This story, first in a Mint sequence, dissects medical insurance plans primarily based on the scores determined by Mint-Beshak.org. It goals to assist shoppers perceive the salient options of every product that has made its strategy to the checklist, beginning with Health AdvantEdge.

Launched in August 2022, Apex Plus Plan is the most recent model of Health AdvantEdge and is renewable for the lifetime. Here is why it will get high score.

No cap on hospital room hire and disease-specific limits

These are the 2 necessary options in any well being plan. Take as an example a well being plan that has a room hire restrict of ₹5,000 per day. “If the precise room value is ₹10,000 per day, not solely will the extra ₹5,000 per day need to be paid by the policyholder however the idea of proportionate deduction may also apply. In such a case the place the insurer has solely paid 50% of the room hire, it would additionally pay solely 50% of each merchandise within the hospital invoice,” says health insurance expert Aditya Shah. What about single private AC room category? “All rooms like general wards and twin-sharing rooms can be taken without any proportionate deduction, but if you take a suite, the concept of proportionate deduction will come in, thereby limiting your claim,” says Shah.

Health AdvantEdge doesn’t have any room hire or sort restrict. The coverage doesn’t have any disease-specific limits both. However, bariatric surgical procedure is proscribed to 50% of the sum insured (SI) and comes with an higher cap of ₹10 lakh.

Waiting interval

Insurance regulator Irdai has specified that the utmost ready interval for pre-existing illnesses shouldn’t transcend 4 years in any well being coverage. ICICI Lombard has capped it at simply 2 years in Health AdvantEdge. Bariatric surgical procedure is the one exception, having a ready interval of three years.

The preliminary ready interval throughout which no protection is offered is 30 days. It is waived off in case of unintentional emergencies. For important diseases, it’s 60-90 days.

Out-patient division (OPD), day care and residential care cowl

The AdvantEdge coverage takes care of day care therapy that requires hospitalization of lower than 24 hours. It is completely different from out-patient division (OPD) cowl wherein you go to a clinic or a hospital for prognosis and therapy however don’t get admitted.

Very few insurance policies in India affords OPD cowl for medical and dental therapy. Health AdvantEdge affords it as an optionally available cowl that may be added by paying further premium. The protection differs as per the bottom SI. It is ₹5,000 if the bottom SI is ₹10 lakh and ₹50,000 in case of ₹1 crore SI. Home care therapy is in-built within the coverage and permits bills of as much as 5% of base SI, as much as a most ₹25,000.

Convalescence profit

Very few insurance policies in India affords convalescence profit. Health AdvantEdge affords a lump sum ₹20,000 on steady hospitalization for 10 days or extra; payable over and above the bottom SI. It is offered solely as soon as in a coverage 12 months.

Maternity cowl

The coverage affords maternity protection on further premium fee. It has a ready interval of simply 9 months, method beneath the trade norm. “Maternity protection will probably be given provided that you pay three annual premiums in a single go for 3 coverage years together with further maternity premium. If the maternity declare doesn’t come up throughout these three years, you don’t need to pay the extra premium once more. However, you’ll nonetheless have to purchase the coverage within the block of three years to keep up the maternity cowl,” says an ICICI Lombard spokesperson.

The coverage additionally affords new child child cowl, together with bills on vaccination, on further premium fee.

SI, declare protector riders

There are attention-grabbing riders reminiscent of declare protector and SI protector. The former supplies protection for the objects which aren’t payable below the bottom plan as per the checklist of excluded objects launched by Irdai reminiscent of gloves, gauze, carry baggage, robes, nebuliser and PPE kits, amongst others, used throughout hospitalization. The second sort of rider protects your sum insured in opposition to rising inflation by linking the SI below the bottom plan to the Consumer Price index (CPI).

Worldwide cowl

Hospitalization bills incurred overseas are lined within the plan however provided that a policyholder opts for an SI of ₹25 lakh and above. It may also have a co-payment of 10%. It means 10% of the claims quantity will probably be paid by the policyholder.

Affordable premiums

As per the Mint-Beshak.org research, Health AdvantEdge premium is in keeping with the trade for comparable merchandise. It is to be famous that the research analysed it for a particular danger profile ( ₹10 lakh cowl for a household of two adults and one little one, residing in Mumbai). It might differ on a case-to-case foundation.

There are just a few options within the coverage that aren’t a par with these of peer merchandise. Shah says Health AdvantEdge doesn’t provide enticing no-claim bonus (NCB) and restore profit. The NCB is 20% of the SI yearly and you’ll stand up to 100% over time if there isn’t a declare. The restore profit is triggered solely as soon as in a coverage 12 months for a similar or completely different illnesses. “Other complete well being plans provide higher NCB and booster profit. That stated, the Health AdvantEdge premium is on the upper aspect. For a 30-year-old, a ₹10 lakh cowl will come at an annual premium of ₹11,650, together with items and companies tax (GST). Mostly, all ICICI Lombard merchandise are priced above trade common,” says Shah.

Wellness profit affords solely as much as 5% low cost on renewal premium. “Health evaluation, complete well being check-ups, fitness center memberships, biking, swimming competitions and walkathons are some actions to gather wellness factors,” says the ICICI Lombard spokesperson. To make sure, day by day step rely—a standard wellness function—isn’t incentivized on this plan.

The newest claims settlement ratio of the product is 99.3%, says ICICI Lombard. The firm has to date offered 79,810 Health AdvantEdge plans in FY24, in comparison with 72,133 in FY23.