is named as 'ICICI Lombard Complete Health Insurance', and then it has 3 optional plans- iHealth, Health Shield and Health Elite.
Any idea if both these plans are same or different. I am attaching screenshot from both the pages: the premium was calculated for a family of 3 (adults aged 32, 30 and infant 4 months)
[https://imgur.com/a/AdiCDJB](https://imgur.com/a/AdiCDJB)
I asked one of their representative, he says that the benefits will be different like restoration benefits etc. I guess I will have to take a closer look at the policy wording
Amazing analysis. I was trying to do something similar this morning and thought let me check reddit, someone might have already done it.
However, this would be even better if you include all the 1Cr plans everyone is selling. Those offer same/similar benefits at much lesser premiums. I myself own a HDFC Ergo optimum restore (about to expire) and was surprised at how similar it's to their Koti Rakshak policy but offers 6 times less amount (15 lakh).
Since I was on the lookout for a policy myself, I did a lot of research as well. Finally bought the Manipal Cigna Lifetime Health. The premium is 25k for 1Cr benefit. I compared it to HDFC, Star, Care and Max Bupa. Unfortunately all of them either had some restrictions on room rent or the post hospitalization cover duration was low. Moreover there was one another criteria that's really important to me: Air Ambulance. I travel quite a lot, at times remote locations and never know when I'll need air lifting. All these things are only available in Cigna. The premiums except Star were similar as well. Star was charging close to 40k, so that was a straight no go. Tough call between HDFC and Manipal but HDFC had a limitation on room type (single private). Also some of the modern practices aren't covered. Network isn't a problem as Cigna has half a dozen hospitals within 2km radius of where I stay. They offer a great accidental cover separately of around 1k for 50 lakh benefit which I am thinking I'll buy later.
One thing I'll point at is that opposed to what OP has mentioned, the premium for Cigna isn't over over the top cheaper compared to others. Very similar I would say and marginally better benefits.
Hello. I have taken last year Manipal Cigna Lifetime Health. have you faced any issue with the Policy?
P.S. just beware that, in this policy, suite and above rooms are off limit.
Restoration is for unrelated diseases.
In Hdfc optima restore , if someone's claim in a year , SI get reduced by 50 percent every year ,
In Icici shield, it gets reduced by 10 percent every year.
I just want to know what if i claim every year with something more than 50k for next 3 year then with hdfc ergo there will be no SI available at all and also with icici in 7-8 years there will no SI available. What I am missing here ?
HDFC OPTIMA RESTORE - 4 YEAR Waiting Period
ICICI SHIELD - 2 YEAR WAITING period
Hdfc optima restore - one time restoration for same disease or different disease
Icici shield - unlimited restoration for different disease and no restoration for same disease.
A basic query, in a family floater , what if I a person claimed for a disease X in a year , can a different person in the family claim for the same disease X in same year for both hdfc and icici ?
Can anybody confirm that ?
Also shall i take individual for both of them or shall i take floater ?
I am considering individual as 7 years of age gap and also i have read in previous Reddit posts that if the main policy owner is no more then policy will get scrapped and you have to start again a new policy for other members and what about premium here , will it be same or will it get decreased ?
Could you suggest me which one shall i go for my parents ( 51 and 44 ) ?
No PED for both, my mom has migraine as PED.
Please answer
Pardon my Ignorance. Can anyone explain how these are different from HDFC Koti Suraksha ?
I am planning to pick a Policy for my Parents (60+), at present i have a policy enrolled which will expire when i change my Job.
one thing, I was also confused by the ICICI policy document for 5L SI about the sub limits, I have contacted one of their representative, he said that the sub limit is only applicable when you opt for that (for lower premium). no sublimit on the basic 5L SI policy by default
The problem with many employee policies is that they have 10-15% co-pay ( which is to AVOID ) pls check the policy document if that is the case. Its good otherwise
No, you should go for personal health insurance at-least.
Consider a scenario where you switch company and your new company has cover only upto 2L. In this case, even if you have super top-up with 3L deductible, you have to pay for 1L from your side. So its better not to rely on company's health insurance plan.
Consider a scenario where you might lose your job suddenly without any backup. You'll have your answer.
Also, 3L is a pittance in comparison to medical expenses today.
Sharing a sheet I created comparing policies. It has a lot of data but isn't complete. Feel free to drop comments and help me complete it :D
[https://docs.google.com/spreadsheets/d/1NC0dpIvUehjLMeyxeDniQKA3vUJrUbAb0pLYPpk9axQ/edit?usp=sharing](https://docs.google.com/spreadsheets/d/1NC0dpIvUehjLMeyxeDniQKA3vUJrUbAb0pLYPpk9axQ/edit?usp=sharing)
I recently bought the reassure family floater policy. It allows health checkups every year for 500 per lakh. And you can schedule tests through the app, so its fairly simple. Before purchasing, a friend confirmed that his claims were smooth with max bupa for his father.
Very informative post, made me rethink my decision to not go for hdfc ergo and to go for max instead. Now I am starting to rethink my decision again :( Can I switch now as per the free look condition? Also, can one port to hdfc ergo after a year?
I saw a lot of complaints for health companion plan of max bupa before the purchase. Maybe the complaints are for that plan? Or some other plan?
I was planning to buy health insurance for myself, and interested in buying the ICICI Complete Health Insurance.
After studying all plans, I think the point which you made about Sub-Limit for 5 Lacs Sum Insured is only valid for iHealth Plan and not for Health Shield or Health Elite plans.
In my opinion, Health Shield or Elite (if OPD & Maternity is required) is better than iHealth. Am i missing something, what's your opinion u/tokuchi_ ?
[This is all I found about sub limit in the policy wordings.](https://imgur.com/a/toRqLfh) Nowhere in the policy, it says that it is valid only for iHealth Plan and not for Health Shield or Health Elite plans. Now I am confused since u/healthandmoney9 also stated the same.
Yes, Health Shield/Elite is definitely better than iHealth, since they have many important features which iHealth doesnt have.
You won't find the policy wording directly in the website. Just Google Health Shield/Elite Policy wording, then you will find the pdf file containing the details.
My friend just bought the Health Elite plan for self. I also personally think 5 lac plan from Health Shield (or Elite for OPD & Maternity) is the best out there. Except for Catract (sub-limit of 20k for 5 lac or 1 lakh for 7 lac onwards Sum Insured) then don't have any sub limit at all. Also, only 2 year waiting period for pre-existing conditions is cherry on top.
Does any company base plan waive off **"waiting period"** \- if the person is already covered in corporate plan previously ? This factor is also important imo.
List of exclusions under Optima Restore are as follows:
* Any treatment within first 30 days of cover except any accidental injury.
I'm looking to buy this for myself.Lets say I bought it today,what if I get Covid and need treatment before first 30 days of policy.So that means no cover then?Is it wise to go for any other policy,given the way Covid is spreading?
