Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Complete Healthcare Basic is sold by Universal Sompo and Health Premia Gold is sold by Max Bupa. 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. Complete Healthcare Basic is reasonably comprehensive. Sure, it doesn’t have all the bells and whistles, but it also doesn’t impose any mindless restrictions. Health Premia Gold, 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 Complete Healthcare Basic. The product comes from Universal Sompo’s stable:
Universal Sompo General Insurance Company is a public-private venture floated by two nationalized banks (Indian Overseas Bank and Allahabad Bank), one private bank (Karnataka Bank), an FMCG giant (Dabur Investment Corporation), and a well-known Japanese insurance firm (Sompo Japan Nipponkoa Insurance Incorporation).
The insurer also sells 135 IRDAI approved products and boasts over 5,000 network hospitals with a claim setllement ratio of 95%. Needless to say, the company isn’t exactly stellar when it comes to processing claims.
Health Premia Gold meanwhile comes from Niva Bupa (erstwhile Max Bupa)’s stable:
Founded in 2008, Niva Bupa (erstwhile Max Bupa) is one of the leading health insurance companies in India. While they have had a bit of a tumultuous time with their promoters, they still sell an impressive suite of products across multiple categories.
And they also boast a claim settlement ratio of 91%, with a network of more than 10,000+ hospitals.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Complete Healthcare Basic |  Health Premia Gold |
|---|---|---|
| Network hospitals | 5,000+ | 10,000+ |
| Claim settlement ratio (avg. of last 3 years) | 95% | 91% |
| Co-payment | No | No |
| Room rent | Any Room | Any Room (Except suite) |
| Disease sub-limit | No | No |
| Pre existing diseases waiting | 3 years | 2 years |
| Pre/Post hospitalization | 30/60 days | 90/180 days |
| No claim bonus | 10% per year (up to 50%) | 10% per year (up to 100%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness) | 100% restoration (once for any illness) |
| Health check-up | Once every 2 years | Once every year |
| Maternity | Available (up to ₹70,000 after 2 years) | |
| Out Patient Department | Up to ₹2,500 | |
| 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, Complete Healthcare Basic doesn’t impose a co-payment clause. And neither does Health Premia Gold.
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 Complete Healthcare Basic but Health Premia Gold only lets you pick a room so long as it isn’t a Suite room.
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, neither Complete Healthcare Basic imposes disease-wise sub-limits nor does Health Premia Gold
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, Complete Healthcare Basic imposes a waiting period of 3 years on pre-existing diseases while Health Premia Gold extends a waiting period of 2 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, Complete Healthcare Basic covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Health Premia Gold covers expenses incurred 90 days before hospitalization and expenses incurred 180 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. And in this case, Complete Healthcare Basic offers a no-claim bonus of 10% and Health Premia Gold similarly extends a 10% no-claim bonus.
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, Complete Healthcare Basic offers domiciliary cover. And Health Premia Gold 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, Complete Healthcare Basic covers Ayush procedures and Health Premia Gold 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, however, Complete Healthcare Basic doesn’t offer protection for maternity-related hospitalizations whereas Health Premia Gold offers maternity cover.
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, Complete Healthcare Basic offers OPD cover whereas Health Premia Gold doesn’t offer OPD protection.
Final Conclusion
It depends on your budget. Complete Healthcare Basic is relatively more affordable when you compare the common use cases but Health Premia Gold obviously offers better protection, since it offers a whole host of benefits that Complete Healthcare Basic simply doesn’t offer. So yeah, depending on the use case you’re trying to optimize for, you can make a choice.
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