It’s all about PACKAGE! From travel plans to surgical procedures, wedding planning to website development, design and launch - everything comes in attractive PACKAGES that are alluring for the target pool.
The appeal of the concept lies in the fact that an individual when seeking such products and services need not look for any of the auxiliary products and/or services. A single package is an umbrella product for all related services.
The same works with health insurance as well - comprehensive health insurance plans that would cater to all related yet diverse healthcare requirements of a policyholder. But is that all? Is that all comprehensive plans are?
Well, we say NO! There’s a lot more than what meets the eye. True that these policies come with some serious leverage that is enough to have transformed it into a flagship product for the health insurance industry. However, no financial product comes without its version of a “thorn” and such is true for this one too. Additionally, with so many products of comprehensive health insurance available across the market, how do you determine which is the best one? How do these plans stand apart from their regular counterpart?
Read on - to know more about the comprehensive policy that you seek, so that you can make an informed decision when choosing your perfect tailored product that offers diverse coverage in all its efficiency.
Benefits of Comprehensive Health Insurance
A comprehensive health insurance policy is a blanket or catch-all financial product that
- offers coverage for a diverse range of healthcare treatments, expensive treatments/ procedures, and various medical expenses,
- is offered to both single policyholders and/or their families, and
- carries a lifelong renewability option.
What Does A Comprehensive Health Insurance Plan Cover?
With such umbrella plans from the best health insurance providers, policyholders have the unique advantage of never needing another policy to cover their health treatment requirements. The coverage offered via the policies is so extensive and the sum insured is so substantial that it meets any and almost all health requirements of policyholders.
Here is a look at the estimated coverage offered by such comprehensive health insurance plans -
I. IN-PATIENT HOSPITALISATION
Like any standard health insurance policy, with the comprehensive variant, policyholders have in-patient hospitalisation treatment/procedure funded via the plan. Considering the high medical inflation rates of recent times, and the sizeable sum insured - the comprehensive policies are the best suited for policyholders and their regular hospitalisation expenses.
II. OUTPATIENT CONSULTATION COVERAGE
While the general health insurance policies take care of the in-hospitalisation expenses, there is still the concern of how one has to dig into their pockets to fund doctor consultation fees, second opinions, pharmacy bills, etc. Since these medical costs are incurred sans hospitalisation, the standard policies are not liable to fund them.
However, even without hospitalisation, such medical treatments do not leave a less financial footprint on the face of one’s savings. To meet this specific requirement, comprehensive policies are the best way out since they offer outpatient (OPD) coverage.
III. DAYCARE PROCEDURES
Comprehensive health insurance policies also fund treatments and medical procedures like
- Dialysis
- Radiotherapy
- Angiography,
- Cataract surgery, etc. -that require less than 24 hours of hospitalisation. Such ailments and their treatment procedures though less time-consuming are often expensive enough to burn a hole in the pocket of a policyholder. Under such circumstances, funding earned from the best health insurance plans comes to proper use.
IV. MODERN TREATMENT COVERAGE
Modern and alternate methods of treatment are gaining rapid popularity. However, the charges for such treatment channels are pretty high-end. To ensure convenient accessibility to such treatments, modern treatment coverage is offered via comprehensive health insurance plans.
P.S.: Please remember that even with the best health insurance plans, modern treatment coverage always comes with a disease-wise sub-limit that is majorly capped at INR 1 lakh.
V. DOMICILIARY HOSPITALISATION
Domiciliary hospitalisation is an essential requirement that is often embedded as a feature in regular and comprehensive health insurance policies. A perk that allows optimum funding for home-based medical treatments in case there are no hospital beds available or the policyholder is unable to go to the hospitals and get admitted.
VI. PRE & POST-HOSPITALISATION
In the case of both standard and comprehensive health insurance policies, you can expect to find coverage for pre and post-hospitalisation expenditures. This might include follow-up visits to the doctor, tests, pharmacy bills, and more. Often the best health insurance plans are chosen based on the number of days that are covered via the pre and post-hospitalisation feature of a policy.
