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What is Private Health Insurance?

Karan Sharma Karan Sharma 03 May 2019

Private vs Public health insurance. Know the key differences between the two.

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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.

Health Suraksha Insurance Gold - HDFC ERGO

This is a comprehensive health insurance plan which provides maternity benefits as well. What’s included in this plan?

Mother + Newborn Cover1. Provides coverage for Medical expenses for maternity including pre-natal and post-natal expenses.
2. Medical expenses of the newborn are covered upto 90 days from the date of child birth.
Convalescence BenefitA lump sum amount is pain in case hospitalization exceeds 10 days
E-opinion for Critical illnessAvail second opinion on diagnosis of critical illness.
In Patient treatmentAvail full coverage without any limitations of diseases covered or on room rents
Pre/Post HospitalizationCovers expenses for 60 days prior to hospitalisation and 90 days after hospitalisation.
Day Care proceduresCoverage up to Sum Insured on medical procedures that take up less than 24 hours.
Organ DonorCovers 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 injuriesDoes not cover accidents encountered while participating in adventure sports.
Self-inflicted injuriesDoes not cover self-imposed injuries.
WarDoes not cover accidents that are caused due to wars.
Participation in defense operationsDoes not cover accidents while you are participating in defense (Army/Navy/Air Force) operations.
Venereal or Sexually transmitted diseasesDoes not cover venereal or sexually transmitted diseases.
Treatment of Obesity or Cosmetic SurgeryNone

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 CoverCovers 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 / TreatmentsCovers expenses for day care treatments (less than 24 hours)
Pre and Post Hospitalisation Expenses30 days before and 60 days after hospitalisation
In patient AYUSH treatmentCovers Expenses for Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy (AYUSH) treatment
Domestic Road Emergency Ambulance CoverReimbursement up to ₹1,500 per hospitalisation
Additional Sum Insured10% of Annual Sum Insured provided on each renewal for every claim free year up to a maximum of 50%
Free Health Check-upFree 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

CriteriaI HealthHealth Protect PlusHealth SmartHealth Smart Plus
Mandatory Covers Hospitalisation+ In Patient AYUSH + Domestic Road Emergency Ambulance Cover + 2 Years PED + Reset Benefit + Wellness ProgramHospitalisation + In Patient AYUSH + Domestic Road Emergency Ambulance Cover + 2 Years PED + Maternity + New Born Baby Cover + OPD + HDC + Convalescence Benefit + Reset Benefit + Wellness Program Hospitalisation + In Patient AYUSH + Domestic Road Emergency Ambulance Cover + 2 Years PED + Maternity + New Born Baby Cover + OPD + HDC + Convalescence Benefit + Reset Benefit + Wellness ProgramHospitalisation+ In Patient AYUSH + Domestic Road Emergency Ambulance Cover + 2 Years PED + Maternity + Newborn Baby Cover + OPD + HDC + Convalescence Benefit + Nursing at Home + CompassionateVisit + Medical Evacuation Cover + Reset Benefit + Wellness Program
Sum Insured3 Lakh/4 Lakh/5 Lakh/7 Lakh/10 Lakh/15 Lakh/20 Lakh/30 Lakh/50 Lakh 3 Lakh/4 Lakh/5 Lakh7 Lakh/10 Lakh15 Lakh/20 Lakh/30 Lakh/50 Lakh
Sub LimitAvailable Sum Insured of ₹5 LakhNANANA
Optional Add on CoversHospital Daily Cash + Convalescence Benefit + Critical Illness + Donor ExpenseCritical Illness + Donor Expenses + Personal Accident CoverCompassionate Visit + Nursing at Home Critical Illness + Donor Expenses + Personal Accident CoverCritical Illness + Donor Expenses + Personal Accident Cover

What’s not included in this plan?

  1. Pre - Existing conditions.
  2. Illness contracted within 30 days of period of insurance start date.
  3. Cataract for 1st 2 years.
  4. Arthritis, gout, rheumatism and spinal disorders.
  5. Dilatation and curettage, Endometriosis.
  6. Varicose Veins / Varicose Ulcers.
  7. Joint replacements unless due to accident.
  8. Stones in the urinary and biliary systems.
  9. Deviated Nasal Septum.
  10. All types of internal congenital anomalies / illness / defects.
  11. Myomectomy, Hysterectomy unless because of malignancy.
  12. All types of Skin and internal tumors / cysts / nodules / polyps of any kind including breast lumps unless malignant.
  13. All types of Hernia, Hydrocele.
  14. Surgery on tonsils, adenoids and sinuses.
  15. Gastric and Duodenal erosions and ulcers.
  16. Benign Prostatic Hypertrophy.
  17. Sinusitis and related disorders.
  18. Dialysis required for chronic renal failure.
  19. 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 one for yourself today.

Karan Sharma
Written by Karan Sharma
Content Specialist and Strategist, foolishly creative and always ready for a game of 'Call of Duty'.