Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Health Gain is sold by Star Health and Sixty Plus Mediclaim is sold by New India Assurance. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products are built for very different use cases. Health Gain is built for those seeking outpatient coverage. Sixty Plus Mediclaim is built for senior citizens. And that means you’re comparing very different products here. So analysis will be tainted by this distinction.
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 Health Gain. The product comes from Star Health’s stable:
Star Health Insurance is India's first standalone health insurance firm. And with an army of retail advisors pushing their products across the country, they’ve managed to capture a fair share of the Indian market.
The company also boasts a network of over 13,000+ hospitals and a decent claim settlement ratio of 83.07%.
Sixty Plus Mediclaim meanwhile comes from New India Assurance’s stable:
New India Assurance, is a government-owned insurance firm that was established in 1919. Their insurance portfolio includes Health, Motor, Travel, and Marine products. But despite being in the business for so long, they’re not the most efficient when it comes to processing your application and dealing with your claims.
And that means, even with a relatively high claim settlement ratio and 3,000 network hospitals, the company isn’t exactly a stellar performer.
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Compare Insurances |  Star Health Health Gain |  New India Assurance Sixty Plus Mediclaim |
|---|---|---|
| Network hospitals | 13,000+ | 3,139 |
| Claim settlement ratio (avg. of last 3 years) | 83.07% | 99.92% |
| Co-payment | 20% (if purchased after turning 61) | 10% |
| Room rent | Any Room (up to 1% of sum insured) | Any Room (up to 1% of sum insured) |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 4 years | 4 years |
| Pre/Post hospitalization | 30/60 days | 30/60 days |
| No claim bonus | ||
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | ||
| Health check-up | ||
| Maternity | ||
| Out Patient Department | ||
| 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, both policies impose a co-payment clause if you’re hospitalized. Health Gain requires you to co-pay a part of the bill 20% if you purchase after turning 61 whereas Sixty Plus Mediclaim imposes a co-payment clause of 10%
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, Health Gain only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured. And Sixty Plus Mediclaim does the same i.e. it only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured.
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, Health Gain doesn’t impose a disease wise sub-limit whereas Sixty Plus Mediclaim imposes disease-wise sub-limits on Angiography, Joint replacement, major cancer surgeries.
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. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Health Gain imposes a 4 year waiting period on pre-existing diseases and Sixty Plus Mediclaim will similarly tell you to wait 4 years before making a claim related to your pre-existing diseases
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, Health Gain covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Sixty Plus Mediclaim covers expenses incurred 30 days before hospitalization and expenses incurred 60 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, Health Gain doesn’t offer a no-claim bonus and neither does Sixty Plus Mediclaim.
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, neither Health Gain offers domiciliary cover nor does Sixty Plus Mediclaim
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 neither Health Gain nor Sixty Plus Mediclaim extend 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 Health Gain offers maternity cover nor does Sixty Plus Mediclaim.
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, Health Gain offers OPD cover whereas Sixty Plus Mediclaim doesn’t offer OPD protection.
Final Conclusion
It should be fairly obvious by now. Health Gain is best suited for those seeking outpatient coverage while Sixty Plus Mediclaim makes a lot of sense if you are looking to cover senior citizens. However, considering Star Health has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that New India Assurance has to offer, if the policy is made available to you.
Other Star Health Health Gain Comparisons
Other New India Assurance Sixty Plus Mediclaim Comparisons
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