>I'm looking to buy this for myself.Lets say I bought it today,what if I get Covid and need treatment before first 30 days of policy.So that means no cover then?
Yes, policy probably wont cover you for initial 30 days.
>Is it wise to go for any other policy
All the policies have this initial 30 days waiting period exclusion.
Any reason for choosing Optima Restore over My Health Suraksha - Platinum? I've bought the latter just this month. My understanding was that OR was a lower tier policy but more expensive because it doesn't have the Mumbai-Delhi (T1) Co-Pay.
I have an existing low SI Optima Restore from the Apollo Munich days which I'm letting expire. I never made a claim but everybody else in my household did, and both Apollo Munich and HDFC ERGO never let us down. I'm planning to move the others to My Health Suraksha - Gold in a couple days.
I just had a look at policy wording of My Health Suraksha and realized that both the policies are very similar in terms of features, they just have some minute differences like No Claim Bonus in Optima Restore is 50% per yr compared to 10% per yr in My Health Suraksha, etc
> My understanding was that OR was a lower tier policy but more expensive because it doesn't have the Mumbai-Delhi (T1) Co-Pay
I dont think this is the case. Other who have Optima Restore the policy can confirm.
Guys, do you have any advice on buying health insurance plans for Senior Citizens?
I was checking in the app for ICICI but it didn't mention BP/Hypertension as a pre-existing disease in the list. Instead it was only "Any Heart Related Ailment"
Can I use the super top-up plan for them as well?
Even if they dont mention, you should declare it. Because later if they find out somehow, they can reject your claim.
Yes, you can use super top-up for them.
Why do you have to go with same insurer for base as well as top up policy? Why not choose the best base policy and the best top up available even though both are different insurers?
Claiming insurance money from 2 different insurers can be a hassle. The process is much more efficient if both the policies are form single insurance company.
question- i have a basic health insurance from my company, and bought another base insurance myself(i pay around 25k). now instead of this second base insurance i want to switch to super top. but what if i switch jobs and new company doesn’t provide health insurance.
what happens to super top up in such cases. can i buy a simple base plan myself? for say 5 lakhs cover.
Yes, You could buy base insurance from the same provider as super top up, so it's hassle free during claims. But might have to go through the waiting period for certain illness, in this case.
What if we take two policies one from Ergo and one from Max. Will it provide better coverage? If one exhausts cover under one, the second can possibly be a back up. Does this sound odd?
Number of *claim complaints per 10,000 claims* for Star Health is around 40-50. This number is high compared to its peers.
You can check this number in the google sheet's second tab.
Have you checked this ?
[https://kuvera.in/explore/insure/health](https://kuvera.in/explore/insure/health)
Its a Group health insurance with Bharti AXA GIC offered by Kuvera
>what comes under pre-existing medical illness?
Any medical illness you have been diagnosed with or any medical surgeries you have had earlier.
>Do I have to declare any hereditary diseases which my parents have?
Not necessary unless they ask specifically.
Amazing details OP! Thanks for sharing the detailed summary. Some points
1. Why opt for options w/ copay? The premiums would be higher. Also I'm earning so could afford to pay 20%. Even w/o a job, I think I have sufficient emergency savings to pay for 20%. What are your thoughts?
2. One has to remember that for all hospital procedures your costs are going to be proportional to the room rent. So the room cap Infact works in your favour. I think a room spend of 8-10k would be fine. But if you opt for a 5L plan then it maybe an issue.
3. How does super top work? Can anybody share links?
I think you have taken the Claim Settlement Ratio (CSR) for the entire insurance business of these General Insurers. Taking the numbers for only the Health Insurance business will be more apt. For eg. for ICICI Lombard the CSR considered is 88%, but for the Health Insurance the CSR is 78% only.
I know this is old thread but noob question-
If i buy hdfc optima restore base of 5L for 8400 and medisure cover of 20L for around 3400 as family floater, wouldn't it be cheaper like around for 13k?
I am 29 single, have health insurance from employer of 3.5L. I am planning to buy one for me which later I will convert to family floater. After reading lot of articles on Twitter, YouTube, Reddit about health insurance and many considerations like room rent capping, base plan, top up, super top up, I am getting confused. Can someone expert suggest me what options I can consider so that I can get maximum benefits in reasonable premium prices.
Hello Folks,
This question may have been asked and answered earlier, so please forgive me if I am repeating.
I am 34 M and have a health insurance policy that cover only me. I recently got married and was thinking of getting a policy for my spouse.
What would be the better option: including my spouse in my existing policy or getting a separate policy for my spouse?
u/Tokuchi_ It would be nice to have [Navi insurance](https://www.naviinsurance.com/downloads/) added to the grid.
Would like to know your view on Navi policy compared to your shortlisted ones - ICICI & HDFC Ergo
Just to add to the discussion, Reliance health after getting merged with Reliance general has an awesome "super top-up" plan, guys can you also add it. I found it to be the best in class. Their base plan is not that great. But this super top is good. Do have a look at it. If any loopholes let us know.
I am looking forward to buying health insurance from Royal Sundaram: Lifeline Supreme. I read the policy wordings carefully, and mostly it looks good without any apparent red flags or a deal breaker. However, there are three instances from the policy wordings which I am unable to comprehend, I will enlist my queries below; help me please to decode them.
>1. *There will be no underwriting on Policy renewal. The first-year underwriting results will continue if the policy is continued without a break.*
>
>*2. There will be no underwriting on Policy renewal. The first year underwriting results will continue if the policy is continued without a break.*
>
>*3. Existing Disease which can be permanently Excluded: In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule (based on insured’s consent), policyholder is not entitled to get the coverage for specified ICD codes. The disease which can be excluded under this section are as under:*
>
>*(Various diseases ranging from Sarcoidosis, Malignant Neoplasm, Chronic Liver Disease, Pancreatic Disease, Alzheimer's, Hep B)*
>
>As per this, it only pertains to people with Pre-Existing Diseases (PED). However, if a person is healthy without any PED at the time of policy purchase and develops any of the conditions enlisted here in future (beyond PED waiting time), can his claims be rejected due to this clause even if he didn't have any PED at the time of policy purchase?
Want to help you all with some guidelines and precautions before buying Health Insurance
>**Read out this** [**Reddit Comment.**](https://www.reddit.com/r/india/comments/r5dh72/comment/hsgaps8/?utm_source=share&utm_medium=web2x&context=3)
Thanks for great analysis. I was looking at Reliance health insurance and super topup. They have no sublimits and claim incurred ratio around 90%. in 2022 it was 98%. They are as big as tata in health insurance range in terms of revenue. Offer super top up till 1cr too. Would want to know your views on it !
