Private vs Public health insurance. Know the key differences between the two.
Many of us still do not understand the difference between private and public health insurance. So here’s a quick read highlighting what private health insurance means.
A private health insurance is any type of health insurance which has not been floated by the state or central government. Private health insurance policies are run by independent health and general insurance companies. It is a type of health insurance which you purchase from an insurance provider, licensed by the Insurance Regulatory and Development Authority of India (IRDAI). A private health insurance policy can be purchased directly from the insurer or through a licensed broker, bank, NBFC, your employer and online brokers/aggregators.
Now that you know what private health insurance is, let us look at two of the prominent private health insurance plans provided by health insurance companies of India.
Note: All information has been sourced from the official website of the respective insurance providers.
HDFC ERGO - my: Health Suraksha
This is a comprehensive health insurance plan which provides maternity benefits as well.
What’s included in this plan?
| Mother + Newborn Cover | |
| Convalescence Benefit | A lump sum amount is pain in case hospitalization exceeds 10 days |
| E-opinion for Critical illness | Avail second opinion on diagnosis of critical illness. |
| In Patient treatment | Avail full coverage without any limitations of diseases covered or on room rents |
| Pre/Post Hospitalization | Covers expenses for 60 days prior to hospitalisation and 90 days after hospitalisation. |
| Day Care procedures | Coverage up to Sum Insured on medical procedures that take up less than 24 hours. |
| Organ Donor | Covers organ harvesting expenses |
| Emergency Ambulance | Covers transportation expenses |
| Sum Insured | ₹3 to ₹10 lakhs with lifetime renewability. Also, there is no age restriction and the policy comes with a cashless hospitalization facility. |
What’s not included in this plan?
| Adventure Sport injuries | Does not cover accidents encountered while participating in adventure sports. |
| Self-inflicted injuries | Does not cover self-imposed injuries. |
| War | Does not cover accidents that are caused due to wars. |
| Participation in defense operations | Does not cover accidents while you are participating in defense (Army/Navy/Air Force) operations. |
| Venereal or Sexually transmitted diseases | Does not cover venereal or sexually transmitted diseases. |
| Treatment of Obesity or Cosmetic Surgery | None |
Waiting Period
Claims accepted post waiting period of 30 days except accidental claims. Few illnesses & treatments are covered after 2 years of policy issuance and 48 months for pre-existing diseases.
Complete Health Insurance by ICICI Lombard
This is a comprehensive health insurance policy which comes with a reset benefit. Under this plan, the insurer will reset up to 100% of the base Sum Insured, once in a policy year, in case the Sum Insured including accrued additional Sum Insured (if any) is insufficient as a result of previous claims in that policy year.
What’s included in this plan?
| Hospitalisation Cover | Covers all expenses pertaining to in - patient hospitalisation. (Room rent, intensive care unit charges, surgeon’s and doctor’s fee, anesthesia, blood, oxygen, operation theatre charges etc.) |
| Day Care Surgeries / Treatments | Covers expenses for day care treatments (less than 24 hours) |
| Pre and Post Hospitalisation Expenses | 30 days before and 60 days after hospitalisation |
| In patient AYUSH treatment | Covers Expenses for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) treatment |
| Domestic Road Emergency Ambulance Cover | Reimbursement up to ₹1,500 per hospitalisation |
| Additional Sum Insured | 10% of Annual Sum Insured provided on each renewal for every claim free year up to a maximum of 50% |
| Free Health Check-up | Free Health Check - up at designated centres. |
| Sum Insured | ₹3 lakhs to ₹50 lakhs with life-long renewability and cashless hospitalisation |
| Eligibility | The minimum entry age for the customer to receive the policy is 6 years and there is no restriction on maximum entry age. |
Plan Details
| CRITERIA | I HEALTH | HEALTH PROTECT PLUS | HEALTH SMART | HEALTH SMART PLUS |
|---|---|---|---|---|
| Mandatory Covers | ||||
| Sum Insured | 3 Lakh/4 Lakh/5 Lakh/7 Lakh/10 Lakh/15 Lakh/20 Lakh/30 Lakh/50 Lakh | 3 Lakh/4 Lakh/5 Lakh | 7 Lakh/10 Lakh | 15 Lakh/20 Lakh/30 Lakh/50 Lakh |
| Sub Limit | Available Sum Insured of ₹5 Lakh | NA | NA | NA |
| Optional Add on Covers | Hospital Daily Cash + Convalescence Benefit + Critical Illness + Donor Expense | Critical Illness + Donor Expenses + Personal Accident Cover | Compassionate Visit + Nursing at Home Critical Illness + Donor Expenses + Personal Accident Cover | Critical Illness + Donor Expenses + Personal Accident Cover |
What’s not included in this plan?
- Pre - Existing conditions.
- Illness contracted within 30 days of period of insurance start date.
- Cataract for 1st 2 years.
- Arthritis, gout, rheumatism and spinal disorders.
- Dilatation and curettage, Endometriosis.
- Varicose Veins / Varicose Ulcers.
- Joint replacements unless due to accident.
- Stones in the urinary and biliary systems.
- Deviated Nasal Septum.
- All types of internal congenital anomalies / illness / defects.
- Myomectomy, Hysterectomy unless because of malignancy.
- All types of Skin and internal tumors / cysts / nodules / polyps of any kind including breast lumps unless malignant.
- All types of Hernia, Hydrocele.
- Surgery on tonsils, adenoids and sinuses.
- Gastric and Duodenal erosions and ulcers.
- Benign Prostatic Hypertrophy.
- Sinusitis and related disorders.
- Dialysis required for chronic renal failure.
- Fissures / Fistula in anus, hemorrhoids /piles.
A private health insurance policy is a comprehensive health insurance plan designed to provide cover for medical emergencies and uncertainties. Under a private health insurance plan, you pay a predefined premium and on the basis of your premium, you are entitled to a certain sum insured. The sum insured is released on the time of medical emergency. Also, you can take a private health plan on a single as well as a family floater basis.
All of these features make a private health plan an ideal choice among people. So go ahead and buy health insurance for yourself today.
