Aegon Religare’s iHealth is a good surgical benefit plan competing with LIC’s Jeevan Arogya and ICICI Pru Life’s Hospital Care II. Should you go for it?

Aegon Religare’s iHealth is a new entrant online health product from a life insurance company. It is a fixed-benefit product offering daily hospitalisation cash, surgical cash benefit and critical illness cover. It competes with LIC’s Jeevan Arogya and ICICI Pru Life’s Hospital Care II. Mediclaim customers who feel cheated by the insurer/TPA making deductions in claims payment may be attracted to this fixed-benefit option.
 

While the main advantage with mediclaim is that it covers any hospitalisation, surgical benefit plan will pay only for surgeries and the amount of payment will vary as per a pre-defined table. Surgical benefit plans are a good option and can work along with mediclaim. You can get payment from both—the mediclaim policy as well as fixed-benefit plan.
 

Aegon Religare’s iHealth covers 849 surgeries which are classified under six categories. The surgeries falling in category-1 are paid up to the sum insured; the benefits are the least for category-6 surgeries, which is any surgery not in the list of 849 surgeries. The sum insured under the silver, gold, diamond and platinum plans are Rs2 lakh, Rs3 lakh, Rs4 lakh and Rs5 lakh respectively. The exit age is 85 years; it is 75 years for critical illness cover. Some procedures could have two-year waiting period. The default is 90 days waiting for non-accident ailments.
 

Positives of Aegon Religare iHealth:
 

• •Surgeries covered – It covers 849 surgeries including 240 day-care procedures.
   
• •Premium – The premium for a 35 year old buying Rs3 lakh cover will be Rs4704.
   
• •Cashless network – It has 3,000 hospitals including big names like Hinduja, Jaslok, Lilavati, Ambani hospital in Mumbai. You will have to deal with the Third Party Administrator (TPA) for cashless service. Paramount is the TPA.
   

Negatives of Aegon Religare iHealth:
 

• •Pre-existing – Pre-existing diseases (PED) are not covered by iHealth, which is also the case for other surgical benefit products. This is a disadvantage considering that mediclaim will cover pre-existing diseases after four years.
   
• •Impact of PED exclusion – There is possibility of claims rejection due to it being linked to PED. Just like early death claims in life insurance are scrutinized to greater extent, early health claims will be likely to be analyzed for links to PED. While this is true for all surgical benefit products, it is very much applicable to Aegon Religare whose disclosures clearly state extremely high percentage of early death claims being rejected for life insurance products.
   
• •Premium same for only three years, not lifetime – This is obvious as medical inflation cannot be easily predicted. 
   
• •Maximum age of renewal of 85 years.
   
• •Kidney stone, piles, etc are not defined in the list of 849 procedures and hence they will be considered as category-6 which pays a pittance.
   

While analyzing the surgical benefit products, there is a need to check the benefit paid for each procedure. All the products give classification of category for each procedure and have a pre-defined benefit for each category. Unfortunately, common man cannot understand all medical procedures and their intricacies and hence may be under impression that the product he purchases will cover the surgery and pay properly. If the surgery is assigned a low category or is not in the list (default is lowest category), the policy will pay peanuts and will defeat the purpose of taking health insurance. Mediclaim is a safe option even with its fine prints.
 

Check if each procedure has broader definition and not too restrictive. Example – All the three insurance products assign highest category for Coronary Artery Bypass Graft (CABG). Aegon Religare iHealth and ICICI Pru Life Hospital Care II pays full sum insured for it (broad definition); LIC Jeevan Arogya will also pay 100% only if two or more arteries are bypassed via open chest surgery (restrictive wordings).

Source – Moneylife research. If procedure is not listed, it will be considered lowest category and paid accordingly. Surgical product benefits and other benefits like hospital cash, etc will vary.