Clipped from: https://www.thehindubusinessline.com/portfolio/personal-finance/feature-shopping-in-health-insurance/article69902138.ece
Centered around a primary goal, health insurance riders and features can expand value to policyholders
Competition in the market is a boon for consumers. Health insurance companies vying for market share has allowed a flurry of features and riders to enter the marketplace that cater to most healthcare needs. This can also prove counter productive if the policyholder zeroes in on the wrong customised plan. The optimal method would be to identify the crucial need as a policyholder and then to filter the available options for the right fit. As otherwise, to scan through the multiple combinations and features within insurance companies would overwhelm policyholders into making a sub-optimal purchase. Here we choose a central need to be served and filter options that provide the most bang for the buck.
Maternity cover
Maternity covers are a work in progress. The options are fewer in number but are better compared to few years ago. Owing to a higher scope of incidence, maternity expenses are generally not covered in health insurance as insurance aims to mitigate unknown risks.
The policies that include them do so at a significant waiting period or as an expensive rider or both. Tata AIG–Medicare premier includes maternity cover of ₹60,000 in the base policy and with a four-year waiting period. The policy itself costs ₹12,000 for a ₹10 lakh cover for a 25-year-old female.
Niva Bupa Health Premia offers a comprehensive package. The base policy provides a ₹40,000 maternity cover after a 2-year waiting period. Even the newborn is covered for the same amount for 90 days after delivery after which the child will have to be included in the plan at a cost. It costs similar to Tata AIG plan.
Disease-specific
For policyholders who have a pre-existing condition such as high BP, heart conditions, cancer or diabetes, the chances of policy issuance are slim. But there are policies that claim a ‘high chance of policy issuance’ for such customers, with or without medical tests. While Star Health’s Comprehensive plan targets patients with high BP, another such variant targets diabetes. The Care Health insurance plan Care Heart targets policyholders with heart conditions. The policies are priced nominally at ₹10,000 to ₹12,500 for a 40-year-old male.
Manipal Cigna–Lifetime policy targets cancer care that can be received Worldwide including US and Canada. This comes as a rider that costs ₹9,500 on top of a premium that costs ₹14,253 per year for a cover of ₹50 lakh. The plan has a waiting period of two years.
Consumables and OPD
Consumables are used once in the course of medical care and then discarded. These are charged by hospitals but not honoured by insurance companies. These charges can size up to 12 per cent of medical bills especially post-Covid. Out patient consultation charges have similarly ballooned in the recent years but not fully reimbursed by insurers and can impact policyholders.
Both are addressed but as add-on riders in many insurance policies. Aditya Birla’s Activ One Max covers consumables in the base policy itself. The rider for consumables costs ₹383 with ICICI Pru Health advantage or ₹774 with Manipal Cigna Lifetime. Considering the small increase in premium, all policyholders should consider the add-on as the costs can be recouped in a single claim paid by the insurer including the consumables.
The cost vs cover for most OPD riders is sub-optimal. By purchasing a rider that costs ₹2,000 on top of the base policy, the OPD covers are a meagre ₹5,000 or so per year. Niva Bupa and Manipal Cigna have a better proposition in this regard. Niva Bupa’s Aspire Gold includes a OPD rider that costs ₹5,730 and covers an overall ₹22,500 OPD cover that is split over the three: consultations, diagnostics and pharmacy. Similarly, Health 360–OPD rider from Manipal Cigna costs ₹1,760 but covers a similar amount across any of the three.
Expanded covers
Health insurance covers have expanded and have done so without substantially increasing the cost for the policyholders; ₹1 crore covers are on offer from most insurers. Compared to ₹9,000-11,000 per year for ₹5 lakh cover, the most inexpensive ₹1 crore cover options can start from ₹12,000 for Aditya Birla’s Activ One. ICICI Pru’s Elevate Combo policy even offers ₹5 crore covers at a cost of ₹15,000 for a 40-year-old male. Another way to increase cover is to opt for Star Health’s Super Star policy (₹8,300 for a ₹5 lakh cover) that allows the policyholder to claim an unlimited amount for a single claim in the policy lifetime. This should cover the critical healthcare needs once. Apart from these, restoration of covers and renewal bonuses allow for the sum insured to increase to seven times over five years (Care Supreme Direct). Manipal Cigna Lifetime with a cover of ₹50 lakh (₹14,250) allows unlimited restorations and ₹7.5 lakh per year renewal of bonus without prescribing a maximum limit.
The health insurance market place offers many other options to cover healthcare. Prospective policyholders should identify their primary need and filter options. One can add adjacencies to improve the use-case but without diluting the primary need or being overwhelmed by the available options. For a holistic cover, Tata AIG Medicare or ICICI Pru Elevatae are comprehensive offerings.
Quick facts
Maternity covers better than a few years ago
Some policies claim a ‘high chance of issuance’ for those with pre-existing conditions
₹1 crore cover on offer from most insurers
Published on August 9, 2025
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