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Introduction

Before we start comparing these two policies we have to set out some ground rules.

Both products are marketed by different insurance companies. Arogya Plus is sold by SBI and ProHealth Accumulate is sold by Manipal Cigna. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.

Second, we know that both products have subtle differences in their core structure. Arogya Plus is reasonably comprehensive. Sure, it doesn’t have all the bells and whistles, but it also doesn’t impose any mindless restrictions. ProHealth Accumulate, meanwhile, is a relatively expensive premium policy tailored to cover as many use cases as possible. So while the differences in features may be subtle, the pricing could be drastically different depending on the cover amount you pick.

And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?

That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.


Let’s start with Arogya Plus. The product comes from SBI’s stable:

SBI General Insurance Company Limited is a joint venture between the State Bank of India and Insurance Australia Group (IAG). The firm, which was founded in 2008, offers insurance products in the areas of auto, travel, home, and health.

However considering they are a part of India’s largest government-owned banking firm, you can expect a bit of dilly-dallying during the claims process. And their claim settlement ratio of 97% isn’t something to boast of either.


ProHealth Accumulate meanwhile comes from Manipal Cigna’s stable:

ManipalCigna Health Insurance Company is a collaborative partnership between Manipal Group and Cigna and together they have over 200 years of expertise in the healthcare business. And while the company has shown some potential recently, it still only corners a small part of the Indian market.

Also, they have a settlement ratio of 90% with more than 8,500+ network hospitals in tow.

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Insurance Parameters

Recommended
Not Recommended
Network hospitals
6,000+
8,500+
Claim settlement ratio

(avg. of last 3 years)

97%
90%
Co-payment

No

20%

(if purchased after turning 65)

Room rent

Any Room

Single Private room

Disease sub-limit

Yes

No

Pre existing diseases waiting

4 years

3 years

Pre/Post hospitalization

60/90 days

60/90 days

No claim bonus

5% per year

(up to 200%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(unlimited no. of times

for different illness)

Health check-up
Once every 3 years
Maternity

Available

(Up to Defined limits)

Out Patient Department

Up to ₹20,000

(Annually)

Day care

Feature Comparison

coPay

Co payment

With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Arogya Plus doesn’t impose a co-payment clause whereas ProHealth Accumulate requires you to co-pay a part of the bill 20% if you purchase after turning 65

roomRent

Room rent

If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, you can pick any room you want with Arogya Plus but ProHealth Accumulate only lets you stay in a single private room. Nothing fancy.

diseaseSublimit

Sub limits

Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, Arogya Plus imposes disease-wise sub-limits on Internal Congenital, Genetic Disorders, mental illness, modern treatments whereas ProHealth Accumulate doesn’t impose a disease wise sub-limit.

ped

Waiting periods for pre-existing diseases

If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. In this case, Arogya Plus imposes a waiting period of 4 years on pre-existing diseases while ProHealth Accumulate extends a waiting period of 3 years on existing conditions.

prePost

Pre and post Hospitalization expenses

Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Arogya Plus covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, ProHealth Accumulate covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits

ncb

No claim bonus

Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Arogya Plus doesn’t offer a no-claim bonus whereas ProHealth Accumulate offers a no-claim bonus.

domiciliary

Domiciliary

Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Arogya Plus offers domiciliary cover. And ProHealth Accumulate also coves domiciliary expenses.

ayush

Ayush treatments

Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Arogya Plus covers Ayush procedures and ProHealth Accumulate also extends coverage for Ayush treatments.

maternity

Maternity benefits

If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, however, Arogya Plus offers maternity cover whereas ProHealth Accumulate doesn’t offer protection for maternity-related hospitalizations.

opd

Out Patient Department (OPD)

Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Arogya Plus offers OPD coverage, and ProHealth Accumulate also offers OPD coverage, although the sub-limits may be different.

Final Conclusion

It should be obvious that ProHealth Accumulate offers better protection and extends a whole host of benefits that Arogya Plus simply doesn’t offer. But considering Manipal Cigna has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that SBI has to offer.

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