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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 of Privileged Elders is sold by Oriental Insurance and iHealth is sold by ICICI Lombard. 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 of Privileged Elders is specifically designed for senior citizens. However, iHealth is quite basic. It offers little protection and it’s a generic policy that anybody could pick off the shelf. 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 of Privileged Elders. The product comes from Oriental Insurance’s stable:

Oriental Insurance is a government-owned company that offers health, vehicle, business, and farmer insurance. The company is a fully-owned component of the Oriental Government Security Life Assurance Company Ltd.

Now because it is a government-owned insurance firm, you can’t expect operational efficiencies across the board. Although, the company does boast a fairly high claim settlement ratio with over 3,264 network hospitals across the country.


iHealth meanwhile comes from ICICI Lombard’s stable:

ICICI Lombard Health Insurance company is a joint venture between India's ICICI Bank and Canada's Fairfax Holdings. They are one of the leading insurance companies with over 270 branches spread across India.

However, with a claim settlement ratio of 85% and a measly network of 7,500+ hospitals, their performance needs significant improvement.

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Insurance Parameters

Recommended
Not Recommended
Network hospitals
3,264
7,500+
Claim settlement ratio

(avg. of last 3 years)

96%
85%
Co-payment

20%

No

Room rent

Any Room

(up to 1% of sum insured)

Any Room

Disease sub-limit

Yes

No

Pre existing diseases waiting

2 years

2 years

Pre/Post hospitalization

30/60 days

30/60 days

No claim bonus

10% per year

(up to 50%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for different illness)

Health check-up
Once every year
Once every year
Maternity
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 of Privileged Elders imposes a mandatory co-payment of 20% . And iHealth 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 of Privileged Elders only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured but you can pick any room you want with iHealth.

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 of Privileged Elders imposes disease-wise sub-limits on Accident Injury, Knee Replacement, Cardio Vascular Diseases, Chronic Renal Failure, Cancer, Hepato-Biliary Disorders, Chronic Obstructive Lung Diseases, Stroke, Benign Prostrate, Orthopaedic Diseases, Opthalmic Diseases whereas iHealth 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. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Health of Privileged Elders imposes a 2 year waiting period on pre-existing diseases and iHealth will similarly tell you to wait 2 years before making a claim related to your pre-existing diseases

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 of Privileged Elders covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, iHealth covers expenses incurred 30 days before hospitalization and expenses incurred 60 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 of Privileged Elders doesn’t offer a no-claim bonus whereas iHealth 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 of Privileged Elders offers domiciliary cover whereas iHealth doesn’t offer domiciliary protection.

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 of Privileged Elders covers Ayush procedures and iHealth 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, neither Health of Privileged Elders offers maternity cover nor does iHealth.

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 of Privileged Elders extends coverage for outpatient consultations, nor does iHealth.

Final Conclusion

If you’re specifically looking to buy a policy for senior citizens, Health of Privileged Elders makes a lot of sense. But considering ICICI Lombard has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that Oriental Insurance has to offer, if the policy is made available to you.

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