Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Activ Health Platinum Essential is sold by Aditya Birla and Health Gain is sold by Star Health. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products are built for very different use cases. Activ Health Platinum Essential is built for senior citizens. Health Gain is built for those seeking outpatient coverage. And that means you’re comparing very different products here. So analysis will be tainted by this distinction.
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 Activ Health Platinum Essential. The product comes from Aditya Birla’s stable:
Aditya Birla started operations in the year 2016 as a subsidiary of Aditya Birla Capital Ltd., which in turn happens to be a joint venture between the famed Aditya Birla Group and MMI Holdings (South Africa).
The company holds a claim settlement ratio of 95% along with a network of more than 11,000+ hospitals, and extremely interesting products for young people with a focus on fitness. And considering their track record has been improving rapidly they are emerging as a top health insurer in the market.
Health Gain meanwhile comes from Star Health’s stable:
Star Health Insurance is India's first standalone health insurance firm. And with an army of retail advisors pushing their products across the country, they’ve managed to capture a fair share of the Indian market.
The company also boasts a network of over 14,000+ hospitals and a decent claim settlement ratio of 83%.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Activ Health Platinum Essential |  Health Gain |
|---|---|---|
| Network hospitals | 11,000+ | 14,000+ |
| Claim settlement ratio (avg. of last 3 years) | 95% | 83% |
| Co-payment | 20% | 20% (if purchased after turning 61) |
| Room rent | Any Room | Any Room (up to 1% of sum insured) |
| Disease sub-limit | Yes | Yes |
| Pre existing diseases waiting | - | 3 years |
| Pre/Post hospitalization | 30/60 days | 30/60 days |
| No claim bonus | 10% per year (up to 100%) | |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | ||
| Health check-up | Once every year | |
| Maternity | ||
| Out Patient Department | Available | |
| 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, Activ Health Platinum Essential imposes a mandatory co-payment of 20% , whereas Health Gain imposes a co-payment clause of 20% if you purchase after turning 61.
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, Activ Health Platinum Essential lets you stay in Any Room. And Health Gain 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, Activ Health Platinum Essential imposes disease-wise sub-limits on Angioplasty, Knee or hip replacement, Cataract, Cholecystectomy whereas Health Gain imposes sub-limits on Cataracts, Modern Treatments
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, Activ Health Platinum Essential imposes a waiting period of null years on pre-existing diseases while Health Gain 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, Activ Health Platinum Essential covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Health Gain 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, Activ Health Platinum Essential offers a no-claim bonus whereas Health Gain 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, Activ Health Platinum Essential offers domiciliary cover whereas Health Gain doesn’t offer domiciliary protection.
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, Activ Health Platinum Essential covers Ayush procedures and Health Gain 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 Activ Health Platinum Essential offers maternity cover nor does Health Gain.
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, Activ Health Platinum Essential doesn’t offer OPD protection whereas Health Gain offers OPD cover.
Final Conclusion
It should be fairly obvious by now. Activ Health Platinum Essential is best suited for senior citizens while Health Gain makes a lot of sense if you are looking to cover those seeking outpatient coverage. However, considering Star Health has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that Aditya Birla has to offer, if the policy is made available to you.
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