If a 40 year old is offered a Rs. 1 crore health insurance cover for self, spouse and a child at a premium of less than Rs. 20,000 per year, it is enough to pop my eyes out.
Last I checked, my National Insurance Policy for Rs. 5 lakh cover (floater basis, including spouse), takes about Rs. 7,500 per year.
One is bound to question the existing policy. Next, you are wondering if there is a catch in the policy offering 1 crore health cover.
As I went to find out details about this 1 crore health cover, I realised, there isn’t much of a catch.
Let’s see the details.
Who is offering this 1 crore health cover ?
The offer of Rs. 1 crore health cover is not novel in itself. Several insurance companies in India such as Cigna TTK, Max Bupa, Royal Sundaram, Religare and New India Assurance are offering policies with cover upto Rs. 6 crores.
But they come at a hefty cost which can range from Rs. 50,000 to Rs. 1 lakh+. Except one – the Aditya Birla Capital health insurance policy offered by PolicyBazaar, which has a vey low cost (as mentioned earlier).
This policy is sold exclusively by Policy Bazaar. Strangely, you cannot even buy it directly with Aditya Birla Capital.
The structure of the policy is 5 lakhs of Base Sum Assured (with Activ Assure) + 95 lakhs of super top up (with Super Health Plus Top up). It is a simple combination of a base policy and a super top up policy.
In case you are not aware, a super top up cover is an effective way to increase your overall health cover at a low cost. The only thing to keep in mind is that there is a deductible applicable to its use.
Here’s an example. In the above mentioned policy, if there is a first claim of Rs. 3 lakh, then it is paid out of the Base Policy. You can’t claim it from the Super Top up as the condition is that the first 5 lakhs have to be taken care of by the policy holder himself (either in cash or via another policy).
Now, subsequently, in the same year, there is another claim for Rs. 5 lakh. In this case, Rs. 2 lakh will be paid out of the Base Policy and Rs. 3 lakh from the Super Top up.
Worse, if there is another claim in the same year for Rs. 10 lakh, then it will be paid out entirely from the Super Top up policy.
This makes for a cost efficient structure.
Key highlights of this Aditya Birla policy are:
- A 1 crore health cover with a structure of 5 lakh (base cover) + 95 lakh (super top up) in a single policy
- 30 days pre and 60 days post hospitalisation coverage
- 586 Day care procedures and Domiciary Hospitalisation are covered
- In terms of Room rent, the policy allows use of a Single Private A/C room (upgradable only in case the room type is not available). ICU charges are upto Sum Insured.
- Reload of Sum Assured for different disease or another insured in the policy (applicable to base cover only, not the super top up part)
- Cash less payout with network hospitals (5800+)
- No co payment / deduction if you choose to take treatment in a bigger city (say you go from Nagpur to Mumbai)
- Annual Health Checkup for all members covered in the policy
- Get upto 30% cash back of premium if you make effort to stay fit and healthy (tracked via its App). The cash back can be used to pay any renewal premium or buy medicines or OPD expenses at network hospitals.
The 1 crore health cover goodness comes with restrictions
#1 The policy is not available to all. If you have a pre existing disease, even diabetes or hypertension, for that matter, you WILL NOT get this policy. It is meant only for fit people.
#2 If you have an existing health policy, you cannot port it into this 1 crore cover policy. This policy is issues afresh ONLY. This means that any waiting periods you lived out in your earlier policy will have to be waited out again for 48 months or 4 years. Accordingly, coverage of some specific treatments such as cataract surgery will be available only after 2 years.
#3 You can buy this policy only from Policy Bazaar. Since this restriction exists, it is only reasonable to assume that you may not port out the policy outside of any Policy Bazaar policy later. It is not very clear though. Does it violate any IRDA norms? Not sure about that.
#4 The restriction of room to a single private A/C room. While in most scenarios, this should be enough, the restriction should not become a bone of contention for any emergency situation where the company refused to honour the full claim and you end up shelling money out of your pocket.
#5 An emergency treatment when you travel outside India is covered under this 1 crore health cover policy (this was only stated by the Policy Bazaar representative and is not mentioned in policy wordings). You cannot take a planned treatment outside of India. Also, it is not clear if there will be any restrictions or deductions.
Does the premium stay the same forever?
No, it does not. Health insurance premium is determined by the age of the eldest member in the group and goes up in age slabs of 5 years. What ever your initial premium is, expect about 3% to 5% increase every year.
So, if you start at 20,000 at age 40 (you being the eldest member), then at age 45, the premium would likely be Rs. 23,000 to Rs. 25,000.
This will further increase when you cross age 50.
Will it cover COVID 19 related expenses? [Updated Aug 2020]
Recent messages and communication from the insurer suggest that they will cover COVID 19 related expenses including those on home treatment. However, to what extent, is unclear.
