Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Health Premia Platinum is sold by Max Bupa and iHealth Plus is sold by ICICI Lombard. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both policies are premium. They offer comprehensive protection, throw in a whole host of benefits and cover a whole host of use cases. So if you are looking for something relatively inexpensive, then both these policies may not cut it.
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 Health Premia Platinum. The product comes from Niva Bupa (erstwhile Max Bupa)’s stable:
Founded in 2008, Niva Bupa (erstwhile Max Bupa) is one of the leading health insurance companies in India. While they have had a bit of a tumultuous time with their promoters, they still sell an impressive suite of products across multiple categories.
And they also boast a claim settlement ratio of 91%, with a network of more than 10,000+ hospitals.
iHealth Plus meanwhile comes from ICICI Lombard’s stable:
ICICI Lombard Health Insurance company is a joint venture between India's ICICI Bank and Canada's Fairfax Holdings. They are one of the leading insurance companies with over 270 branches spread across India.
However, with a claim settlement ratio of 85% and a measly network of 7,500+ hospitals, their performance needs significant improvement.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Health Premia Platinum |  iHealth Plus |
|---|---|---|
| Network hospitals | 10,000+ | 7,500+ |
| Claim settlement ratio (avg. of last 3 years) | 91% | 85% |
| Co-payment | No | No |
| Room rent | Any Room | Any Room |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 2 years | 2 years |
| Pre/Post hospitalization | 90/180 days | 30/60 days |
| No claim bonus | 10% per year (up to 100%) | 10% per year (up to 50%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for any illness) | 100% restoration (once for different illness) |
| Health check-up | Once every year | Once every year |
| Maternity | Available (up to ₹2,00,000 after 2 years) | Available (up to ₹50,000 after 3 years) |
| Out Patient Department | Up to ₹50,000 (Annually) | Up to ₹5,000 (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, Health Premia Platinum doesn’t impose a co-payment clause. And neither does iHealth Plus.
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, Health Premia Platinum doesn’t impose any restrictions on the kind of room you can pick. And iHealth Plus also doesn’t impose any restrictions on this front. You can pick any room you want.
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, Health Premia Platinum doesn’t impose a disease wise sub-limit whereas iHealth Plus imposes disease-wise sub-limits on Cataracts.
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, Health Premia Platinum imposes a 2 year waiting period on pre-existing diseases and iHealth Plus will similarly tell you to wait 2 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, Health Premia Platinum covers expenses incurred 90 days before hospitalization and expenses incurred 180 days post-hospitalization. Meanwhile, iHealth Plus 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. And in this case, Health Premia Platinum offers a no-claim bonus of 10% and iHealth Plus similarly extends a 10% 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, Health Premia Platinum offers domiciliary cover whereas iHealth Plus 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, Health Premia Platinum covers Ayush procedures and iHealth Plus 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, Health Premia Platinum offers maternity cover and iHealth Plus offers maternity cover too, although the sub-limits for normal delivery and C-section procedures may be different, including the waiting period.
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, Health Premia Platinum offers OPD coverage, and iHealth Plus also offers OPD coverage, although the sub-limits may be different.
Final Conclusion
After considering all the features on hand and the claim settlement ratio of Max Bupa, we believe that Health Premia Platinum is a better alternative to iHealth Plus for most use cases that we’ve evaluated so far.
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