ProHealth Accumulate is a good policy. It covers most bases. It doesn't have outrageous conditions, it pays for emergency treatments when you're abroad. and offers cover for outpatient consultations. However considering they include the outpatient benefit, it's much more expensive than ProHealth Protect - another similar policy from the Manipal Cigna stable.
What's good here?
You most likely don't have to split the bill
If you bought this policy after you turned 65, you have to pay 20% of the bill every time you make a claim. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.
You can pick a Single Private room but nothing fancy
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
You always have full cover irrespective of the disease
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre & post hospitalization expenses covered
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 90 days after discharge. This includes the cost of medication by the way.
Good Restoration Benefit
Even after you claim part of the cover on one occasion, you will be allowed to claim the full cover any number of times repeatedly if you are hospitalized for different complications. All in the same year by the way!!!
Day Care treatments covered
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.
Full coverage even if you are forced to hospitalize at home
The insurer will bear the costs even if you are hospitalized at home due to a condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.
Covers Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will cover you fully, up to the sum insured.
Doctor consultations covered
In the event, you are feeling sick and you want to visit your family physician for a general checkup, the insurer will cover the costs, up to a certain limit. In this case, it’s ₹5,000 annually.
What's bad here?
Long waiting period for pre-existing diseases
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems only after 4 long years. It could be much shorter you know? Like 2 years perhaps!
What's lacking here?
Underwhelming bonus feature
Your sum insured increased by 5% each year, so long as you make no claims during this period. And while it might seem like a bonus, you have to wonder how a 5% increase each year is going to be meaningful, especially considering other policies offer you a much higher bonus.
No free Health Checkups unless you wait 3 years
If you’re planning on getting a full body checkup just to make sure you’re in fine working condition, the insurer will cover the cost once in 3 years. However, just so you know, most insurance policies offer free yearly health checkups.
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