Finally, is the 1 crore health cover a good deal?
A 1 crore health cover is a large enough cover. For the next decade or so, this amount should suffice for meeting expenses under almost any hospitalisation requirement.
I reckon that this specific Aditya Birla policy can stand good in most cases related to hospitalisation and related treatment. The single private A/C room restriction is a bit of a bummer but again you are unlikely to need anything more than that in most cases.
The cash back of premium if you continue to stay fit is a nice little gamification touch and can motivate a lot of policy holders to start that daily walk. 🙂
Policy Bazaar, the sole distributor of this policy, also claims to have its own relationship managers in various hospital in metro cities who will assist you with regards to your claims.
All in all, this one sounds like a good deal if –
- you are okay trusting the brand of Aditya Birla Capital (with claim settlement ratio of 94%, not known specifically for this relatively new policy)
- you are fit today (no pre existing diseases)
- you are not hung up about porting your existing policy (Policy Bazaar won’t allow).
My take – don’t just get lured by the 1 crore health cover. You need to think through your personal situation before making a decision to take this policy.
Sir pls info me, If I can choose 1 crore policy of Aditya Birla and policy amount reduced ,and choose by
52 Lakh then how many amount of policy pay for monthly mode? Me my spouse and two children.
Pls inform me.
Hello, You should check directly with policybazaar.
It seems you lost the way somewhere the way you started your article, or else, you might have changed your mind midway not to reveal the catch.
You did not elaborate about the deductible of 5 lacs for each time you claim from super top up. This is just insane.
In a super top up, deductible is applcable only once during the year and not every time. Not sure why you have this understanding that it is for every claim!
Hi Kishore, there is a small diffrence in topup if the claim is more than the deductible then only that policy will trigger. where as in supertopup deductible can be met either single claim or aggregate of multiple claims in entire policy period. then this policy will pay amount more than then deductible amount.
I am still confused if it is a top up or a Super Top up Policy ?
Some of the wordings in Policy document are very confusing
Can you please let us know how you confirmed it to be a Super Top up policy ?
Hey, lets say i buy this 1 Cr sum insured policy and get hospitalized with a medical bill of Rs 4 lakhs. now will i need to pay for this or the insurer will take care of this out of my own pocket? assuming this is my first ever claim for the policy,
Aditya, if the claim is within the permissible ones (there are some waiting periods for certain diseases), it would be paid up by the policy.
got the same policy for myself. has waiting period of 2 years to cover most diseases, but promising since they offer this to only healthy individuals.
Yes there is 2 years waiting period for almost everything so this policy is just another honey trap
hi, how is this plan different from any other health insurance. the premium is same as a 10 lakh family floater. does it have more exclusions than a normal plan?
Rahul, per se, the plan looks similar. However, pay attention to some finer aspects – specially the policy being offered only by PB and coverage to fully healthy people only.
“first 5 lakhs have to be taken care of by the policy holder himself (either in cash or via another policy)”
I got confused here !
Sachin, it was an example to explain a super topup policy structure and why ABSL policy is cheap.
Suppose you only had a super top up policy, with a deductible of Rs. 5 lakhs. It means that for any of the claims during the year for upto 5 lakhs, the Super Topup is not going to work. You can make claims after the first Rs. 5 lakhs from the Super Top Up.
However, in case of the ABSL policy, they are providing a base cover of Rs. 5 lakhs + a super top of Rs. 95 lakhs. They state that they are covering you all the way.
Hope this helps.
These two statements are contradicting :
if there is a first claim of Rs. 3 lakh, then it is paid out of the Base Policy.
You can’t claim it from the Super Top up as the condition is that the first 5 lakhs have to be taken care of by the policy holder himself (either in cash or via another policy).
So the first 5 lakhs of treatment to be borne by Policy holder or the base policy covers it ???
In this structure, the first 5 lakhs are covered by the base policy and the the super top is used.
What in case my first hospitalisation claim itself is more than 10 or 15 lakhs?
The policy structure is such that it will cover the full amount.
NIDHEESH V M
Hello Sir. Will I get cashless facility in network hospital if base policy is from another insurer. FYI. Aditya Birla Capital now gives super top up directly . Or only reimbursement
The product is a combo of base + super top up, so not sure if you will need to use it along with another policy.
In policy bazar it is asking for details of height weight etc to be filled. If I m overweight policy is not issued to me. Also if I mention less weight and not claim at all for 4 years but thereafter I claim will that policy will give claim?
What is clause about Restoration of Cover? Like if there is an expense of 4L in Year 1, and next year again there is an expense of 3L – will the basic 5L cover be restored and utilised from this, or will it go from the Top-Up Cover?
After the next year renewal the 5 Lakh is available afresh.
Chinmaya Vijay Dhiman
Thanks for all the reply sir… I took this 1 CR policy… Hope so it’ll not cheat me..