Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Medicare Senior is sold by TATA AIG and Premier Mediclaim Plan is sold by New India Assurance. 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. Medicare Senior is specifically designed for null. However, Premier Mediclaim Plan 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 Medicare Senior. The product 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.
Premier Mediclaim Plan meanwhile comes from New India Assurance’s stable:
New India Assurance, is a government-owned insurance firm that was established in 1919. Their insurance portfolio includes Health, Motor, Travel, and Marine products. But despite being in the business for so long, they’re not the most efficient when it comes to processing your application and dealing with your claims.
And that means, even with a relatively high claim settlement ratio and 3,139 network hospitals, the company isn’t exactly a stellar performer.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Medicare Senior |  Premier Mediclaim Plan |
|---|---|---|
| Network hospitals | 10,000+ | 3,139 |
| Claim settlement ratio (avg. of last 3 years) | 96% | 99% |
| Co-payment | 15% | No |
| Room rent | Shared Room | Any Room |
| Disease sub-limit | Yes | Yes |
| Pre existing diseases waiting | 4 years | 3 years |
| Pre/Post hospitalization | 30/60 days | 60/90 days |
| No claim bonus | ||
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | ||
| Health check-up | Once every 2 years | |
| Maternity | Available (up to ₹50,000 after 3 years) | |
| Out Patient Department | Up to ₹5,000 (Annually) | |
| 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, Medicare Senior imposes a mandatory co payment of 85% if you opt for shared room and 70% if you opt for any other room whereas Premier Mediclaim Plan 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, Medicare Senior only lets you stay in a shared room but you can pick any room you want with Premier Mediclaim Plan.
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, Medicare Senior imposes disease-wise sub-limits on Cataract, Joint Replacement, Hernia, Hysterectomy, Benign Prostate surgery whereas Premier Mediclaim Plan imposes sub-limits on Cataracts, Modern treatments
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, Medicare Senior imposes a waiting period of 4 years on pre-existing diseases while Premier Mediclaim Plan 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, Medicare Senior covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Premier Mediclaim Plan 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. In this case, however, Medicare Senior doesn’t offer a no-claim bonus and neither does Premier Mediclaim Plan.
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, Medicare Senior offers domiciliary cover whereas Premier Mediclaim Plan doesn’t offer domiciliary protection.
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 Medicare Senior doesn’t extend coverage for Ayush treatments whereas Premier Mediclaim Plan covers 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, Medicare Senior doesn’t offer protection for maternity-related hospitalizations whereas Premier Mediclaim Plan offers maternity cover.
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, Medicare Senior doesn’t offer OPD protection whereas Premier Mediclaim Plan offers OPD cover.
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 Premier Mediclaim Plan. However, if you are specifically looking to buy a policy for null, then it’s a no brainer, Medicare Senior is your go-to option.
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