VII. PRE-EXISTING AILMENTS
Pre-existing medical conditions often influence -
- The policy premium
- Loading charges
- If the policy application is accepted or rejected
- Waiting period
With the best comprehensive health insurance policies from reputed insurers, you, as a policyholder, might enjoy the perks of a mitigated waiting period and acceptance of a policy proposal despite having severe pre-existing medical conditions. This is a rare find in the case of standard health insurance plans and hence, with a comprehensive variant, policyholders with pre-existing ailments hold a severe perk.
VIII. ADD-ON COVERS
Health insurance policies are as vital to a policyholder as their optional supplements of health insurance add-ons. These riders ensure the absolute customisation of the plans that best suit the medical requirements of individual policyholders. With the best comprehensive health insurance policies, one can expect a buffet of health insurance riders like -
1.HOSPITAL CASH - A substantial amount that is offered to the family of the hospitalised policyholder that would help them meet their daily expenses considering that they are down a family member, who may or might not be the sole breadwinner of the family. This rider is a financial perk more for the family members of the hospitalised policyholder, than the policyholder himself/herself.
P.S.: There might be an associated clause in this amount disbursal that requires the policyholder to be hospitalised for a certain number of days at a stretch.
2. MATERNITY & NEWBORN BABY COVER - A health insurance rider that covers any and all medical treatments for prenatal, post-natal, and delivery conditions. At times, such add-ons also cover the medical treatment charges involved in treating a newborn.
P.S.: The maternity and newborn baby coverage rider comes with an extensive waiting period and often beckons a substantial loading charge on a policy that leads to a serious premium spike.
3. AYUSH TREATMENT - With the standard health insurance policy, Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy or AYUSH coverage is sometimes available.
However, some policyholders, especially senior citizens, at times look forward to alternate medical channels of treatment in the hope of finding medical cures with lower or no side effects. In such cases, the AYUSH treatment riders become pretty effective (Unless your comprehensive health insurance plan already has the AYUSH coverage in its features, of course.)
4. CONSUMABLE COVERAGE/INFLATION SHIELD/NO-CLAIM BONUS SHIELD - One of the best health insurance add-ons that can be availed with comprehensive health plans is that of Protector riders - a package of 3 perks - no-claim bonus shield, consumable coverage, and inflation shield. This rider is not just a financial boost, but also a medical one - one that is extremely beneficial for the policyholders.
IX. AMBULANCE CHARGES
Whether it’s a road or air ambulance, the help doesn’t come cheap. Policyholders who are already facing an emergency, possibly fatal or near-fatal situation, should not need to worry about such urgent financial payoffs. With a comprehensive health insurance policy in play, such auxiliary medical charges are taken care of.
P.S.: Please remember,
- Ambulance coverage in health insurance plans, no matter if it's standard or comprehensive, comes with a cap that may extend from INR 2,000 to INR 20,000.
- With air ambulances, there might be certain clauses of emergency-only situations. Make sure to go through the health insurance policy document carefully to ensure that you don’t fall into such loopholes and get covered for the charges.
X. SECOND OPINION CHARGES
Imagine getting a diagnosis of a critical ailment or being advised to undergo complicated surgery. Wouldn’t you seek out a second medical opinion? That wouldn’t exactly be pocket-friendly now, right? I mean you are looking at renewed diagnostic tests, medicines, scans, pharmacy bills, and more.
Comprehensive health insurance policies often offer policyholders the optimum funding that offers coverage for such second opinions and the subsequent treatment, tests, and more.
XI. ORGAN DONOR CHARGES
Organ transplantation is a major treatment that in no way is cheap and yet it is a much-needed surgery that is unavoidable when circumstances call for it. Taking this into account and the reason why individuals are motivated to avail of health insurance plans, especially the comprehensive variant, organ transplantation coverage is offered.
However, be mindful of whether the coverage comes with a capped amount and if both the receiver and the donor of the organ are covered for their transplantation.
