Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Family Medicare is sold by United India and ProHealth Plus 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 massive differences in their core structure. Family Medicare is quite basic. It offers little protection and may not be entirely suitable if you are looking for robust protection. However, ProHealth Plus is a premium policy tailored to cover as many use cases as possible. So in all honesty, you are 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 Family Medicare. The product comes from United India’s stable:
United India General Insurance company is an amalgamation of 22 different entities. The insurer has played an integral part in underwriting numerous government insurance schemes like - Maharashtra Government’s Mahathma Jyothiba Phule Jan Arogya Yojana Health Insurance Scheme (2020) & Prime Minister Suraksha Bima Yojana.
However, since it is a government-owned insurance firm, it’s not the most nimble insurance company out there.
ProHealth Plus 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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Compare Insurances Insurance Parameters Recommended Not Recommended |  Family Medicare |  ProHealth Plus |
|---|---|---|
| Network hospitals | 3,043 | 8,500+ |
| Claim settlement ratio (avg. of last 3 years) | 94% | 90% |
| Co-payment | 10% (if purchased after turning 61) | 20% (if purchased after turning 65) |
| Room rent | Any Room (up to 1% of sum insured) | Any Room (Except suite) |
| Disease sub-limit | No | No |
| Pre existing diseases waiting | 4 years | 3 years |
| Pre/Post hospitalization | 30/60 days | 60/180 days |
| No claim bonus | 10% 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 | Once every year |
| Maternity | Available (up to ₹25,000 after 4 years) | |
| Out Patient Department | Up to ₹2,000 (Annually) | |
| 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, both policies impose a co-payment clause if you’re hospitalized. Family Medicare imposes a co-payment of 10% whereas ProHealth Plus imposes a co-payment of 20% if you’re hospitalized
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, Family Medicare only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured, whereas ProHealth Plus lets you stay in any room except a Suite.
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 Family Medicare imposes disease-wise sub-limits nor does ProHealth Plus
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, Family Medicare imposes a waiting period of 4 years on pre-existing diseases while ProHealth Plus 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, Family Medicare covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, ProHealth Plus covers expenses incurred 60 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. In this case, however, Family Medicare doesn’t offer a no-claim bonus whereas ProHealth Plus offers a 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, Family Medicare doesn’t offer domiciliary protection whereas ProHealth Plus offers domiciliary cover.
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, Family Medicare covers Ayush procedures and ProHealth Plus 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, Family Medicare doesn’t offer protection for maternity-related hospitalizations whereas ProHealth Plus 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, Family Medicare doesn’t offer OPD protection whereas ProHealth Plus offers OPD cover.
Final Conclusion
Since this isn’t a fair comparison, to begin with, we will only tell you this much. If you want something that’s affordable, you could go for Family Medicare. However, if you want top-class protection, then it’s a no brainer, ProHealth Plus is your go-to option.
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