Overview
The Royal Sundaram NextGen plan is a basic health insurance policy offering customizable features like reduced waiting periods for pre-existing conditions (Asthma, Hypertension, High Cholesterol, Diabetes), consumables cover and OPD add-ons, and enhanced pre- and post-hospitalization benefits. The plan has no co-payment clause and no disease wise sub-limits, ensuring full coverage up to the sum insured without additional out-of-pocket expenses.
Experts Review
Written by Nikhil Nair
Senior Writer
The Royal Sundaram NextGen plan is a versatile health insurance solution with several customizable options. The plan covers in-patient care, modern treatments, pre-hospitalization expenses for up to 30 days, and post-hospitalization expenses for up to 60 days—all up to the sum insured. It also includes coverage for day care treatments, organ donor expenses, and domiciliary hospitalization, again up to the full sum insured.
Further, its reduced waiting periods for specific pre-existing conditions add-on and reload multiplier and OPD services add-on’s enhance its appeal. The plan's lack of co-payment and absence of disease-wise sub-limits ensure comprehensive coverage without additional financial burdens.
That said, the plan has several limitations. Room rent restrictions (Single Private A/C Room) and low No-Claim Bonuses (10% up to 50% of Base SI) may not be as competitive as other policies. The default restoration benefit is limited, which might not provide adequate financial protection during multiple claims.
While add-ons improve the policy, they increase premiums and reduce overall comprehensiveness. Royal Sundaram's average claim settlement ratio of 94% (across 2021-24) is competitive, but buyers should weigh all factors before opting for this policy.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No significant drawbacks found.
Royal Sundaram
Key Insights
Founded
2001
Royal Sundaram was established 24 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
93% claims settled in 30 Days
Royal Sundaram settles 93% of all claims it receives demonstrating strong credibility.
Network Hospitals
10,000+
Royal Sundaram maintains a moderate network of 10,000 hospitals, offering reasonable coverage across key locations.
Complaints
17 complaints per 10,000 claims registered
Royal Sundaram experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Customisable
Choose a co-payment between 5% and 20% to reduce premiums.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Customisable
Change Single Private Room to Any Room or Shared Accommodation.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Customisable
For any illness: Pre existing disease waiting period is modified/reduced from 3 Years to 1 or 2 Years.
Customisable
For Asthma, Hypertension, High Cholesterol, Diabetes.: Pre existing disease waiting period is reduced from 3 Years to 30 Days.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Reduction in PED
Recommended
For any illness: Pre existing disease waiting period is modified/reduced from 3 Years to 1 or 2 Years.
ABCD Benefit
Recommended
For Asthma, Hypertension, High Cholesterol, Diabetes.: Pre existing disease waiting period is reduced from 3 Years to 30 Days.
Consumables
Recommended
Covers list of 68 non-medical items as per list I
OPD
Get coverage for OPD and tele consultations with general physician and specialist doctors, discount on pharmacy, diagnostic test & health check-ups.
Maternity Benefits
Get discount on maternity related treatment availed at a specified list of networks.
Voluntary Co-Payment
Choose a co-payment between 5% and 20% to reduce premiums.
Room Rent Modifier
Change Single Private Room to Any Room or Shared Accommodation.
Health & Wellness
Get tele-consultation with doctors whenever you require, a virtual health coach to help you boost your health and Health & Wellness app to manage yours health status.
Reload Multiplier
Restores the cover unlimited times up to 100% of the sum insured for any illness.
Pre-Post Hospitalisation Cover
Extends the pre-hospitalization from 30 days to 60 days and post-hospitalization from 90 days to 180 days.
Treatment at Home
Covers the expenses for treatment taken at home for a maximum of 15 days upto ₹50,000 per incidence. A maximum of 2 incidences will be covered in a policy year.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Cataract
Stones in biliary and urinary systems
Hernia / Hydrocele (all types)
Hysterectomy for any benign disorder
Lumps / Cysts / Nodules / Polyps / Internal tumours
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting periodCustomisable
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. This policy also further allows to reduce the PED waiting period to 1 or 2 Years for all diseases and to 30 Days for certain diseases.
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Frequently Asked Questions
Does NextGen have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does NextGen have room rent restrictions?
Does NextGen offer a restoration benefit?
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