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Introduction

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

Both products are marketed by different insurance companies. Health Gain is sold by Star Health 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 massive differences in their core structure. Health Gain is specifically designed for those seeking outpatient coverage. However, Health Premia Gold is a premium policy built for people who want to leave no stone unturned when it comes to their health. It’s expensive and it does pretty much everything you expect a good policy to do. 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 Health Gain. 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 14,000+ hospitals and a decent claim settlement ratio of 83%.


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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Insurance Parameters

Recommended
Not Recommended
Network hospitals
14,000+
10,000+
Claim settlement ratio

(avg. of last 3 years)

83%
91%
Co-payment

20%

(if purchased after turning 61)

No

Room rent

Any Room

(up to 1% of sum insured)

Any Room

(Except suite)

Disease sub-limit

Yes

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 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for any illness)

Health check-up
Once every year
Maternity

Available

(up to ₹70,000 after 2 years)

Out Patient Department

Available

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 Gain requires you to co-pay a part of the bill 20% if you purchase after turning 61 whereas Health Premia Gold doesn’t impose a co-payment clause

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 Gain only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured, whereas Health Premia Gold lets you stay in any room except a Suite.

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 Gain imposes disease-wise sub-limits on Cataracts, Modern Treatments whereas Health Premia Gold doesn’t impose a disease wise sub-limit.

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 Gain 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.

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 Gain 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

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 Gain doesn’t offer a no-claim bonus whereas Health Premia Gold offers a no-claim bonus.

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, Health Gain doesn’t offer domiciliary protection whereas Health Premia Gold offers domiciliary cover.

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 Gain covers Ayush procedures and Health Premia Gold 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 Gain doesn’t offer protection for maternity-related hospitalizations whereas Health Premia Gold 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, Health Gain offers OPD cover whereas Health Premia Gold doesn’t offer OPD protection.

Final Conclusion

It should be obvious by now. Health Premia Gold is packed with features, while Health Gain is specifically meant for those seeking outpatient coverage. 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 Niva Bupa (erstwhile Max Bupa) has to offer, if the policy is made available to you.

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