Introduction

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

Both products are marketed by different insurance companies. Comprehensive is sold by Star Health and Energy Gold is sold by HDFC Ergo. 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. Comprehensive is quite comprehensive. It offers considerable protection and it doesn’t impose as many restrictions. However, Energy Gold is specifically designed for people suffering from diabetes/hypertension. 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 Comprehensive. The product comes from Star Health’s stable:

Star Health Insurance is India's first standalone health insurance firm. And with an army of retail advisors pushing their products across the country, they’ve managed to capture a fair share of the Indian market.

The company also boasts a network of over 13,000+ hospitals and a decent claim settlement ratio of 83.07%.


Energy Gold meanwhile comes from HDFC Ergo’s stable:

Founded in the year 2002, the company is a joint venture between India’s HDFC and Germany’s ERGO International AG. It offers policies across motor, travel, health and other sectors. And it also happens to be one of the largest insurers in the country.

More importantly, HDFC Ergo boasts a claim settlement ratio of 97.55%, with a network of 11,300+ hospitals

All in all, an impressive resume.

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Insurance Parameters

Network hospitals
14,000+
11,300+
Claim settlement ratio

(avg. of last 3 years)

82.01%
97.5%
Co-payment

10%

(if purchased after turning 61)

No

Room rent

Single Private room

Any Room

Disease sub-limit

No

No

Pre existing diseases waiting

3 years

2 years

Pre/Post hospitalization

60/90 days

30/60 days

No claim bonus

50% per year

(up to 100%)

10% per year

(up to 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for any illness

after complete exhaustion of sum insured)

100% restoration

(once for any illness)

Health check-up
Once every year
Once every year
Maternity

Available

(up to ₹20,000 after 2 years)

Out Patient Department

Up to ₹1,200

(cap of ₹300 on each consultation)

Day care

Feature Comparison

co_pay

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, Comprehensive imposes a co-payment clause of 10% if you purchase after turning 61 whereas Energy Gold doesn’t impose a mandatory co-payment clause.

room_rent

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, Comprehensive only lets you stay in a single private room but you can pick any room you want with Energy Gold.

disease_sublimit

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 Comprehensive imposes disease-wise sub-limits nor does Energy Gold

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, Comprehensive imposes a waiting period of 3 years on pre-existing diseases while Energy Gold extends a waiting period of 2 years on existing conditions.

pre_post

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, Comprehensive covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Energy Gold covers expenses incurred 30 days before hospitalization and expenses incurred 60 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, Comprehensive offers a no-claim bonus of 50% whereas Energy Gold offers a no-claim bonus of 10%. And the no-claim bonus may be capped at different levels too.

domiciallary

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, Comprehensive offers domiciliary cover whereas Energy Gold doesn’t offer domiciliary protection.

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 Comprehensive covers Ayush treatments whereas Energy Gold doesn’t extend 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, Comprehensive offers maternity cover whereas Energy Gold 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, Comprehensive offers OPD cover whereas Energy Gold doesn’t offer OPD protection.

Final Conclusion

If you’re specifically looking to buy a policy for people suffering from diabetes/hypertension, Energy Gold makes a lot of sense. But considering Star Health has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that HDFC Ergo has to offer, if the policy is made available to you.

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