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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 Insurance Gold and Health Insurance 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 have subtle differences in their core structure. Health Insurance Gold is reasonably comprehensive. Sure, it doesn’t have all the bells and whistles, but it also doesn’t impose any mindless restrictions. Health Insurance Platinum, 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.

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Insurance Parameters

Recommended
Not Recommended
Network hospitals
6,200+
6,200+
Claim settlement ratio

(avg. of last 3 years)

92%
92%
Co-payment

20%

(if purchased after turning 61)

20%

(if purchased after turning 61)

Room rent

Single Private room

Single Private room

Disease sub-limit

No

No

Pre existing diseases waiting

3 years

2 years

Pre/Post hospitalization

60/90 days

90/180 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 different illness)

100% restoration

(once for different illness)

Health check-up
Once every year
Once every year
Maternity

Available

(up to ₹50,000 after 4 years)

Available

(up to ₹2,00,000 after 4 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, both policies impose a co-payment clause if you’re hospitalized. Health Insurance Gold imposes a co-payment clause of 20% if you purchase after turning 61. Health Insurance Platinum also imposes a similar co-payment of 20% if you purchase after turning 61.

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 Insurance Gold lets you stay in a single private room and Health Insurance Platinum also lets you stay in a single private room. Nothing fancy.

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, neither Health Insurance Gold imposes disease-wise sub-limits nor does Health Insurance Platinum

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 Insurance Gold imposes a waiting period of 3 years on pre-existing diseases while Health Insurance Platinum 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 Insurance Gold covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Health Insurance Platinum 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. And in this case, Health Insurance Gold offers a no-claim bonus of 50% and Health Insurance Platinum similarly extends a 50% 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 Insurance Gold offers domiciliary cover. And Health Insurance Platinum 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, Health Insurance Gold covers Ayush procedures and Health Insurance 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, Health Insurance Gold offers maternity cover and Health Insurance Platinum offers maternity cover too, although the sub-limits for normal delivery and C-section procedures may be different, including the waiting period.

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 Insurance Gold extends coverage for outpatient consultations, nor does Health Insurance Platinum.

Final Conclusion

It depends on your budget. Health Insurance Gold is relatively more affordable when you compare the common use cases but Health Insurance Platinum obviously offers better protection, since it offers a whole host of benefits that Health Insurance Gold simply doesn’t offer. So yeah, depending on the use case you’re trying to optimize for, you can make a choice.

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