Oriental Insurance Health of Privileged Elders vs Oriental Insurance Mediclaim Insurance Policy
Introduction
Before we start comparing these two policies we have to set out some ground rules.
For starters, both policies, Health of Privileged Elders and Mediclaim Insurance Policy 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 massive differences in their core structure. Health of Privileged Elders is specifically designed for senior citizens. However, Mediclaim Insurance Policy 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.
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Compare Insurances Insurance Parameters Recommended Not Recommended | ||
---|---|---|
Network hospitals | 3,264 | 3,264 |
Claim settlement ratio (avg. of last 3 years) | 96% | 96% |
Co-payment | 20% | No |
Room rent | Any Room (up to 1% of sum insured) | Any Room (up to 1% of sum insured) |
Disease sub-limit | Yes | No |
Pre existing diseases waiting | 2 years | 4 years |
Pre/Post hospitalization | 30/60 days | 30/60 days |
No claim bonus | ||
Domiciliary | ||
Ayush treatments | ||
Restoration benefit | ||
Health check-up | Once every year | Once every year |
Maternity | ||
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. However in this case Health of Privileged Elders imposes a mandatory co-payment of 20% whereas Mediclaim Insurance Policy doesn’t impose a mandatory 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, Health of Privileged Elders only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured. And Mediclaim Insurance Policy does the same i.e. it only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured.
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 Mediclaim Insurance Policy doesn’t impose a disease wise sub-limit.
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 of Privileged Elders imposes a waiting period of 2 years on pre-existing diseases while Mediclaim Insurance Policy extends a waiting period of 4 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 of Privileged Elders covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Mediclaim Insurance Policy covers expenses incurred 30 days before hospitalization and expenses incurred 60 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. In this case, however, Health of Privileged Elders doesn’t offer a no-claim bonus and neither does Mediclaim Insurance Policy.
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. And Mediclaim Insurance Policy 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 of Privileged Elders covers Ayush procedures and Mediclaim Insurance Policy 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, neither Health of Privileged Elders offers maternity cover nor does Mediclaim Insurance Policy.
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 Mediclaim Insurance Policy.
Final Conclusion
Since this isn’t a fair comparison, to begin with, we will only tell you this much. If you want something that’s affordable, you could go for Mediclaim Insurance Policy. However, if you are specifically looking to buy a policy for senior citizens, then it’s a no brainer, Health of Privileged Elders is your go-to option.
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