Future Generali has launched a health insurance product that offers most of the features one can aspire for in health insurance. Prominent amongst them are global coverage and large sum insured options beginning from ₹75 lakh and moving to the range of ₹1 crore to ₹6 crore, in multiples of ₹50 lakh OPD (outpatient diagnostics) cover, wellness features, shorter wait period for pre-existing diseases (PEDs), and maternity benefits also feature in the plan which caters to individual and family floaters as well. Most of these features are individually available in offerings from other insurers, but have all been combined in this policy. At the same time, the pricing (premium per annum) too reflects the breadth of offering in Health Elite.

Features comparison

A ₹1-crore sum insured (SI) for a 31–35 year-old costs ₹84,740 in the Health Elite plan.

Treatment abroad: The policy offers to cover medical treatment (including emergency treatment) abroad with a co-pay clause of 20 per cent (claim is considered after 20 per cent is paid by policyholder) and return airfare limited to ₹3 lakh per year. The cover is for listed critical illness, and up to SI from the second year onwards. In the first year alone, it is limited to 50 per cent of the SI. However, this cover is not applicable for treatments in US and Canada. They can be included with a nominal add-on (₹700 for ₹1 crore for a 30-year old). In comparison, most other policies offer only emergency treatment abroad if they have a worldwide coverage clause. Care Health is an exception. Its Global Care plan also offers US/Non-US plans and costs ₹58,131 for ₹1 crore SI.

OPD Cover: The Health Elite Policy covers OPD procedures up to ₹50,000 per year, including consultations, diagnostic tests, and medications. This also includes dental, optical and home visit covers, but the co-pay could be different for each, standing between 20 and 30 per cent. Other plans from insurers generally offer to cover OPD expenses with a limit of ₹1,000 – ₹5,000 per year. Manipal Cigna’s Prime Advantage plan also covers OPD expenses till ₹20,000 in the base ₹1-crore policy with option to increase it to ₹50,000. The premium for this ₹1-crore policy is ₹19,239 per annum.

PED wait: The PED  waiting period in Health Elite plan is 2 years, which is an improvement over most other plans where it ranges from 3 to 4 years. Star Health’s PED Buyback feature in its ₹1-crore health policy covers PEDs after 1 year and costs ₹27,619.

Maternity expenses: These are covered (if at all) after four years of waiting in most other policies.  Health Elite plan covers maternity expenses from second year itself with ₹1-2 lakh for normal/caesarean delivery for both mother and child and child vaccination. Star Health’s Comprehensive package also provides half the above maternity benefits under its ₹1-crore policy along with ₹2 lakh additional cover for newborn. This plan costs ₹23,000 per year.

Other features

The other base features include NCB (No Claim Bonus), restoration benefits, co-pay clause and wellness features. Health Elite NCB feature allows a 10 per cent growth in SI upto a 100 per cent bonus on claim free years, implying a 10-year period to double the cover. Other policies (₹1 crore) feature a faster doubling of SI in three-four years. Health Elite’s restoration benefits (replenishing SI upon a claim in a year) improve the health cover to 100 per cent of SI, but is applicable only for unrelated illnesses (w.r.t to first claim). Niva Bupa, Star Health and Manipal Cigna are some plans that support both related and unrelated claims in restored SI claims. Wellness benefits refers to points achieved on leading a healthy lifestyle which can be used for premium discounts or for signing up for additional riders. Health Elite plan allows for 5 per cent discount on premium at the highest level of healthy activity. Aditya Birla Activ health insurance offers 6-50 per cent discounts in wellness features.

In all, while the plan is feature rich, premiums are also higher than most other policies, since those policies offer only one or two of the above-mentioned features of Health Elite. Hence, policy holders must make an informed choice based on need for such a wide and all-encompassing cover, as mentioned in our Big Story ‘ Think Small’ in the October 16 edition.  

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