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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 Premia Gold is sold by Max Bupa and Medicare Premier 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 Premia Gold. The product 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.


Medicare Premier 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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Insurance Parameters

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

(avg. of last 3 years)

91%
96%
Co-payment

No

No

Room rent

Any Room

(Except suite)

Any Room

Disease sub-limit

No

No

Pre existing diseases waiting

2 years

2 years

Pre/Post hospitalization

90/180 days

60/90 days

No claim bonus

10% per year

(up to 100%)

50% per year

(up to 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for any illness)

100% restoration

(once for any illness)

Health check-up
Once every year
Once every year
Maternity

Available

(up to ₹70,000 after 2 years)

Available

(up to ₹50,000 after 4 years)

Out Patient Department

Up to ₹5,000

(Annually)

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 Premia Gold doesn’t impose a co-payment clause. And neither does Medicare Premier.

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 Premia Gold only lets you pick a room so long as it isn’t a Suite room but you can pick any room you want with Medicare Premier .

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 Premia Gold imposes disease-wise sub-limits nor does Medicare Premier

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 Premia Gold imposes a 2 year waiting period on pre-existing diseases and Medicare Premier 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 Premia Gold covers expenses incurred 90 days before hospitalization and expenses incurred 180 days post-hospitalization. Meanwhile, Medicare Premier covers expenses incurred 60 days before hospitalization and expenses incurred 90 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 Premia Gold offers a no-claim bonus of 10% whereas Medicare Premier offers a no-claim bonus of 50%. And the no-claim bonus may be capped at different levels too.

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 Premia Gold offers domiciliary cover. And Medicare Premier 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 Premia Gold covers Ayush procedures and Medicare Premier 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 Premia Gold offers maternity cover and Medicare Premier 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, Health Premia Gold doesn’t offer OPD protection whereas Medicare Premier offers OPD cover.

Final Conclusion

After considering all the features on hand and the claim settlement ratio of TATA AIG, we believe that Medicare Premier is a better alternative to Health Premia Gold for most use cases that we’ve evaluated so far.

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