Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Care Heart is sold by Care and Individual Health Protector is sold by Iffco Tokio. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have massive differences in their core structure. Care Heart is specifically designed for people suffering from heart ailments. However, Individual Health Protector is quite basic. It offers little protection and it’s a generic policy that anybody could pick off the shelf. So in many ways, you’re comparing apples and oranges here.
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 Care Heart. The product comes from Care’s stable:
Care Health Insurance (formerly Religare Health Insurance) was founded in 2012. And in that time, they’ve managed to corner a large part of the Indian Insurance market.
What’s more impressive?
Care Health Insurance has a remarkable claim settlement ratio of 90% and a network of more than 11,400+ hospitals.
Individual Health Protector meanwhile comes from Iffco Tokio’s stable:
Iffco Tokio is a joint venture between Indian Farmers Fertiliser Cooperative Limited (IFFCO), a government-owned fertilizer company, and Japan-based Tokio Marine Group. They have a sizable presence in many rural markets, however, their presence in urban areas isn't exactly extraordinary.
The company has a network of over 7,000 hospitals and its CSR ratio isn’t useful, since they have been settling a lot of pending claims from last year.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Care Heart |  Individual Health Protector |
|---|---|---|
| Network hospitals | 11,400+ | 7,000+ |
| Claim settlement ratio (avg. of last 3 years) | 90% | 95% |
| Co-payment | 20% | No |
| Room rent | Single Private room | Any Room |
| Disease sub-limit | Yes | Yes |
| Pre existing diseases waiting | 2 years | 3 years |
| Pre/Post hospitalization | 30/60 days | 60/90 days |
| No claim bonus | 10% per year (up to 50%) | 25% per year (up to 100%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness) | 100% restoration (unlimited no. of times for any illness) |
| Health check-up | Once every year | Once every 2 years |
| Maternity | ||
| Out Patient Department | ||
| Day care |
Feature Comparison
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, Care Heart imposes a co payment of 20% if you're under the age of 70 and 30% if you're 71 and above whereas Individual Health Protector doesn’t impose a co-payment clause.
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, Care Heart only lets you stay in a single private room but you can pick any room you want with Individual Health Protector.
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, Care Heart imposes disease-wise sub-limits on Knee Replacement, Hernia, Hysterectomy, Benign Prostate, Treatment of Cerebrovascular disorders, Treatment of Cancer whereas Individual Health Protector imposes sub-limits on Modern treatments
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, Care Heart imposes a waiting period of 2 years on pre-existing diseases while Individual Health Protector extends a waiting period of 3 years on existing conditions.
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, Care Heart covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Individual Health Protector covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits
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, Care Heart offers a no-claim bonus of 10% whereas Individual Health Protector offers a no-claim bonus of 25%. And the no-claim bonus may be capped at different levels too.
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, Care Heart offers domiciliary cover. And Individual Health Protector also coves domiciliary expenses.
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, Care Heart covers Ayush procedures and Individual Health Protector also extends coverage for Ayush treatments.
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, neither Care Heart offers maternity cover nor does Individual Health Protector.
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, neither Care Heart extends coverage for outpatient consultations, nor does Individual Health Protector.
Final Conclusion
If you’re specifically looking to buy a policy for people suffering from heart ailments, Care Heart makes a lot of sense. But considering Care has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that Iffco Tokio has to offer, if the policy is made available to you.
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