Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Activ Care Premier is sold by Aditya Birla and ProHealth Protect is sold by Manipal Cigna. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have massive differences in their core structure. Activ Care Premier is specifically designed for senior citizens. However, ProHealth Protect is quite basic. It offers little protection and it’s a generic policy that anybody could pick off the shelf. So in many ways, you’re comparing apples and oranges here.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let’s start with Activ Care Premier. The product comes from Aditya Birla’s stable:
The company only began operations in the year 2016 as a subsidiary of Aditya Birla Capital Ltd., which in turn happens to be a joint venture between the famed Aditya Birla Group and MMI Holdings (South Africa).
While the company boasts a claim settlement ratio of 87.54% along with a network of more than 10,051+ hospitals, do remember they’ve only been in the market for a few years now. So they don’t have an extensive track record.
ProHealth Protect meanwhile comes from Manipal Cigna’s stable:
ManipalCigna Health Insurance Company is a collaborative partnership between Manipal Group and Cigna and together they have over 200 years of expertise in the healthcare business. And while the company has shown some potential recently, it still only corners a small part of the Indian market.
Also, they have a settlement ratio of 88.90% with more than 6,500+ network hospitals in tow.
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Compare Insurances |  Aditya Birla Activ Care Premier |  Manipal Cigna ProHealth Protect |
|---|---|---|
| Network hospitals | 10,051+ | 6,500+ |
| Claim settlement ratio (avg. of last 3 years) | 87.54% | 88.9% |
| Co-payment | 10% | 20% (if purchased after turning 65) |
| Room rent | Single Private room | Single Private room |
| Disease sub-limit | Yes | No |
| Pre existing diseases waiting | 2 years | 4 years |
| Pre/Post hospitalization | 30/60 days | 60/90 days |
| No claim bonus | 10% per year (up to 50%) | 5% per year (up to 200%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness) | 100% restoration (unlimited no. of times for any illness) |
| Health check-up | Once every year | Once every 3 years |
| Maternity | ||
| Out Patient Department | Up to ₹2,500 (Annually) | |
| Day care |
Feature Comparison
Co payment
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Activ Care Premier imposes a mandatory co-payment of 10% , whereas ProHealth Protect imposes a co-payment clause of 20% if you purchase after turning 65.
Room rent
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, Activ Care Premier lets you stay in a single private room and ProHealth Protect also lets you stay in a single private room. Nothing fancy.
Sub limits
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, Activ Care Premier imposes disease-wise sub-limits on null whereas ProHealth Protect doesn’t impose a disease wise sub-limit.
Waiting periods for pre-existing diseases:
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. In this case, Activ Care Premier imposes a waiting period of 2 years on pre-existing diseases while ProHealth Protect extends a waiting period of 4 years on existing conditions.
Pre and post Hospitalization expenses
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Activ Care Premier covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, ProHealth Protect covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits
No claim bonus
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Activ Care Premier offers a no-claim bonus of 10% whereas ProHealth Protect offers a no-claim bonus of 5%. And the no-claim bonus may be capped at different levels too.
Domiciliary
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Activ Care Premier offers domiciliary cover. And ProHealth Protect also coves domiciliary expenses.
Ayush treatments
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Activ Care Premier covers Ayush procedures and ProHealth Protect also extends coverage for Ayush treatments.
Maternity benefits
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, neither Activ Care Premier offers maternity cover nor does ProHealth Protect.
Out Patient Department (OPD)
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Activ Care Premier offers OPD cover whereas ProHealth Protect doesn’t offer OPD protection.
Final Conclusion
Since this isn’t a fair comparison, to begin with, we will only tell you this much. If you want something that’s affordable, you could go for ProHealth Protect. However, if you are specifically looking to buy a policy for senior citizens, then it’s a no brainer, Activ Care Premier is your go-to option.
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