National Insurance National Senior Citizen Mediclaim policy vs Manipal Cigna ProHealth Preferred
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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. National Senior Citizen Mediclaim policy is sold by National Insurance and ProHealth Preferred is sold by Manipal Cigna. 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. National Senior Citizen Mediclaim policy is specifically designed for senior citizens. However, ProHealth Preferred 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. 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 National Senior Citizen Mediclaim policy. The product comes from National Insurance’s stable:
National Insurance is the country's oldest general insurance firm and is wholly owned by the Government of India. That means, despite a claim settlement ratio of 93% and over 3,200 network hospitals it can be a bit difficult to reach the insurer when you need them the most. Perhaps due to the fact that they are still a public sector enterprise.
ProHealth Preferred meanwhile comes from Manipal Cigna’s stable:
ManipalCigna Health Insurance Company is a collaborative partnership between Manipal Group and Cigna and together they have over 200 years of expertise in the healthcare business. And while the company has shown some potential recently, it still only corners a small part of the Indian market.
Also, they have a settlement ratio of 90% with more than 8,500+ network hospitals in tow.
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Compare Insurances Insurance Parameters Recommended Not Recommended | National Senior Citizen Mediclaim policy | ProHealth Preferred |
|---|---|---|
| Network hospitals | 3,200+ | 8,500+ |
| Claim settlement ratio (avg. of last 3 years) | 93% | 90% |
| Co-payment | No | 20% (if purchased after turning 65) |
| Room rent | Any Room (up to 1% of sum insured) | Any Room (Except suite) |
| Disease sub-limit | Yes | No |
| Pre existing diseases waiting | 2 years | 2 years |
| Pre/Post hospitalization | 30/60 days | 60/180 days |
| No claim bonus | 5% per year (up to 50%) | 10% per year (up to 200%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (unlimited no. of times for different illness) | |
| Health check-up | Once every 2 years | Once every year |
| Maternity | Available (up to ₹1,00,000 after 4 years) | |
| Out Patient Department | Up to ₹15,000 (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, National Senior Citizen Mediclaim policy doesn’t impose a co-payment clause whereas ProHealth Preferred requires you to co-pay a part of the bill 20% if you purchase after turning 65
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, National Senior Citizen Mediclaim policy only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured, whereas ProHealth Preferred lets you stay in any room except a Suite.
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, National Senior Citizen Mediclaim policy imposes disease-wise sub-limits on Cataracts, Benign Prostatic Hyperplasia, Modern treatments whereas ProHealth Preferred 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. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, National Senior Citizen Mediclaim policy imposes a 2 year waiting period on pre-existing diseases and ProHealth Preferred will similarly tell you to wait 2 years before making a claim related to your pre-existing diseases
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, National Senior Citizen Mediclaim policy covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, ProHealth Preferred covers expenses incurred 60 days before hospitalization and expenses incurred 180 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, National Senior Citizen Mediclaim policy offers a no-claim bonus of 5% whereas ProHealth Preferred offers a no-claim bonus of 10%. And the no-claim bonus may be capped at different levels too.
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, National Senior Citizen Mediclaim policy offers domiciliary cover. And ProHealth Preferred 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, National Senior Citizen Mediclaim policy covers Ayush procedures and ProHealth Preferred 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, however, National Senior Citizen Mediclaim policy doesn’t offer protection for maternity-related hospitalizations whereas ProHealth Preferred 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, National Senior Citizen Mediclaim policy doesn’t offer OPD protection whereas ProHealth Preferred 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 all encompassing, you could go for ProHealth Preferred. However, if you are specifically looking to buy a policy for senior citizens, then you may want to consider National Senior Citizen Mediclaim policy.
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