National Insurance National Mediclaim policy vs New India Assurance Sixty Plus Mediclaim
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Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. National Mediclaim policy is sold by National Insurance and Sixty Plus Mediclaim is sold by New India Assurance. 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. National Mediclaim policy is quite basic. It offers little protection and it’s a generic policy that anybody could pick off the shelf. However, Sixty Plus Mediclaim is specifically designed for senior citizens. So in many ways, you’re 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 National Mediclaim policy. The product comes from National Insurance’s stable:
National Insurance is the country's oldest general insurance firm and is wholly owned by the Government of India. That means, despite a claim settlement ratio of 93% and over 3,200 network hospitals it can be a bit difficult to reach the insurer when you need them the most. Perhaps due to the fact that they are still a public sector enterprise.
Sixty Plus Mediclaim meanwhile 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.
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Compare Insurances Insurance Parameters Recommended Not Recommended | National Mediclaim policy | Sixty Plus Mediclaim |
|---|---|---|
| Network hospitals | 3,200+ | 3,139 |
| Claim settlement ratio (avg. of last 3 years) | 93% | 99% |
| Co-payment | No | 10% |
| Room rent | Any Room (up to 1% of sum insured) | Any Room (up to 1% of sum insured) |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 4 years | 4 years |
| Pre/Post hospitalization | 45/60 days | 30/60 days |
| No claim bonus | 5% per year (up to 50%) | |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for different illness) | |
| Health check-up | Once every 4 years | |
| Maternity | ||
| Out Patient Department | ||
| 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. However in this case National Mediclaim policy doesn’t impose a mandatory co-payment clause whereas Sixty Plus Mediclaim imposes a mandatory co-payment of 10%.
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, National Mediclaim policy only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured. And Sixty Plus Mediclaim does the same i.e. it only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured.
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, National Mediclaim policy doesn’t impose a disease wise sub-limit whereas Sixty Plus Mediclaim imposes disease-wise sub-limits on Angiography, Joint replacement, major cancer surgeries.
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. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, National Mediclaim policy imposes a 4 year waiting period on pre-existing diseases and Sixty Plus Mediclaim will similarly tell you to wait 4 years before making a claim related to your pre-existing diseases
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, National Mediclaim policy covers expenses incurred 45 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Sixty Plus Mediclaim covers expenses incurred 30 days before hospitalization and expenses incurred 60 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, National Mediclaim policy offers a no-claim bonus whereas Sixty Plus Mediclaim doesn’t offer a no-claim bonus.
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, neither National Mediclaim policy offers domiciliary cover nor does Sixty Plus Mediclaim
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 National Mediclaim policy covers Ayush treatments whereas Sixty Plus Mediclaim doesn’t extend 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 National Mediclaim policy offers maternity cover nor does Sixty Plus Mediclaim.
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, neither National Mediclaim policy extends coverage for outpatient consultations, nor does Sixty Plus Mediclaim.
Final Conclusion
If you’re specifically looking to buy a policy for senior citizens, Sixty Plus Mediclaim makes a lot of sense. But considering National Insurance 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, if the policy is made available to you.
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