Product Review. Extras come with a catch

Health insurance penetration in India, though still low, is growing. New products across several segments, including health and critical illness, continue to be launched. But not many have new features.

Future Generali recently launched a new health insurance policy — Health Total. The product is comprehensive with cover for OPD (treatment taken as out-patient), medical treatment taken outside India and domiciliary hospitalisation. These are not features you find in regular health plans.

However, each benefit comes with a clause that you need to watch out for. The policy offers cover for up to ₹1 crore with minimum cover of ₹3 lakh. Like other health insurance policies, this plan too allows life-long renewal.

The policy offers three different plans — Vital (sum insured up to ₹10 lakh), Superior (sum insured of ₹15/20/25 lakh) and Premiere (sum insured of ₹50/100 lakh) .

In ‘Vital’, the floater plan covers spouse, dependant children and dependant parents.

In the other two plans, up to 15 members including daughter/son-in-law, parents-in-law and non-dependant children, are covered.

The policy gives 20-60 per cent discount on premium for every additional member under the floater plan, depending on the age. All three plans cover day-care treatment and give a bonus of 50 per cent of sum insured for every claim-free year to a maximum of 100 per cent. Expenses on ayurvedic/siddha/unani/homeopathy treatment are covered on reimbursement basis.

There is a two-year waiting period for claiming on pre-existing diseases.

However, in the third year also, only 50 per cent of actual expenses on such diseases will be covered; full coverage starts from the fourth year onwards. Discounts of 10-20/25 per cent on premium are given if individuals agree to bear a portion of the bill.

Voluntary deductibles start from ₹10,000 in Vital plan and go up to ₹5,00,000 in Premiere plan. The discount on premium allowed due to these deductibles can range from 10 per cent to 25 per cent.

Health Total has many attractions. A high bonus for no-claim years, coverage for alternative treatments, support for medical treatment outside India, domiciliary and OPD are some of it. But, looking into the fine print of the policy document, there is a catch in some of these frills.

For instance, out-patient expenses are covered with a cap of ₹10,000 in Premiere plan and ₹3,000 in Superior plan (only for consultations and diagnostics).

Also, there is no OPD cover in Vital plan. With medical cost inflation in double-digits, this policy may not help you if your family is shelling out a large sum on medicines every month and you want to cover those expenses.

Similarly, though cost of medical treatment taken outside India is covered, there is a four-year waiting period for it from the time of inception of the policy, and, domiciliary expenses (treatment from home) are covered only up to 10 per cent of sum insured in all the three variants of the policy.

Do also note that there is a compulsory co-payment clause if senior citizens are covered under the plan.

If your father, say, is 64 years, you will be required to bear 20 per cent of the cost of any medical treatment he undergoes.

For individuals of age 75 and above, the co-payment is 40 per cent.

In the premium version of the health policy of Royal Sundaram, most of the above mentioned features are available.

Further, there is no waiting period for medical treatment outside India and no co-payment clause.

The pre-existing disease waiting period is only two years and domiciliary expenses are covered up to sum insured.

In terms of premium, Future Generali’s Health Total’s Vital plan is neither too expensive nor cheap.

For a family of three, with the eldest of age 36-40 years and a child, the premium for a sum insured of ₹10 lakh works out to about ₹16,101.

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