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 Insurance Platinum is sold by Zuno (erstwhile Edelweiss) 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 policies are premium. They offer comprehensive protection, throw in a whole host of benefits and cover a whole host of use cases. So if you are looking for something relatively inexpensive, 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.
Let’s start with Health Insurance Platinum. The product comes from Zuno (erstwhile Edelweiss)’s stable:
Zuno (erstwhile Edelweiss) Health Insurance company was founded in 2017 when they were hived off the homegrown Edelweiss Financial Services Limited. The company provides an array of products across multiple categories and they boast a claim settlement ratio of almost 92% with more than 6,200 network hospitals.
The only problem is - They’re still trying to find a firm foothold in the market.
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 96% with over 10,000 network hospitals across India.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Medicare | |
|---|---|---|
| Network hospitals | 6,200+ | 10,000+ |
| Claim settlement ratio (avg. of last 3 years) | 92% | 96% |
| Co-payment | 20% (if purchased after turning 61) | No |
| Room rent | Single Private room | Any Room |
| Disease sub-limit | No | No |
| Pre existing diseases waiting | 2 years | 3 years |
| Pre/Post hospitalization | 90/180 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 different illness) | 100% restoration (once for any illness) |
| Health check-up | Once every year | Once every 2 years |
| Maternity | Available (up to ₹2,00,000 after 4 years) | |
| Out Patient Department | ||
| 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, however, Health Insurance Platinum requires you to co-pay a part of the bill 20% if you purchase after turning 61 whereas Medicare doesn’t impose a co-payment clause
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 Platinum only lets you stay in a single private room but you can pick any room you want with Medicare.
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 Platinum imposes disease-wise sub-limits nor does Medicare
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 Platinum imposes a waiting period of 2 years on pre-existing diseases while Medicare 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, Health Insurance Platinum covers expenses incurred 90 days before hospitalization and expenses incurred 180 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
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 Platinum offers a no-claim bonus of 50% and Medicare similarly extends a 50% 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, Health Insurance Platinum offers domiciliary cover. And Medicare also coves domiciliary expenses.
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 Platinum covers Ayush procedures and Medicare 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, Health Insurance Platinum offers maternity cover whereas Medicare doesn’t offer protection for maternity-related hospitalizations.
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 Platinum extends coverage for outpatient consultations, nor does Medicare.
Final Conclusion
After considering all the features on hand, we believe that Medicare is a better alternative to Health Insurance Platinum for most use cases that we’ve evaluated so far.
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