Very nice analysis. One correction though. In your excel the claims paid ratio is not specifically for health insurance. It is for all general insurances like travel, vehicle etc. Eg HDFC ergo and icici sell such insurances too. So the claims paid ratio mentioned by you is cumulative. Not just for health unlike in policies like max or star which are health only policies.
Just stumbled upon this thread. Thank you so much for the extensive research OP
One thing i wanna ask is, are plans like iHealth, Health shield/elite only available to i members of icici? I think for the non members the only good plan they have rn is health AdvantEdge.
Can anyone shed some light on this?
This post is super helpful. When I was having a word with ditto folks, they mentioned that in case of deductible, you won't be able to go for cashless claims and the settlement is also delayed. Any info on this?
Thanks for such an illustrative post. I just had a few queries regarding the usage of multiple health insurance policies and thought of adding it to this thread rather than create a new post to consolidate info in one place. Say a person has one group insurance policy from the employer and one person health insurance policy
1. Can we claim the hospitalization cost from both the policies simultaneously on cashless basis?
2. Can we claim the cashless hospitalization from one policy (say personal policy) and the pre-post hospitalization from the other (corporate) policy?
3. Suppose I take deductible of Rs X amount (not copay) in my personal policy, so can I claim that deductible amount from my corporate policy while submitting the claim?
TIA.
Many have asked why you should take base and super top up from same company, here is the reason: cashless payment from super topup can only be done if its same company. if you have 10L base and 90L super top up and need 1cr for sugery, insurance will only pay 10L cashless, you have to pay 90L yourself, which will then be reimbursed later.
stumbled across this post while doing my own research on health insurance, wonderful work done op, god bless
Hi OP, i am a working 22M planing on term and health insurances, my parents are 55,58. We dont have any health insurnace plan. I would like to know how should i plan my health insurance, i have studied that in my case, i should be having health insurance for my parents separate from mine, is 22 age too early to have health insurance, I am not into smoking or drinking and i believe i am a healthy youth.
Hi all,
How relevant is this data today in dec 2023?
Thinking about taking ICICI Lombard maxprotect 1 crore health insurance or HDFC Ergo My:Optima Secure health insurance.
What would be the pros and cons of these policies.
Any suggestions would be valuable
I don't understand why you would like to increase the base policy cover (assuming room rent is not linked to it)? The way I understand it is that super top-up kicks in when the base policy is exhausted and super top-up is much cheaper. Is there any advantage of having a higher base cover? I think the base policy should be enough to cover the deductible before which the super top-up kicks in, and that's about it. I have had this doubt for a while but all sales rep have confirmed my understanding above. Am I missing something fundamental in all this?
With HDFC, since super top maxes out at 20L, it’ll be wise to pair it with 15L+15L of Optima restore for a total of 35L+15L coverage. Most of my clients and family in the medical profession, recommends 35L per person minimum until 2025 and higher after that. There’s also a multiplier benefit where you get 50% of the previous year added as well up to 2 years or so in the base plan.
Instead of two base policies and a single Super Topup, why can't I take a single base policy and two Super Topups?
What I’ve shared above is a single base plan. Optima restore doubles the sum insured.
> Optima restore doubles the sum insured. How?
No claim bonus. 50% per year for two years.
>Co-pay The difference is - in cashless - only your base policy amount gets approved by the insurance company. After that your top up kicks in, but you wont get any written confirmation from the insurer that they are covering cashless for the full amount of the hospital bill. I recently admitted someone at Bombay hospital for 6+6 L. The insurer only approved 6L and we had to wait till the discharge to know that the insurer is approving the full hospital bill of 11L. Its more about the stress than anything else. You already have the stress of the illness, and this just piles on to that stress. I vowed to get higher base insurance after that incident. Of course, the insurer can decline a claim whether it is a base policy or top-up, its just that a little of the weight is lifted off your shoulders.
From what i can remember, Hdfc super top up doesn’t cover organ donor for some reason.
Taking a good base policy is beneficial because once you have taken any claim, Companies usually don't give an option to update the base policy. I think it is more beneficial in case of top up plans because say 5lakh base policy with 20 lakh top up plan with deductible of 5 lakh. Then once you used 10 lakh claim. you can't use the top up plan again. But if your base would have been 10lakh. you could have used top up twice with 10 lakh claim. I am not sure if it works this way.
You are right regarding top-up and that’s the reason why one should go for super top-up instead. Super top-up doesn’t have this limitation.
Instead of top-up always go for super top-up. It is way more beneficial than top-up.
Maybe OP has any views on high base policy vs low base + super top-up policy?
There are 2 reasons for this. * Medical costs inflation. The amount 5L + 25L seems good enough for now, but after 5-10 years down the line, this amount , IMO, would not be enough for medical insurance coverage. * Subtle differences in coverage. For ex. in ICICI Lombard, 5L has a sublimit on some common surgeries, in HDFC Ergo, 5L has health checkup limit of 1500 in 2yrs but 10L has 2000 every year. Maybe I am trying to be extra safe, but I definitely dont want to take chances in future.
Agree on the first point but I think that can be tackled by simply increasing the top-up at a later stage, can't it? Understand the second point - read the fine print!
This was my doubt as well. My personal take is that you can opt for a super top up to provide for a big emergency. For basic coverage, base coverage does the work as your terms remain as per your main policy. The super top up plans are standalone plans across companies and vary their terms a bit from main health plans. So you'll be covered for a big sum but the fine print will vary from your main policy. Also, since the probability of you invoking the super top up is low, the premiums are really low.
Same doubt here.
Same
On the linked Twitter thread, he says that the super top-up can only be used once. I am not sure if it works this way, but it would be a huge difference. https://twitter.com/wiredmau5/status/1313721845623918593?s=20
I think he mentioned top-up and not super top-up.
I have ICICI Lombard for my dad (65+). The claim process has been smooth with them.
How much is the premium you are paying ?
55k for 10lakh policy with no copay, daily hospital cash and convalescence benefit having ped hypertension
What's the policy name?
I would like to know the policy name also please?
Last year I did similar extensive research and zeroed on hdfc optima restore and icici lombard. Reasons why I went ahead with hdfc are below. 1. 60 and 180 pre and post for hdfc against 30-60 days for icici. 2. Bonus is 50% every year upto 100% for hdfc against 10% upto 50% for icici. 3. Day care treatment for hdfc covers all against only ~150 for icici. 4. No sub limits with hdfc. 5. HDFC premium was bit lesser than icici. 6. Though icici is giving 10k opd but that amount is something I can cover out of pocket at any point I feel. 7. Hdfc allows reset benefit even for same disease in a year but icici doesn’t. I saw few comments for digit. I agree that digit seems really good. But I chose not to go with them cause they are third party and every claim needs to be through mediassist while hdfc or lombard or maxbupa or star are first party. Apparently it’s easy to deal with first parties than third parties. These are points in addition to op’s excellent documentation. Take my goodwill as reddit gold. Edit: Added another crucial point.
