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Introduction

Before we start comparing these two policies we have to set out some ground rules.

For starters, both policies, Premier Mediclaim Plan and Sixty Plus Mediclaim 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. Premier Mediclaim Plan is quite basic. It offers little protection and it’s a generic policy that anybody could pick off the shelf. However, Sixty Plus Mediclaim is specifically designed for senior citizens. 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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Insurance Parameters

Recommended
Not Recommended
Network hospitals
3,139
3,139
Claim settlement ratio

(avg. of last 3 years)

99%
99%
Co-payment

No

10%

Room rent

Any Room

Any Room

(up to 1% of sum insured)

Disease sub-limit

Yes

Yes

Pre existing diseases waiting

3 years

3 years

Pre/Post hospitalization

60/90 days

30/60 days

No claim bonus
Domiciliary
Ayush treatments
Restoration benefit
Health check-up
Maternity

Available

(up to ₹50,000 after 3 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, Premier Mediclaim Plan doesn’t impose a co-payment clause. And Sixty Plus Mediclaim imposes a mandatory co-payment of 10% .

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, you can pick any room you want with Premier Mediclaim Plan but Sixty Plus Mediclaim only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured.

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, Premier Mediclaim Plan imposes disease-wise sub-limits on Cataracts, Modern treatments whereas Sixty Plus Mediclaim imposes sub-limits on Angiography, Joint replacement, major cancer surgeries

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, Premier Mediclaim Plan imposes a 3 year waiting period on pre-existing diseases and Sixty Plus Mediclaim will similarly tell you to wait 3 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, Premier Mediclaim Plan covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Sixty Plus Mediclaim 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, Premier Mediclaim Plan doesn’t offer a no-claim bonus and neither does Sixty Plus Mediclaim.

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, neither Premier Mediclaim Plan offers domiciliary cover nor does Sixty Plus Mediclaim

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, Premier Mediclaim Plan covers Ayush procedures and Sixty Plus Mediclaim 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, however, Premier Mediclaim Plan offers maternity cover whereas Sixty Plus Mediclaim 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, Premier Mediclaim Plan offers OPD cover whereas Sixty Plus Mediclaim doesn’t offer OPD protection.

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 senior citizens, then it’s a no brainer, Sixty Plus Mediclaim is your go-to option.

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