HDFC Life Insurance
Company Ltd is the largest Life insurance company to join the ever growing list of health insurance companies in India. HDFC Life has first time come out with a comprehensive pure protection health insurance plan that reimburses medical expenses incurred in a hospital by the name of HDFC Life Health Assure Plan. So, is Health Assure Plan also one of Individual or the family floater products offered by other health insurance companies? What is it that makes Health Assure different from other health insurance plans already available in the market? Let us take a closer look at this product.
Health Assure Plan offers you to choose two different options with Individual as well as Family Floater plan type, in which you may cover your spouse, children, both parents and parent-in-law.
• Health Assure Silver Plan
• Health Assure Gold Plan
HDFC Life Health Assure Plan provides a host of unique features. The benefit you get will depend upon the plan option you have chosen as mentioned below:
The policy provides Multiplier Limit equal to 50% of policy sum assured in the following year for any of insured members in any year in case of you do not make any claim. Thus, your Annual limit may increase to maximum of 200% of your policy sum assured in case there are no claims in two consecutive years. If you make a claim in any year, the Multiplier Limit will reduce by 50% of your policy Sum assured in the following year. However, Annual Limit will not fall below your policy Sum assured, irrespective of any number of claims in the previous year.
Hospital Cash Benefit
The company will pay per day amount as hospital cash benefit for each subsequent day of hospitalization, if you have taken Gold Plan option (Individual or Floater) and are admitted to a hospital for period exceeding 24 continuous hours. However, this benefit is not a stand-alone benefit and shall be paid along with settlement of claim payable under Inpatient Hospitalization Benefit and is payable from within the Annual limit.
Under the Gold Plan option, the company will provide you every three years starting from second year policy Wellness Health Check-up Vouchers which can be redeemed at any of the network diagnostic center towards Health Check-up subject to a value to 0.1% of Sum Assured and must be utilized within 1 year of issue. The value of these Wellness Vouchers does not reduce your Annual Limit.
Guaranteed Life Time Renewability
The plan offers you guaranteed renewability for life time provided that you should pay the premiums in time and the policy continues without any break in cover. This feature of the product makes it stand out among the numerous other family floater products available in the market. Lot of health insurance companies doesn’t offer renewal of health insurance policies after the age of 65 years or 70 years.
Conversion Option for Children
The plan offers the flexibility for your dependent children covered under family floater plans who have attained the age of 18 years to convert their cover in to a separate policy with continuity of benefits up to the Sum assured in the family floater policy wherein they were initially covered.
Premium Guarantee Renewable for 3 years
The company gives fix premium renewal guarantee for a period of three years from the date of inception or renewal of the policy. It means the premium does not change during the three years even if you make a claim or with increased age.
Other features of the product include general features which are offered by most of the health insurance companies in their policies. Some of these features are as below:
• Cashless Treatment: The Company has tied up with more than 4,500 Network hospitals across India and offers its customers the facility of cashless treatment by providing them health identity cards.
• Free Look Period: The product comes with a 15 day free look period. Within this period if the policyholder is not satisfied with the terms and conditions of the policy, then he can return the policy. The company shall arrange to refund the premium amount paid subject to deduction of the proportionate risk premium for the period of cover, the expenses incurred on medical examination and stamp duty, if any.
• Pre and Post Hospitalization Expenses: The policy covers medical expenses incurred up to 30 days prior immediately before admission to the hospital and 60 days after discharge from the hospital.
• Day Care benefit: The Company will pay actual permissible medical expenses incurred upon undergoing any of 200 the day care procedure listed where 24 hours hospitalization is not necessary subject to maximum amount of 10% of policy Sum Insured.
• Maternity Benefit: Under Gold Family Floater Plan, the company will reimburse the actual medical expenses incurred by you towards Hospitalization as an inpatient due to pregnancy or any other complications thereof, including delivery and medical termination of pregnancy subject to a maximum limit of 3% of the sum assured per pregnancy, provide that only for two episodes of pregnancy in the life time of insured life.
• Tax Benefits: The premium paid under the policy is eligible for tax deduction under Section 80D of the Income Tax Act. The maximum deduction can be claimed currently is Rs 35,000(inclusive of additional deduction of Rs 20,000 in case of insurance on the health of parent(s) who are senior citizen).
Cost Sharing and Pro-ration of Claims
The company will charge co-pay clause of 20%, if the policyholder is taking treatment in non-network hospitals. Co-pay means the percentage of admissible claim amount which has to be fully borne by you. Further, if you opt for a room that costs higher than the room rent that you are eligible for, then the total eligibly medical bill will be settled on a pro rata basis irrespective of whether you are admitted into a network or non-net work hospital.
What is not covered?
• Medical including Maternity Benefits will not be available for Pre-existing Conditions until 36 months of continuous coverage have elapsed since the inception of the first Policy with you.
• No treatment taken during the first 30 days since the commencement of the Policy, unless the treatment needed is a result of an Accident or Emergency.
• Treatments for ENT, Gastrointestinal, Gynecological and Urogenital will be covered only after 24 consecutively months of continuous coverage of the policy.
• It will not cover some things permanently like treatment received outside India, Non-Allopathic and Experimental Treatment, breach of law, Conflicts and Disasters, Military Services, Aviation, Hazardous activities, Self inflicted injuries or attempted suicide, Substance misuse and De-addiction, Rehabilitation and Convalescence, Cosmetic Treatments, Sleep and Obesity, Harmon Replacement Therapy, Dental Treatment except due to accident, Routine Eye(s) and Ear ailments, HIV/AIDS, Sexually transmitted disease and other Sexual Problems, Circumcision, voluntary miscarriage, pre and post hospitalization expenses exclusion for Maternity Benefit, Failure to take Reasonable Medical care, Psychological disorder, Congenital Conditions, Domiciliary Treatment, Stem Cell Banking and Immunizations & Nutritional Treatment. Read also: Common Exclusion Clauses in Health Insurance!
As we saw above, the policy offers some very good and unique benefits compared to other health insurance products available in the market. But it may just be a matter of time before other companies also follow suit. If that happens the customer will truly be spoilt for choice of good plans available in the market. This will ultimately benefit the customer.
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Suresh K Narula is founder and Principal Financial Planner at Prudent Financial Planners. He has earned the professional CERITIFIED FINANCIAL PLANNER and got registered with SEBI as Investment Advisor. He writes on personal and financial planning
articles and got published in Dainik Bhaskar, Business Bhaskar and The Financial Planner's Guild, India. He is also a member of Financial Planner's Guild India ( An association of practicing SEBI registered Investment advisers) to create awareness about Financial Planning in general public, promote professional excellence and ensure high quality practice standards. Suresh received his an M.com from Himachal Pardesh University and an MFC from Punjab University, Chandigarh. He can be reached at firstname.lastname@example.org