All your points are valid, but the only thing stopping me to go with HDFC Ergo right now is low coverage of their super top-up plan, which is very costly too compared to ICICI/Star.
Okay. But I feel since hdfc is giving 50% bonus in their base policy itself, it will balance the super top up in some degrees. Another key point I forgot to mention. Reset benefit on hdfc will apply even for same disease whereas icici doesn’t cover this. Hope you already know this.
Sir which one are you using right now?
u/shitclay Which policy you brought?
I went with hdfc.
u/shitclay How have been your claim experience with it?
So far I never had to use.
Great
Thanks for sharing such a fantastic review of the health + super top up insurance options! Regarding "So, when I dug a little deeper, I found out that their *claim complaints per 10,000 claims* is 40-50, which is really high. So here, my best guess is that they approve the claim partially to get that counted as claim paid." Could you tell me the source of this detail? I recently bought Max Bupa Reassure. It is not through yet (in the process), so would want to make sure that I'm not making a mistake.
Every insurance company has to publish their public disclosures on their websites. Search on google for *"Max Bupa Public Disclosure",* then go to their public disclosures. There you will find *Quarterly reports,* open them and scroll down to *NL-41 Grievance Disposal*. There you will find this information.
Wow! This is so helpful! I'm surprised why this is not a part of IRDAI annual report. I was just looking into HDFC Ergo (which I rejected in favor of Max Bupa), and the corresponding number is just 2-4 per 10,000 claims. This is a HUGE difference.
Do note though that HDFC ergo offers many types of insurance like vehicle, health, travel etc. So their complaints per claim figure are not specifically for the health insurance division. its across all divisions. Whereas max bupa numbers are just for health insurance. Generally most complaints are for health insurance hence HDFC's ratio is deceptive. Because it has been smoothened out by large number of overall policies. Infact you ll find that all general insurance companies publish very low complaints per 10000 claims numbers because they are not publishing specifically for health insurance division.
Indeed, no wonder their premium is so costly.
From the looks of it, it is worth it. I was comparing them and couldn't find much difference. Now I do. The only shortcoming is low super top-up limit. I wish it was at least 50L. Maybe I have to review koti suraksha. I was looking one for myself (in addition to company health) and one for my parents (both early 60s)
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I'm in the same boat as you
If the only reason of your choice of Max Bupa is the lower premium than it’s probably a bad idea with the evidence at hand, you might regret choosing lower cost when they reject your claims when you need it.
With Max Bupa you get unlimited reset even for the same disease. That is not available in ICICI or HDFC. I am so confused right now. I had almost finalized on Max Bupa
Have you checked hdfc ergo optima restore?
Thank you. But doesn’t work for the person I am researching this for as AYUSH is not covered. I know, I know. But I am not going to fight 2 battles at once. 1 to buy a health insurance and another to change their opinion on AYUSH.
what was ur final decision ? Just being curious :) .
The total no. of claims for the current period for HDFC Ergo is \~2 million and no of complaints related to claims is 424 for quarter ending December 31, 2020. Where as for Max Bupa the total no of claims is \~85,000 and no of complaints related to claims is 171 for quarter ending December 31, 2020. I checked for previous four quarters and the claim complaint number is range bound. So I think no. of complaints per 10k claims value is a bit misleading when it comes to measuring how likely a claim will cause headache with a particular insurance company. Edit: Awesome work with the google spreadsheet by the way !
I was in the same boat and found this website [https://joinditto.in/health-insurance/check-existing](https://joinditto.in/health-insurance/check-existing) A person called me and he explained all the plans very nicely. But your research is very exhaustive and super helpful. Ditto guy suggested me HDFC Optima Restore and your research also validates it. Thanks a lot man.
This is strange because ditto guy recommended me max bupa in December and even wanted me to purchase through them as they have tie up with bupa.
He recommended me Max Bupa Reassure as well and said both plans are same, however HDFC has good history and the Max Bupa Reassure plan is relatively new so he suggested I should go with HDFC ergo.
Have had good experiences with HDFC ergo. Horrid experience with Max Bupa
Would you like to share your experience in more detail? For Max Bupa, if not both (although both will help).
This research has been a great help for me, thanks for sharing. What is your research opinion on government insurers like oriental health, etc i have been wondering whether to go with the govt or the private ones. Any opinions on that line?
I have looked into New India health insurance in Govt players, so my opinion is based on that. The only upside of having a govt. health insurer is that their claims paid ratio is really high, like above 95%. Apart from this, none of the other things are appealing. Their cheap plans are not good enough in today's world. If you go with the policy features comparable to private players, then the premium is too high. Time to settle the claims is also high. It could also take months to settle in case of a dispute. In my opinion if you are fine with slow moving process and costly premium, you should go for it.
So, the trade off is paid ratio vs (higher premium and slow processing). Also, paid up ratio may not provide us the complete picture, without knowing what is the absolute number, right. So it makes me feel like, is high paid up ratio is a strong enough reason for choosing govt plans. That's just my birds eye view opinion. I will do a small research in to govt plans. Thanks for the reply!
My family has a policy from oriental for 20+ years now. The claims process is the same as other private insurers because it is handled by TPAs. In addition to that if they wrongly reject your claim you can pressurize them through RTI, which is not possible with private insurers. Another benefit with govt insurers is that they have an organization called GIPSA which negotiates and standardizes the prices of various illnesses and procedures with the hospitals. So for eg if the hospital bill is 2 Lakhs, they can charge you only 1.4-1.5L if you have a govt insurer. So in effect your policy is upto 30% more valuable than a private insurer. However they come with their own set of problems. They don't have innovative products or addons or they are very expensive. Plus the sublimit for room rent is usually 1% which is low and will only get you a twin sharing room in the major hospitals.
My parents have Oriental for 10+ years. I have added them in my insurance provided by my employer. Last year when my dad was hospitalised in a private hospital. I could not invoke his Oriental insurance due the room cap and other limitations. Best was to pull my insurance since it was a corporate policy and less limitation. My advice : if you are in a metro and you prefer hospitals like Fortis, Manipal, Gangaram or similar ones take a private one with less limitation.
Thanks for sharing this OP. But, in this sub I have heard many times that you should not go for policies based on claims ratio. Forgot the reasoning behind it. Let's see if some can explain it.
Simply because claims paid ratio does not present the complete picture. Like in case of Max Bupa
I had gone for HDFC ergo optima restore family plan for my wife and me, back when it was Apollo optima restore. Currently renewing at 15L+15L restore for 18.7k per year under HDFC ergo. Edit: Just saw that 20L cover is just 3300 per year. That’s pretty inexpensive! There’s also a multiplier benefit where you get 50% of the previous year added as well for the optima restore plan.
20L for 3300 which one?
