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 Protect is sold by Manipal Cigna and myHealth Koti Suraksha 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 are quite basic in their structure. They offer modest protection and aren’t comprehensive enough to cover a wide array of use cases. So if you are looking for something more robust, then both these policies may not cut it.
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 Protect. 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 Koti Suraksha 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 Protect |  HDFC Ergo myHealth Koti Suraksha |
|---|---|---|
| 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) | 20% |
| Room rent | Single Private room | Single Private room |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 4 years | 4 years |
| Pre/Post hospitalization | 60/90 days | 60/180 days |
| No claim bonus | 5% 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) | |
| Health check-up | Once every 3 years | |
| 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, however, ProHealth Protect imposes a co-payment clause of 20% whereas myHealth Koti Suraksha imposes co-payment of 20% if you purchase after turning 60
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 Protect lets you stay in a single private room and myHealth Koti Suraksha 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, ProHealth Protect doesn’t impose a disease wise sub-limit whereas myHealth Koti Suraksha imposes disease-wise sub-limits on Cataract, Benign – Tumours/Cysts/Nodule/Polyp, Stone in Urinary System, Hernia Related, Appendectomy, Hysterectomy.
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, ProHealth Protect imposes a 4 year waiting period on pre-existing diseases and myHealth Koti Suraksha 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, ProHealth Protect covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, myHealth Koti Suraksha 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. In this case, however, ProHealth Protect offers a no-claim bonus of 5% whereas myHealth Koti Suraksha offers a no-claim bonus of 10%. 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, ProHealth Protect offers domiciliary cover. And myHealth Koti Suraksha 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 Protect covers Ayush procedures and myHealth Koti Suraksha 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 ProHealth Protect offers maternity cover nor does myHealth Koti Suraksha.
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, neither ProHealth Protect extends coverage for outpatient consultations, nor does myHealth Koti Suraksha.
Final Conclusion
After considering all the features on hand and the claim settlement ratio of HDFC Ergo, we believe that myHealth Koti Suraksha is a better alternative to ProHealth Protect for most use cases that we’ve evaluated so far.
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