XII. ANNUAL HEALTH CHECKUP
Comprehensive health insurance plans fund diverse expenditures involved in medical tests and health check-ups. With an active health insurance plan coverage, annual health checkups are also funded. This helps policyholders stay ahead of any ailments that they might have contracted over a year at minimal or no charges via annual health checkups.
XIII. CRITICAL ILLNESS TREATMENT
Some comprehensive health insurance policies offer funds for treatments of critical ailments like cancer, stroke, paralysis, etc. This is a huge step up considering that in the case of potential policyholders with critical ailments -
- Firstly, getting a health insurance policy becomes close to impossible, and
- Secondly, even if they manage to avail of a plan, the premium is sky-high
So, when a policyholder opts for a comprehensive health insurance policy that ensures critical ailment coverage and one that comes with a substantial sum insured, that’s a major perk.
You must have noticed by now that in some of the features mentioned above we have said that both regular and comprehensive plans offer them. So, then what’s the difference between the two? Who holds the better perks here? Let’s find out!
What is the Difference Between Regular and Comprehensive Health Insurance Policies?
| PARAMETERS | STANDARD HEALTH INSURANCE PLANS | COMPREHENSIVE HEALTH INSURANCE PLANS |
|---|---|---|
| SCOPE OF COVERAGE | The scope of coverage is limited to strictly medical expenses - basic diagnostic tests, doctor’s fees, etc. Specialised treatments, funding for preventive care, etc. are not actually covered in the standard plans. | With comprehensive policies, the scope of coverage is extensive and much diverse. Surgeries, medical procedures, preventive care, diagnostic tests, and at times vision and dental tests are also funded. |
| OUT-OF-POCKET EXPENSES | A lower scope of coverage accompanied by higher shots at copayment, deductible, and coinsurances indicate higher spending from one’s savings. | Comprehensive coverage ensures that policyholders don’t end up spending much from their pockets since the health insurer covers a majority. |
| NETWORK HOSPITALS | With the best health insurers, the network hospitals are well spread out. | Compared to the standard health insurance policies, the comprehensive variant holds a more extensive network of hospitals that are staffed with specialists. |
| PREMIUMS | Limited coverage in the regular variant suggests comparatively lower premiums. | Extensive coverage in the comprehensive variant requires the need for a higher premium that needs to be paid off by policyholders. |
Comprehensive Health Insurance Policy in India
Please remember, when seeking a comprehensive health insurance plan, you are looking at a policy that offers funding right from the time an ailment is detected to the time the policyholder gets cured. So there have to be some specific parameters that will help you decide the best comprehensive health insurance policies.
| PARAMETERS | HDFC ERGO Optima Secure | NIVA BUPA ReAssure 2.0 Platinum+ | Care Care |
|---|---|---|---|
| PRE-EXISTING AILMENTS COVERAGE | 3 years waiting period applicable | 3 years waiting period applicable | 4 year waiting period is applicable |
| FREE ANNUAL HEALTH CHECK-UPS | ✓ | ✓ | ✓ |
| ORGAN TRANSPLANTATION COVERAGE | Donor is covered | The donor is covered, but only when the hospitalisation claim is paid. The recipient’s harvesting charges are covered. | Donor is covered |
| PRE AND POST-HOSPITALISATION COVERAGE | 60/ 180 days | 60/ 180 days | 30/ 60 days |
| AMBULANCE CHARGES | ROAD: Up to Sum Insured AIR: Up to INR 5 L, but only in emergencies. | ROAD: Up to Sum Insured AIR: Up to INR 2.5 L, but only in emergencies. | ✓ |
| AYUSH TREATMENT COVERAGE | ✓ | ✓ | ✓ |
Wrapping Up
Choosing a health insurance policy is no easy feat, neither is it a small financial decision. However, in case there are not too many health complications, a comprehensive variant may prove to be the best possible way out because of the umbrella coverage nature of the plans.