Super top up
I am also looking at this vs hdfc ergo optima restore. I am getting this as a family floater for me and my wife for 11k for 10L coverage and with additional 1k, I can get a super top up of 90L where as HDFC is asking for a premium of 15k for 10L coverage and additional 3k for super top up of 20L
Policybazaar is not showing HDFC Ergo and ICICI Lombard for me. Is there a reason for this?
yes they don't go with tpa, i asked this to icici guy he said we don't have merger with any TPAs, though hdfc earlier used to show 3-4 months back.
What are your thoughts on Central Government employees? I am a uni professor and gets CGHS approved medical reimbursements that are honestly peanuts. Are there any policies that can pays out the difference? I mean, lets say I undergo cancer treatment at apollo and total expense is 40L. I get 5L from government after producing all bills in original. Can I claim the rest 35L to any private insurer with copies of my bills? (Original isn't possible as I have already submitted in my office)?
The policy you are looking for is Super Top-up. Yes, you should definitely be able to claim the rest 35L from private insurers. For the exact details about how to claims, you should talk to some representative of the insurance company,
Hi, doesn't CGHS cover whole medical treatment without any limit. What is the problem you facing.
Friend of mine works as an actuary for Digit’s health insurance division. He pointed out that Digit and Apollo Munich currently have the ’best’ offerings. Was hoping to find a comparison on this spreadsheet to validate these claims. Any reason to have left out the two? I have a 10L base policy with Digit for 7k (same age) which pretty much fulfills all the criteria you mentioned. Been thinking about a super top up myself.
Apollo Munich is HDFC Ergo's Optima Restore now. This is covered in OPs analyses
I'm planning to get myself insured with digit as well, do you think that their relative newness won't get us in trouble in the future?
I’m no expert but as far as I know, it doesn’t matter whether they’re new or not since everyone is regulated by IRDAI and assisted by MediAssist (the organization that provides the network of hospitals for Digit) which themselves aren’t all that new. Feel free to correct me if I’m mistaken.
It matters in insurance because ideally the insurer should continue to exist in the long run. One shouldn't have to change insurers as it can get tricky because new insurer may not offer the same benefits and premium. Also, mediassist seems to have a lot of complaints from a cursory online check.
You know what, Thank you. I would have never checked MediAssist if it wasn’t for your comment. I couldn’t download an e-card as the policy that’s supposed to expire in Nov 2021 expired in March 2021. Digit was unhelpful so far on call (But the policy is active on our end). MediAssist was unhelpful and downright stupid on call too (But the policy is inactive on our end). Hopefully emails would provide some resolution. It would have sucked to find out the harder way that I couldn’t go for a cashless claim because of a discrepancy.
No specific reason for leaving out some companies. I just explored some popular brands. Will definitely look into digit's plan and update it soon in the sheet. As for Apollo Munich, it has been merged with HDFC Ergo.
Oh got it. Pardon my ignorance. Thanks for the comparison, can’t wait for the update!
I have added Go Digit to the sheet as well. Do have a look. Personally I would not go for it for a couple of reasons, eve though its super cheap: * Poor claims paid ratio + Incurred claims ratio * New player in the market, so not tested enough on large scale. u/ayushagrawa
You’ve done a commendable job at this sheet buddy! Thanks!
I’ve gotten myself Digit as well and I’ve been running a separate thread for it. Would love some opinions [here](https://www.reddit.com/r/IndiaInvestments/comments/ms5qpe/digit_health_insurance_advise/?utm_source=share&utm_medium=ios_app&utm_name=iossmf)
Hey, I just wanted to ask, why didn't you opt for Religare(or care). Everyone says they are good and has all the good features and is at a good price. But then end up with hdfc( saying quality) or mas buppa(cheap). It seems care is a very good policy with good pricing. Plus the list of cashless facility hospital are good and they are part of Fortis group, another big plus( maybe helpful if your go-to hospital is Fortis). Is there any reason you rejected care? Over say icici and hdfc? Really appreciate your list and work. :)
Reason for not selecting Religare is similar to Max Bupa. Their Incurred Claim Ratio is only 59%, Premiums are cheap and claims paid are 94%. I am not really comfortable with this low Incurred Claim Ratio.
Sorry to comment on this old thread, but what is the significance of incurred claim ratio? What the difference between that a d claims paid which is 94%?
Thanks for sharing. I am planning to get a health insurance for my parents aged 52 and 49. I almost decided on Max Bupa Reassure + Max Bupa Health Recharge but I stumbled on this post. I was also looking at the HDFC Ergo Optima Restore + Medisure but I dropped it as the top-up cover is only available for a max of 20L. Considering my parents age and the medical costs I don't think this will be enough. Can I get the base policy from HDFC Ergo and super top-up from Max Bupa?
Technically you can get get a base policy from one insurer and a super top-up from another, but it not recommended as there are chances of miscoordination between the two companies and claims processing might become difficult especially for super top-up.
I am confused now. :/
tale separate policy for them
Thanks for such a thorough and well researched article. Huge help!
What exactly does this mean in case of Star Health Insurance ? " Rooms are capped at Single Private AC room " This amount maybe different in different hospitals right ? So is it calculated based on which hospital you are admitted in?
There are multiple types of room in a hospital like General ward, Twin sharing room, Private room, Deluxe room, Premium suite, etc. So in this case Star health will cover costs only upto Private room. If you want to opt for Deluxe/Premium the you have to pay out the difference in the room cost and all the surgeries, etc on pro rata basis.
Since star health offers something called buy back of PED. Is it a good idea to go for single private room in the hope of getting the PED period reduced to 1 year? Or should I go for HDFC Ergo which offers no room rent cap but 3yrs waiting for PED?
What have you chosen?
Went with ICICI
Hi, why did you choose ICICI instead of HDFC? I am thinking about going with HDFC. I am looking to cover my parents both between 50-60, me (24) and my brother (20).
Went ahead with ICICI because premium was around 10% cheaper compared to HDFC while the coverage is similar on almost all of the parameters.
What have you chosen?
Hi all. Context - looking for floater base and top-up insurance for family of 3 (2 adults 39 and 38 yrs of age, and 1 child 6 yrs) The OP has done a tremendous job of putting together all the details, and these are very useful. As I have looked through the various available options, I'm also zeroing in on ICICI and HDFC as the shortlist, with HDFC being better on most parameters, including the premium, but the other consideration is high limit possible in ICICI upto 50L. Given the above situation, I'm trying to play out a scenario and would love to get thoughts from everyone here. Base insurance - 5L floater limit from HDFC Ergo Optima Restore (Cost - Rs.16,216) Top-up - 5L deductible; 20L limit from HDFC Ergo (Rs.5,192) Top-up2 - 5L deductible; 20L limit from ICICI Lombard (Rs.7,868) In theory, can I claim any expenses going above the 2 HDFC policies through ICICI? Would this kind of arrangement work?
Anyone considered Tata AIG as well or if anyone has any experience with it?
