Overview
The United India Individual Gold plan is a health insurance policy designed for individuals aged 36 to 60, offering sum insured options from ₹2 lakhs to ₹10 lakhs. The plan features no co-payment and room rent capped at 1% of the sum insured for the room [and 2% for ICU/ICCU]. However, it imposes disease-wise sub-limits on specific treatments [like cataract, hernia], making it a moderate coverage option for middle-aged individuals.
Experts Review
Written by Ishita Jain
Editor
The United India Individual Gold plan provides essential health coverage for individuals aged 36 to 60, with sum insured options up to ₹10 lakhs. Its key feature is the absence of a co-payment, meaning the insurer bears the full hospitalization cost up to the sum insured, which is beneficial for policyholders, as it avoids out-of-pocket expenses.
However, the policy has notable limitations. Unlike the Platinum variant, the Gold plan imposes disease-wise sub-limits on procedures such as cataract surgery, hernia repair, and hysterectomy, thereby restricting claim amounts for these specific conditions. Both plans restrict room rent to 1% of the sum insured [ICU/ICCU: 2% of SI], which could lead to additional expenses if higher room categories are chosen.
Premiums for the Gold plan are generally 15-20% lower than those for the Platinum variant, reflecting its more limited coverage and more extended waiting periods. Operationally, United India Insurance, being a public-sector insurer, has a claim settlement ratio of around 94% [avg. Of 2021-24], but may experience slower claim processing than private peers.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Maternity benefits not offered, which is a key feature.
United India
Key Insights
Founded
1938
United India was established 87 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
94% claims settled in 30 Days
United India settles 94% of all claims it receives demonstrating strong credibility.
Network Hospitals
4,000+
United India has a limited network of 4,000 hospitals, which may restrict access to cashless services for policyholders.
Complaints
13 complaints per 10,000 claims registered
United India experiences a moderate number of complaints, indicating room for improvement in addressing customer concerns.
Features
All
Great
Good
Bad
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.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Cataracts, Hernia, Hysterectomy and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
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.
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
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 2 days, with a maximum payout of ₹500-2000 for up to 10 days.
Hospital Cash
The insurer pays a lumpsum by adding a fixed sum (daily cash) every day until the day of discharge so you can deal with any potential loss in income during this time. The money will be reimbursed to you after you submit the required documents post-discharge, and while this looks like a neat benefit to have, we don’t recommend it since the benefit doesn’t compensate for the extra premium you pay.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Artificial life maintenance including life support machine use, from the date of confirmation by the treating doctor that the patient is in a vegetative state.
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.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy .
24 Months Waiting Period
Cataract
Benign Prostatic Hypertrophy
Piles, Fissures and Fistula-in-Ano
Sinusitis and related disorders
Waiting Period
30 days Initial waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard overall. However, there is no specific illness waiting period which is a plus.
What's missing in the policy
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
V
Vimal S (new)
Designed for individuals aged 36 to 60, catering to this age group.
V
Vinay V (new)
No co-payment is a good feature, reduces out-of-pocket expenses.
V
Vinod G.
Sum insured options from ₹2 lakhs to ₹10 lakhs.
A
Amrita J (new)
The plan features might be very basic compared to private insurer offerings.
Y
Yusuf P (new)
Straightforward benefits without too many complex features.
A
Aaliya K
Room rent is capped, which can be a limitation in expensive hospitals.
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Frequently Asked Questions
Does Individual Gold Plan 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 to 3-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 Individual Gold Plan have room rent restrictions?
Does Individual Gold Plan offer a restoration benefit?
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