Comprehensive Individual vs Prime Advantage with 50K OPD Health Insurance Plan
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| PLAN DETAILS |
 Comprehensive Individual |
 Prime Advantage with 50K OPD |
| Premium Including GST | ||
| Sum Assured | 5L, 7.5L, 10L, 15L, 20L, 25L, 50L, 75L & 1Cr | 5L, 7.5L, 10L, 12.5L, 15L, 20L, 25L, 30L, 40L, 50L & 1Cr |
| Product Type | Reimbursement Hospitalization and Cashless | Individual and Family Floater |
| Key Features (Key features of the plan) |
Automatic Restoration – 100% Available No claim bonus Hospital cash benefit Cover against accidental death and permanent total disablement Health checkup for every claim-free year Wellness program – earn wellness reward Option available to buy back pre-existing disease |
OPD upto INR 50000 Guaranteed Bonus Unlimited Tele-Consultation Unlimited Restoration of 10 L No Co-Pay Health Check-up from 1st Year Waives off one year renewal Policy Premium upon occurrence of Accidental Death or diagnosis of any of the listed Critical Illnesses |
| OPD Details (In some policies, OPD (Out patient department) expenses are also covered.) |
300 Per Consultation & overall limit 2100/- | Upto Rs 50K/- |
| EMI Option | no | yes |
| Pre-acceptance Medical Check Up (Whether a pre-acceptance check up is required or not to buy the policy) |
Not Applicable | Required |
|
Room Rent (A limit of room rent cover during hospitalization if any) |
Private Single Standard A/C | Single Private AC room |
| Domicillary Hospitalization (It is the expenses incurred on treatment of the patient at home) |
Upto Rs. 10L | Up to Rs 100000 |
| Pre-hospitalization (Expenses before the insured is hospitalized) |
60 Days | 60 Days |
| Post-hospitalization (Expenses after discharge from the hospital) |
90 Days | 180 Days |
| Non-allopathic (Expenses incurred on non-allopathic treatment) |
Rs.15k for Ayush Treatment | Upto Rs 1000000 |
| Day Care Treatment Covered (Day care treatments refers to the treatments that do not necessarily require 24hrs of hospitalization like MRI.) |
Upto 10L & All Day Care Treatment Covered | Upto Rs 1000000 |
| Hospital_network (Number of Hospital Network in city) |
||
| Organ Donor Expenses (Expenses incurred on organ donor in case of organ transplants) |
Applicable | Upto Rs 1000000 |
|
Hospital Daily Allowance (Some plans offer daily allowance to take care of expenses like food, etc) |
750/- per day | 800/- day and Max 5,600 (These are only available on shared accomodation) |
| Pre-existing Coverage (If the insured is having some existing diseases, that would be covered after particular time period) |
After 3 years, Can get reduced to 1 year on additional premium payment | 24 Months |
| Cumulative Bonus (The amount by which your sum assured gets increased, if there is no claim.) |
Rs 10L per year upto Rs 10L | (Guaranteed) Rs 2.5L per year upto Rs 20L |
| Restoration Details (Increase of Sum Insured for non-related illness if the original sum insured is exhausted) |
Upto Rs 10L (on related and unrelated illness & on full exhaustion) | Unlimited (on related and unrelated illness & on partial exhaution) |
| Ambulance Charges (Expenses incurred on ambulance charges) |
Yes | Upto 1000000 |
| Worldwide Emergency (The emergency medical assistance and cover against medical expenses while the customer is abroad) |
NA | NA |
|
Maternity Benefits (All Hospitalization cost covered at the time of pregnancy.) |
Not Covered | Optional (Can be opted through enhance plus rider) |
| New Born Baby Covered (Newborn babies can be covered under the insurance plan after a certain period) |
No | Optional (Can be opted through enhance plus rider) |
| Health Checkup (An added benefit of one time full health checkup of policy holder.) |
Given after every claim free year (limit varies as per Sum Insured) | Annually from 1st Year onwards |
| Non-allopathic Details (Expenses incurred on non-allopathic treatment) |
yes | yes |
| Vaccination (Cover againts any medical expenses occurred in Vaccinations for certain diseases) |
Yes | Not Available |
| Animal Bite (Cover againts any medical expenses occurred due to any Animal Bite) |
NA | Not Applicable |
|
Sub Limit (Sub-limit is a monetary capping that applies on specific diseases like cataract) |
Not Applicable | Applicable |
| Co-pay (Mentioned %, if any is to be borne by Insured and rest will be borne by insurer) |
You pay 10% of claim | No Co-Pay |
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Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.