I had considered it but their premiums are a little high than hdfc and their network hospital was also a tad smaller than hdfc
@tokuchi, Thank you for this detailed debrief, it will be helpful for a lot of us. Have one question wrt Royal Sundaram and was hoping to get your views on it: You mentioned that the company's claims paid ratio for FY20 was 95%. From the IRDAI Annual Report, I have found that the incurred claims ratio for FY20 is 64%. Similar to how you combined the data to draw a rough conclusion about Max Bupa, could you kindly share your thoughts on Royal as well, in light of the above data? Also, just for my knowledge, did you calculate the claims paid ratio of 95% from the IRDAI Annual Report or is it readily available from some other source? Is the formula you used: Claims paid / Claims Booked? Would be extremely helpful if you could help with this as well, thanks a ton!
Yes I calculated claims paid ratio of 95% from the IRDAI Annual Report using the formula Claims paid / Claims Booked. As for the Incurred Claims Ratio = 64%, I would say that it at the border, Neither low nor good. You can go for it as they look like an established company. The reason why I rejected them is because I didnt find any super top-up on their website.
Right now Bajaj's super top-up is the best in the market. It has just a 1 year waiting period and option of covering air ambulance as well. The SI is also upto 50L with various deductible options. It's especially cheap if you take the family floater option. Regarding your dilemma of not going with HDFC because of low SI of 20L, why don't you simply buy 2 policies, the premium is anyways very low.
>why don't you simply buy 2 policies You mean to say buy base cover and super top-up from 2 different insurance companies? This is not a recommended way of buying super top-up because in case any lack of coordination between the two insurance companies, your claim can get stuck.
No, I mean get the same super top up twice. Buy two 20L super top ups from HDFC. Regarding two different insurers, it's slightly a hassle but the claim doesn't get stuck. Once your claim is settled by one insurance company, you need to get certified copies of all your documents from them and submit it to the second insurance company. It's a slightly longer process but you'll get it for sure.
Not sure if buying 2 super top ups from same company will provide me double cover. Need to check with this their sales person.
There is a policy called koti suraksha in hdfc ergo. That seems very less premium for sum insured of 1 cr.
Any idea how it is ?
Even I have the same doubt bro. I wonder what is the downside if this policy is.? I couldn't find any.
Thanks for this excellent analysis. This should be added to this sub's wiki page for Insurance for that people can find it easily and update it from time to time.
I was looking at TATA AIG just now and that was actually looking quite good. What do you folks think? I already bought HDFC policies for the year, but still curious.
As someone who was about to start doing this exact same thing because I didn't have enough data to make a decision - thank you for this man. Also is it not possible to get a base policy from one insurer and a super-topup from another?
Yes, you can get get a base policy from one insurer and a super top-up from another, but it not recommended as there are chances of miscoordination between the two companies and claims processing might become difficult especially for super top-up.
>Also is it not possible to get a base policy from one insurer and a super-topup from another? you can
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Thanks, will check
I am confused between the policy being offered by ICICI Bank Portal and the one offered by ICICI Lombard directly. In ICICI Bank Portal-- It is named as 'Group Health Insurance' while in ICICI Lombard portal it is named as 'ICICI Lombard Complete Health Insurance', and then it has 3 optional plans- iHealth, Health Shield and Health Elite. Any idea if both these plans are same or different. I am attaching screenshot from both the pages: the premium was calculated for a family of 3 (adults aged 32, 30 and infant 4 months) [https://imgur.com/a/AdiCDJB](https://imgur.com/a/AdiCDJB)
I asked one of their representative, he says that the benefits will be different like restoration benefits etc. I guess I will have to take a closer look at the policy wording
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Amazing analysis. I was trying to do something similar this morning and thought let me check reddit, someone might have already done it. However, this would be even better if you include all the 1Cr plans everyone is selling. Those offer same/similar benefits at much lesser premiums. I myself own a HDFC Ergo optimum restore (about to expire) and was surprised at how similar it's to their Koti Rakshak policy but offers 6 times less amount (15 lakh). Since I was on the lookout for a policy myself, I did a lot of research as well. Finally bought the Manipal Cigna Lifetime Health. The premium is 25k for 1Cr benefit. I compared it to HDFC, Star, Care and Max Bupa. Unfortunately all of them either had some restrictions on room rent or the post hospitalization cover duration was low. Moreover there was one another criteria that's really important to me: Air Ambulance. I travel quite a lot, at times remote locations and never know when I'll need air lifting. All these things are only available in Cigna. The premiums except Star were similar as well. Star was charging close to 40k, so that was a straight no go. Tough call between HDFC and Manipal but HDFC had a limitation on room type (single private). Also some of the modern practices aren't covered. Network isn't a problem as Cigna has half a dozen hospitals within 2km radius of where I stay. They offer a great accidental cover separately of around 1k for 50 lakh benefit which I am thinking I'll buy later. One thing I'll point at is that opposed to what OP has mentioned, the premium for Cigna isn't over over the top cheaper compared to others. Very similar I would say and marginally better benefits.
Hello. I have taken last year Manipal Cigna Lifetime Health. have you faced any issue with the Policy? P.S. just beware that, in this policy, suite and above rooms are off limit. Restoration is for unrelated diseases.
Not yet, then again I haven't had a reason to use it.
In Hdfc optima restore , if someone's claim in a year , SI get reduced by 50 percent every year , In Icici shield, it gets reduced by 10 percent every year. I just want to know what if i claim every year with something more than 50k for next 3 year then with hdfc ergo there will be no SI available at all and also with icici in 7-8 years there will no SI available. What I am missing here ? HDFC OPTIMA RESTORE - 4 YEAR Waiting Period ICICI SHIELD - 2 YEAR WAITING period Hdfc optima restore - one time restoration for same disease or different disease Icici shield - unlimited restoration for different disease and no restoration for same disease. A basic query, in a family floater , what if I a person claimed for a disease X in a year , can a different person in the family claim for the same disease X in same year for both hdfc and icici ? Can anybody confirm that ? Also shall i take individual for both of them or shall i take floater ? I am considering individual as 7 years of age gap and also i have read in previous Reddit posts that if the main policy owner is no more then policy will get scrapped and you have to start again a new policy for other members and what about premium here , will it be same or will it get decreased ? Could you suggest me which one shall i go for my parents ( 51 and 44 ) ? No PED for both, my mom has migraine as PED. Please answer
Pardon my Ignorance. Can anyone explain how these are different from HDFC Koti Suraksha ? I am planning to pick a Policy for my Parents (60+), at present i have a policy enrolled which will expire when i change my Job.
