New India Assurance Sixty Plus Mediclaim vs HDFC Ergo myHealth Koti Suraksha

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, Sixty Plus Mediclaim imposes a mandatory co-payment of 10% whereas myHealth Koti Suraksha imposes co-payment of 20% if you purchase after turning 60.

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, Sixty Plus Mediclaim only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured and myHealth Koti Suraksha lets you stay in a single private room. In effect, both policies impose restrictions on the kind of room you can pick.

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, Sixty Plus Mediclaim imposes disease-wise sub-limits on Angiography, Joint replacement, major cancer surgeries whereas myHealth Koti Suraksha imposes sub-limits on Cataract, Benign – Tumours/Cysts/Nodule/Polyp, Stone in Urinary System, Hernia Related, Appendectomy, Hysterectomy

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, Sixty Plus Mediclaim 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

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, Sixty Plus Mediclaim covers expenses incurred 30 days before hospitalization and expenses incurred 60 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

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, Sixty Plus Mediclaim doesn’t offer a no-claim bonus whereas myHealth Koti Suraksha offers a no-claim bonus.

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, Sixty Plus Mediclaim doesn’t offer domiciliary protection whereas myHealth Koti Suraksha offers domiciliary cover.

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 Sixty Plus Mediclaim doesn’t extend coverage for Ayush treatments whereas myHealth Koti Suraksha covers Ayush treatments.

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 Sixty Plus Mediclaim offers maternity cover nor does myHealth Koti Suraksha.

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 Sixty Plus Mediclaim extends coverage for outpatient consultations, nor does myHealth Koti Suraksha.