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 Medicare is sold by TATA AIG. 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. Comprehensive is reasonably comprehensive. Sure, it doesn’t have all the bells and whistles, but it also doesn’t impose any mindless restrictions. Medicare, 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 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%.


Medicare meanwhile comes from TATA AIG’s stable:

Tata AIG Health Insurance company is a joint venture between the Tata Group and American International Group. It was founded in 2001 and it’s one of the few companies that market products that are truly comprehensive, albeit expensive.

The company also boasts a claim settlement ratio of 88.53% with over 7,200 network hospitals across India.

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Compare Insurances

Insurance Parameters

Network hospitals
14,000+
10,000+
Claim settlement ratio

(avg. of last 3 years)

82.01%
89.07%
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

3 years

Pre/Post hospitalization

60/90 days

60/90 days

No claim bonus

50% per year

(up to 100%)

50% 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 2 years
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 requires you to co-pay a part of the bill 10% if you purchase after turning 61 whereas Medicare doesn’t impose a 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 Medicare.

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 Medicare

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. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Comprehensive imposes a 3 year waiting period on pre-existing diseases and Medicare will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases

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, Medicare 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. And in this case, Comprehensive offers a no-claim bonus of 50% and Medicare similarly extends a 50% no-claim bonus.

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. And Medicare 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, Comprehensive covers Ayush procedures and Medicare 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, Comprehensive offers maternity cover whereas Medicare 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 Medicare doesn’t offer OPD protection.

Final Conclusion

It should be obvious that Medicare offers better protection and extends a whole host of benefits that Comprehensive simply doesn’t offer. 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 TATA AIG has to offer.

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