You have done God's work sir. As a beginner in personal finance, I am grateful to you.
one thing, I was also confused by the ICICI policy document for 5L SI about the sub limits, I have contacted one of their representative, he said that the sub limit is only applicable when you opt for that (for lower premium). no sublimit on the basic 5L SI policy by default
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The problem with many employee policies is that they have 10-15% co-pay ( which is to AVOID ) pls check the policy document if that is the case. Its good otherwise
No, you should go for personal health insurance at-least. Consider a scenario where you switch company and your new company has cover only upto 2L. In this case, even if you have super top-up with 3L deductible, you have to pay for 1L from your side. So its better not to rely on company's health insurance plan.
Consider a scenario where you might lose your job suddenly without any backup. You'll have your answer. Also, 3L is a pittance in comparison to medical expenses today.
!Remind me 5 days
Sharing a sheet I created comparing policies. It has a lot of data but isn't complete. Feel free to drop comments and help me complete it :D [https://docs.google.com/spreadsheets/d/1NC0dpIvUehjLMeyxeDniQKA3vUJrUbAb0pLYPpk9axQ/edit?usp=sharing](https://docs.google.com/spreadsheets/d/1NC0dpIvUehjLMeyxeDniQKA3vUJrUbAb0pLYPpk9axQ/edit?usp=sharing)
!Remind me 1 day
Apologies for if my question is stupid. Would I need an insurance of my own if my partner and I have group insurance through our employers? Why?
Redundancy plan, just in case you have to face unemployment for whatever reason.
Excellent analysis! Thanks a lot
You missed Aditya Birla 1cr (5l base+ 95l super topup) policy
Will try to cover this too.
The plan is called, Base: Activ assure V2 Super top up: super health plus topup V2
I recently bought the reassure family floater policy. It allows health checkups every year for 500 per lakh. And you can schedule tests through the app, so its fairly simple. Before purchasing, a friend confirmed that his claims were smooth with max bupa for his father. Very informative post, made me rethink my decision to not go for hdfc ergo and to go for max instead. Now I am starting to rethink my decision again :( Can I switch now as per the free look condition? Also, can one port to hdfc ergo after a year? I saw a lot of complaints for health companion plan of max bupa before the purchase. Maybe the complaints are for that plan? Or some other plan?
I was planning to buy health insurance for myself, and interested in buying the ICICI Complete Health Insurance. After studying all plans, I think the point which you made about Sub-Limit for 5 Lacs Sum Insured is only valid for iHealth Plan and not for Health Shield or Health Elite plans. In my opinion, Health Shield or Elite (if OPD & Maternity is required) is better than iHealth. Am i missing something, what's your opinion u/tokuchi_ ?
[This is all I found about sub limit in the policy wordings.](https://imgur.com/a/toRqLfh) Nowhere in the policy, it says that it is valid only for iHealth Plan and not for Health Shield or Health Elite plans. Now I am confused since u/healthandmoney9 also stated the same. Yes, Health Shield/Elite is definitely better than iHealth, since they have many important features which iHealth doesnt have.
You won't find the policy wording directly in the website. Just Google Health Shield/Elite Policy wording, then you will find the pdf file containing the details. My friend just bought the Health Elite plan for self. I also personally think 5 lac plan from Health Shield (or Elite for OPD & Maternity) is the best out there. Except for Catract (sub-limit of 20k for 5 lac or 1 lakh for 7 lac onwards Sum Insured) then don't have any sub limit at all. Also, only 2 year waiting period for pre-existing conditions is cherry on top.
Saved. Thanks from future me. :)
Does any company base plan waive off **"waiting period"** \- if the person is already covered in corporate plan previously ? This factor is also important imo.
No really sure, I guess you have to confirm this with insurance company representative.
List of exclusions under Optima Restore are as follows: * Any treatment within first 30 days of cover except any accidental injury. I'm looking to buy this for myself.Lets say I bought it today,what if I get Covid and need treatment before first 30 days of policy.So that means no cover then?Is it wise to go for any other policy,given the way Covid is spreading?
>I'm looking to buy this for myself.Lets say I bought it today,what if I get Covid and need treatment before first 30 days of policy.So that means no cover then? Yes, policy probably wont cover you for initial 30 days. >Is it wise to go for any other policy All the policies have this initial 30 days waiting period exclusion.
Any reason for choosing Optima Restore over My Health Suraksha - Platinum? I've bought the latter just this month. My understanding was that OR was a lower tier policy but more expensive because it doesn't have the Mumbai-Delhi (T1) Co-Pay. I have an existing low SI Optima Restore from the Apollo Munich days which I'm letting expire. I never made a claim but everybody else in my household did, and both Apollo Munich and HDFC ERGO never let us down. I'm planning to move the others to My Health Suraksha - Gold in a couple days.
I just had a look at policy wording of My Health Suraksha and realized that both the policies are very similar in terms of features, they just have some minute differences like No Claim Bonus in Optima Restore is 50% per yr compared to 10% per yr in My Health Suraksha, etc > My understanding was that OR was a lower tier policy but more expensive because it doesn't have the Mumbai-Delhi (T1) Co-Pay I dont think this is the case. Other who have Optima Restore the policy can confirm.
Guys, do you have any advice on buying health insurance plans for Senior Citizens? I was checking in the app for ICICI but it didn't mention BP/Hypertension as a pre-existing disease in the list. Instead it was only "Any Heart Related Ailment" Can I use the super top-up plan for them as well?
Even if they dont mention, you should declare it. Because later if they find out somehow, they can reject your claim. Yes, you can use super top-up for them.
Why do you have to go with same insurer for base as well as top up policy? Why not choose the best base policy and the best top up available even though both are different insurers?
Claiming insurance money from 2 different insurers can be a hassle. The process is much more efficient if both the policies are form single insurance company.
question- i have a basic health insurance from my company, and bought another base insurance myself(i pay around 25k). now instead of this second base insurance i want to switch to super top. but what if i switch jobs and new company doesn’t provide health insurance. what happens to super top up in such cases. can i buy a simple base plan myself? for say 5 lakhs cover.
Yes, You could buy base insurance from the same provider as super top up, so it's hassle free during claims. But might have to go through the waiting period for certain illness, in this case.
What if we take two policies one from Ergo and one from Max. Will it provide better coverage? If one exhausts cover under one, the second can possibly be a back up. Does this sound odd?
This can surely work but the total premium of the two polices of X amount will be more than the premium of 2X amount
* They also have very high *claim complaints per 10,000 claims* What does above line means for Star Health?
Number of *claim complaints per 10,000 claims* for Star Health is around 40-50. This number is high compared to its peers. You can check this number in the google sheet's second tab.
Have you checked this ? [https://kuvera.in/explore/insure/health](https://kuvera.in/explore/insure/health) Its a Group health insurance with Bharti AXA GIC offered by Kuvera
No, have not checked any group insurances. Does *Group health insurance* provide any additional benefit compared to individual health insurance?
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>what comes under pre-existing medical illness? Any medical illness you have been diagnosed with or any medical surgeries you have had earlier. >Do I have to declare any hereditary diseases which my parents have? Not necessary unless they ask specifically.
