Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Mediclaim is sold by New India Assurance and ProHealth Accumulate is sold by Manipal Cigna. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have massive differences in their core structure. Mediclaim is quite basic. It offers little protection and may not be entirely suitable if you are looking for robust protection. However, ProHealth Accumulate is a premium policy tailored to cover as many use cases as possible. So in all honesty, you are comparing apples and oranges here.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let’s start with Mediclaim. The product comes from New India Assurance’s stable:
New India Assurance, is a government-owned insurance firm that was established in 1919. Their insurance portfolio includes Health, Motor, Travel, and Marine products. But despite being in the business for so long, they’re not the most efficient when it comes to processing your application and dealing with your claims.
And that means, even with a relatively high claim settlement ratio and 3,139 network hospitals, the company isn’t exactly a stellar performer.
ProHealth Accumulate meanwhile comes from Manipal Cigna’s stable:
ManipalCigna Health Insurance Company is a collaborative partnership between Manipal Group and Cigna and together they have over 200 years of expertise in the healthcare business. And while the company has shown some potential recently, it still only corners a small part of the Indian market.
Also, they have a settlement ratio of 90% with more than 8,500+ network hospitals in tow.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Mediclaim |  ProHealth Accumulate |
|---|---|---|
| Network hospitals | 3,139 | 8,500+ |
| Claim settlement ratio (avg. of last 3 years) | 99% | 90% |
| Co-payment | No | 20% (if purchased after turning 65) |
| Room rent | Any Room (up to 1% of sum insured) | Single Private room |
| Disease sub-limit | No | No |
| Pre existing diseases waiting | 4 years | 3 years |
| Pre/Post hospitalization | 30/60 days | 60/90 days |
| No claim bonus | 25% per year (up to 50%) | 5% per year (up to 200%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness) | 100% restoration (unlimited no. of times for different illness) |
| Health check-up | Once every 3 years | Once every 3 years |
| Maternity | ||
| Out Patient Department | Up to ₹20,000 (Annually) | |
| Day care |
Feature Comparison
Co payment
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Mediclaim doesn’t impose a mandatory co-payment clause whereas ProHealth Accumulate imposes a co-payment clause of 20% if you purchase after turning 65.
Room rent
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, Mediclaim only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured and ProHealth Accumulate lets you stay in a single private room. In effect, both policies impose restrictions on the kind of room you can pick.
Sub limits
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, neither Mediclaim imposes disease-wise sub-limits nor does ProHealth Accumulate
Waiting periods for pre-existing diseases
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. In this case, Mediclaim imposes a waiting period of 4 years on pre-existing diseases while ProHealth Accumulate extends a waiting period of 3 years on existing conditions.
Pre and post Hospitalization expenses
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Mediclaim covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, ProHealth Accumulate covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits
No claim bonus
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Mediclaim offers a no-claim bonus of 25% whereas ProHealth Accumulate offers a no-claim bonus of 5%. And the no-claim bonus may be capped at different levels too.
Domiciliary
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Mediclaim doesn’t offer domiciliary protection whereas ProHealth Accumulate offers domiciliary cover.
Ayush treatments
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Mediclaim covers Ayush procedures and ProHealth Accumulate also extends coverage for Ayush treatments.
Maternity benefits
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, neither Mediclaim offers maternity cover nor does ProHealth Accumulate.
Out Patient Department (OPD)
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Mediclaim doesn’t offer OPD protection whereas ProHealth Accumulate offers OPD cover.
Final Conclusion
It should be obvious that ProHealth Accumulate offers substantially better features when compared to Mediclaim. But considering Manipal Cigna has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that New India Assurance has to offer.
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