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Introduction

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

For starters, both policies, Health Ensure Family Plan and Health Guard Platinum are marketed by the same insurance company. So in some ways, a lot of the differences within the product will be limited to the features themselves.

Second, we know that both products are quite basic in their structure. They offer modest protection and aren’t comprehensive enough to cover a wide array of use cases. So if you are looking for something more robust, then both these policies may not cut it.

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.

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Insurance Parameters

Recommended
Not Recommended
Network hospitals
8,000+
8,000+
Claim settlement ratio

(avg. of last 3 years)

95%
95%
Co-payment

No

No

Room rent

Any Room

(up to 1% of sum insured)

Single Private 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

5% per year

(up to 25%)

50% per year

(up to 150%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for different illness

after complete exhaustion of sum insured)

Health check-up
Once every 3 years
Once every 2 years
Maternity

Available

(up to ₹25,000 after 6 years)

Out Patient Department
Day care

Feature Comparison

coPay

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, Health Ensure Family Plan doesn’t impose a co-payment clause. And neither does Health Guard Platinum.

roomRent

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, Health Ensure Family Plan only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured and Health Guard Platinum lets you stay in a single private room. In effect, both policies impose restrictions on the kind of room you can pick.

diseaseSublimit

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, Health Ensure Family Plan imposes disease-wise sub-limits on null whereas Health Guard Platinum imposes sub-limits on null

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, Health Ensure Family Plan imposes a waiting period of 2 years on pre-existing diseases while Health Guard Platinum extends a waiting period of 3 years on existing conditions.

prePost

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, Health Ensure Family Plan covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Health Guard Platinum 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. In this case, however, Health Ensure Family Plan offers a no-claim bonus of 5% whereas Health Guard Platinum offers a no-claim bonus of 50%. And the no-claim bonus may be capped at different levels too.

domiciliary

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, neither Health Ensure Family Plan offers domiciliary cover nor does Health Guard Platinum

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, Health Ensure Family Plan covers Ayush procedures and Health Guard Platinum 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, Health Ensure Family Plan doesn’t offer protection for maternity-related hospitalizations whereas Health Guard Platinum offers maternity cover.

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, neither Health Ensure Family Plan extends coverage for outpatient consultations, nor does Health Guard Platinum.

Final Conclusion

After considering all the features on hand, we believe that Health Guard Platinum is a better alternative to Health Ensure Family Plan for most use cases that we’ve evaluated so far.

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