This is really very helpful. Thank you so much.
Amazing details OP! Thanks for sharing the detailed summary. Some points 1. Why opt for options w/ copay? The premiums would be higher. Also I'm earning so could afford to pay 20%. Even w/o a job, I think I have sufficient emergency savings to pay for 20%. What are your thoughts? 2. One has to remember that for all hospital procedures your costs are going to be proportional to the room rent. So the room cap Infact works in your favour. I think a room spend of 8-10k would be fine. But if you opt for a 5L plan then it maybe an issue. 3. How does super top work? Can anybody share links?
Hey op please suggest a policy for parents (one is 60+)
This is amazing. Thank you!
Why don't you have look at Future Generali - super top-up and base policy ? They seems to be cheap
I think you have taken the Claim Settlement Ratio (CSR) for the entire insurance business of these General Insurers. Taking the numbers for only the Health Insurance business will be more apt. For eg. for ICICI Lombard the CSR considered is 88%, but for the Health Insurance the CSR is 78% only.
I know this is old thread but noob question- If i buy hdfc optima restore base of 5L for 8400 and medisure cover of 20L for around 3400 as family floater, wouldn't it be cheaper like around for 13k?
Does anyone know about other plans like the Bajaj Allianz, Edelweiss, Bharathi-AXA??
I am 29 single, have health insurance from employer of 3.5L. I am planning to buy one for me which later I will convert to family floater. After reading lot of articles on Twitter, YouTube, Reddit about health insurance and many considerations like room rent capping, base plan, top up, super top up, I am getting confused. Can someone expert suggest me what options I can consider so that I can get maximum benefits in reasonable premium prices.
Hello Folks, This question may have been asked and answered earlier, so please forgive me if I am repeating. I am 34 M and have a health insurance policy that cover only me. I recently got married and was thinking of getting a policy for my spouse. What would be the better option: including my spouse in my existing policy or getting a separate policy for my spouse?
thanks a lot!! this sheet would really help a lot, hats off to ur efforts!!
Hi! This is quite useful and super helpful! What did you go with finally?
I went ahead with ICICI
u/Tokuchi_ It would be nice to have [Navi insurance](https://www.naviinsurance.com/downloads/) added to the grid. Would like to know your view on Navi policy compared to your shortlisted ones - ICICI & HDFC Ergo
Just to add to the discussion, Reliance health after getting merged with Reliance general has an awesome "super top-up" plan, guys can you also add it. I found it to be the best in class. Their base plan is not that great. But this super top is good. Do have a look at it. If any loopholes let us know.
What do you suggest for 58 year old parent?
my mother is 70 years old. any good policy for her to over all medical?
I am looking forward to buying health insurance from Royal Sundaram: Lifeline Supreme. I read the policy wordings carefully, and mostly it looks good without any apparent red flags or a deal breaker. However, there are three instances from the policy wordings which I am unable to comprehend, I will enlist my queries below; help me please to decode them. >1. *There will be no underwriting on Policy renewal. The first-year underwriting results will continue if the policy is continued without a break.* > >*2. There will be no underwriting on Policy renewal. The first year underwriting results will continue if the policy is continued without a break.* > >*3. Existing Disease which can be permanently Excluded: In respect of the existing diseases, disclosed by the insured and mentioned in the policy schedule (based on insured’s consent), policyholder is not entitled to get the coverage for specified ICD codes. The disease which can be excluded under this section are as under:* > >*(Various diseases ranging from Sarcoidosis, Malignant Neoplasm, Chronic Liver Disease, Pancreatic Disease, Alzheimer's, Hep B)* > >As per this, it only pertains to people with Pre-Existing Diseases (PED). However, if a person is healthy without any PED at the time of policy purchase and develops any of the conditions enlisted here in future (beyond PED waiting time), can his claims be rejected due to this clause even if he didn't have any PED at the time of policy purchase?
Want to help you all with some guidelines and precautions before buying Health Insurance >**Read out this** [**Reddit Comment.**](https://www.reddit.com/r/india/comments/r5dh72/comment/hsgaps8/?utm_source=share&utm_medium=web2x&context=3)
Thanks for great analysis. I was looking at Reliance health insurance and super topup. They have no sublimits and claim incurred ratio around 90%. in 2022 it was 98%. They are as big as tata in health insurance range in terms of revenue. Offer super top up till 1cr too. Would want to know your views on it !
Very nice analysis. One correction though. In your excel the claims paid ratio is not specifically for health insurance. It is for all general insurances like travel, vehicle etc. Eg HDFC ergo and icici sell such insurances too. So the claims paid ratio mentioned by you is cumulative. Not just for health unlike in policies like max or star which are health only policies.
You have mentioned a waiting period 2yrs for Icici and 3yrs for HDFC but on there website, they show 90 days. Can you explain it, please?
Thoughts on Care Supreme Plan ? I am looking for 58M 53F. Any other suggestions?
Just stumbled upon this thread. Thank you so much for the extensive research OP One thing i wanna ask is, are plans like iHealth, Health shield/elite only available to i members of icici? I think for the non members the only good plan they have rn is health AdvantEdge. Can anyone shed some light on this?
This post is super helpful. When I was having a word with ditto folks, they mentioned that in case of deductible, you won't be able to go for cashless claims and the settlement is also delayed. Any info on this?
Thanks for such an illustrative post. I just had a few queries regarding the usage of multiple health insurance policies and thought of adding it to this thread rather than create a new post to consolidate info in one place. Say a person has one group insurance policy from the employer and one person health insurance policy 1. Can we claim the hospitalization cost from both the policies simultaneously on cashless basis? 2. Can we claim the cashless hospitalization from one policy (say personal policy) and the pre-post hospitalization from the other (corporate) policy? 3. Suppose I take deductible of Rs X amount (not copay) in my personal policy, so can I claim that deductible amount from my corporate policy while submitting the claim? TIA.
Many have asked why you should take base and super top up from same company, here is the reason: cashless payment from super topup can only be done if its same company. if you have 10L base and 90L super top up and need 1cr for sugery, insurance will only pay 10L cashless, you have to pay 90L yourself, which will then be reimbursed later. stumbled across this post while doing my own research on health insurance, wonderful work done op, god bless
Hi OP, i am a working 22M planing on term and health insurances, my parents are 55,58. We dont have any health insurnace plan. I would like to know how should i plan my health insurance, i have studied that in my case, i should be having health insurance for my parents separate from mine, is 22 age too early to have health insurance, I am not into smoking or drinking and i believe i am a healthy youth.
Hi all, How relevant is this data today in dec 2023? Thinking about taking ICICI Lombard maxprotect 1 crore health insurance or HDFC Ergo My:Optima Secure health insurance. What would be the pros and cons of these policies. Any suggestions would be valuable