Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. ProHealth Premier is sold by Manipal Cigna and myHealth Suraksha Gold is sold by HDFC Ergo. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have subtle differences in their core structure. ProHealth Premier is a relatively expensive premium policy tailored to cover as many use cases as possible. myHealth Suraksha Gold, meanwhile, is reasonably comprehensive. Sure, it doesn’t have all the bells and whistles, but it also doesn’t impose any mindless restrictions. So while the differences in features may be subtle, the pricing could be drastically different depending on the cover amount you pick.
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 ProHealth Premier. The product 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.
myHealth Suraksha Gold meanwhile comes from HDFC Ergo’s stable:
Founded in the year 2002, the company is a joint venture between India’s HDFC and Germany’s ERGO International AG. It offers policies across motor, travel, health and other sectors. And it also happens to be one of the largest insurers in the country.
More importantly, HDFC Ergo boasts a claim settlement ratio of 97.55%, with a network of 12,000+ hospitals
All in all, an impressive resume.
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Compare Insurances |  Manipal Cigna ProHealth Premier |  HDFC Ergo myHealth Suraksha Gold |
|---|---|---|
| Network hospitals | 6,500+ | 12,000+ |
| Claim settlement ratio (avg. of last 3 years) | 88.9% | 97.55% |
| Co-payment | 20% (if purchased after turning 65) | No |
| Room rent | Any Room (Except suite) | Any Room |
| Disease sub-limit | No | No |
| Pre existing diseases waiting | 2 years | 3 years |
| Pre/Post hospitalization | 60/180 days | 60/180 days |
| No claim bonus | 10% per year (up to 200%) | 10% per year (up to 100%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (unlimited no. of times for any illness) | 100% restoration (once for any illness) |
| Health check-up | Once every year | Once every year |
| Maternity | Available (up to ₹2,00,000 after 4 years) | |
| Out Patient Department | Up to ₹15,000 (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, ProHealth Premier imposes a co-payment clause of 20% if you purchase after turning 65 whereas myHealth Suraksha Gold doesn’t impose a mandatory co-payment clause.
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, ProHealth Premier only lets you pick a room so long as it isn’t a Suite room but you can pick any room you want with myHealth Suraksha Gold .
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, neither ProHealth Premier imposes disease-wise sub-limits nor does myHealth Suraksha Gold
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, ProHealth Premier imposes a waiting period of 2 years on pre-existing diseases while myHealth Suraksha Gold extends a waiting period of 3 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, ProHealth Premier covers expenses incurred 60 days before hospitalization and expenses incurred 180 days post-hospitalization. Meanwhile, myHealth Suraksha Gold covers expenses incurred 60 days before hospitalization and expenses incurred 180 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. And in this case, ProHealth Premier offers a no-claim bonus of 10% and myHealth Suraksha Gold similarly extends a 10% no-claim bonus.
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, ProHealth Premier offers domiciliary cover. And myHealth Suraksha Gold 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, ProHealth Premier covers Ayush procedures and myHealth Suraksha Gold 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, however, ProHealth Premier offers maternity cover whereas myHealth Suraksha Gold doesn’t offer protection for maternity-related hospitalizations.
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, ProHealth Premier offers OPD cover whereas myHealth Suraksha Gold doesn’t offer OPD protection.
Final Conclusion
It should be obvious that ProHealth Premier offers better protection and extends a whole host of benefits that myHealth Suraksha Gold simply doesn’t offer. But considering Manipal Cigna has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that HDFC Ergo has to offer.
Other Manipal Cigna ProHealth Premier Comparisons
Other HDFC Ergo myHealth Suraksha Gold Comparisons
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