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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 Senior 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 products have massive differences in their core structure. Health Premia Gold is a premium policy built for people who want to leave no stone unturned when it comes to their health. It’s expensive and it does pretty much everything you expect a good policy to do. However, Medicare Senior is specifically designed for null. 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 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 Senior 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

15%

Room rent

Any Room

(Except suite)

Shared Room

Disease sub-limit

No

Yes

Pre existing diseases waiting

2 years

4 years

Pre/Post hospitalization

90/180 days

30/60 days

No claim bonus

10% per year

(up to 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for any illness)

Health check-up
Once every year
Maternity

Available

(up to ₹70,000 after 2 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, however, Health Premia Gold doesn’t impose a co-payment clause whereas Medicare Senior imposes a mandatory co payment of 85% if you opt for shared room and 70% if you opt for any other room.

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 lets you stay in any room except a Suite, whereas Medicare Senior only lets you stay in a shared 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, Health Premia Gold doesn’t impose a disease wise sub-limit whereas Medicare Senior imposes disease-wise sub-limits on Cataract, Joint Replacement, Hernia, Hysterectomy, Benign Prostate surgery.

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 Premia Gold imposes a waiting period of 2 years on pre-existing diseases while Medicare Senior extends a waiting period of 4 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 Premia Gold covers expenses incurred 90 days before hospitalization and expenses incurred 180 days post-hospitalization. Meanwhile, Medicare Senior 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 Premia Gold offers a no-claim bonus whereas Medicare Senior doesn’t offer 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 Premia Gold offers domiciliary cover. And Medicare Senior 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 treatments whereas Medicare Senior doesn’t extend 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, however, Health Premia Gold offers maternity cover whereas Medicare Senior doesn’t offer protection for maternity-related hospitalizations.

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 Premia Gold extends coverage for outpatient consultations, nor does Medicare Senior.

Final Conclusion

It should be obvious by now. Health Premia Gold is packed with features, while Medicare Senior is specifically meant for null. But considering Niva Bupa (erstwhile Max Bupa) has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that TATA AIG has to offer, if the policy is made available to you.

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