If you're 60+ and you're actively considering New India's Senior Citizen Mediclaim policy, do note that you won't get a lot of protection with a 1.5 lakh cover. Besides, the policy won't pay out the full cover in many cases. So if you are looking for comprehensive coverage this policy simply doesn't cut it.
What's good here?
You’ll never have to split the bill
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Short 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 after just 1.5 years. It’s probably the best deal you can get to be honest.
What's bad here?
Restrictions on the rooms you can pick and much more
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more - Read more here
Has disease wise sub-limits
Your insurance cover won’t be fully available in case you are treated for Appendicectomy, Angiography, Tonsillectomy, Hysterectomy and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
No coverage for Day Care treatments
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will not cover these costs. Think dialysis, chemotherapy or minor surgeries.
No coverage if you are forced to hospitalize at home
The insurer will not cover the costs if you are forced to hospitalize at home due to a medical condition. In insurance lingo, they call this a policy with no domiciliary cover.
Pre & Post hospitalization expenses covered up to a certain limit
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 upto 10% of sum insured for about 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Underwhelming bonus feature
Your sum insured increases by 5% each year, so long as you make no claims during this period. But before you get too ahead of yourself, do note that they’ll stop offering you the bonus when your sum insured increases by 30%. And while this is a decent deal, most insurance companies offer a much higher bonus. But hey, it's still a bonus.
Free Health Checkups
You'll get a free health checkup if you go 4 years without making a claim (subject to a cap of Rs. 5,000 or 1% of the sum insured, whichever is lower). It's not very useful.
Some Cover for Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will pay up to 25% of the cover in case you’re availing these treatments.
What's lacking here?
No Restoration Benefit
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
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