The rollout of a new insurance product is nothing ingenious, given the plethora of companies in the fray and customer requirements to fulfil.
However, we have a unique case of a hospital chain launching a health insurance product currently released as a trial version.
Narayana Hrudayalaya – a group that runs several hospitals in a few select cities in India – is rolling out a new medical policy under the Narayana Insurance banner, Aditi.
Earlier, we had Apollo Munich health insurance from a well-known hospital group. However, it was subsequently sold to HDFC Ergo in 2019.
Read on for more on Aditi health insurance to gain an informed perspective on what works and what may have negative effects.
Reasonable coverage
The new health insurance policy is in trial mode. Aditi is available only for residents of Mysore, Chamaraj Nagar, Coorg, Mandya, and Hassan. Residential address proof is required for the policy to be issued. Once this experimental phase is successful, the product will be rolled out to other cities.
This policy comes with a sum assured of ₹5 lakh for general hospitalisation and ₹1 crore for surgeries.
In-patient treatments and surgeries are available on cashless mode at the network hospitals – only the Narayana Hrudayalaya chain. Currently, there are 21 hospitals in India spread across cities such as Bangalore, Mysore, Ahmedabad, Mumbai, Kolkata, Delhi, and Raipur.
The good part about Aditi is that there is no initial waiting period, and unlike other policies, there are no waiting periods for specific illnesses.
For pre-existing illnesses, there is no waiting period unless specified before the commencement of the policy.
The caveat is that if you want to take the policy, you and other family members you want to be covered must undergo detailed medical tests and examinations to determine eligibility for all benefits.
As with other insurance policies, pre- and post-hospitalisation expenses, ambulance charges, day care procedures, specific modern as well as alternative treatments are all covered.
Another interesting policy point is that consumables are fully covered by Aditi health insurance. While most are covered, a few others, such as masks, handwash, tissues, caps, etc, are subsumed into the room charges.
Treatment is allowed only in the general ward of the Narayana Hospitals network and not in any special rooms for Aditi policyholders.
Restrictions and premiums
The health insurance policy severely restricts coverage in any hospital outside the Narayana Hrudayalaya network.
Coverage in non-network hospitals is allowed only in emergencies and serious medical conditions that developed abruptly, and would need urgent treatment to prevent death, disability, or any other serious long-term health implications.
If the specific treatment is not available in the Narayana Hrudayalaya chain, treatment at non-network hospitals may also be allowed by the Aditi policy on a selective basis.
Also, if a person faces emergencies while travelling to a location where Narayana Hrudayalaya hospitals are unavailable, treatment may be allowed at non-network hospitals. However, in such cases, the policyholder would have to produce proof of travel and a satisfactory reason for doing so the insurer to accept the claim.
For a family of four, where the eldest member is 45 years old (in the best of health), the Aditi health insurance policy has two premium plans. Narayana Aditi plan 1 comes with a premium of ₹13,819 (including GST, but excluding stamp duty charges) for a floater coverage of ₹5 lakh for regular treatments and ₹1 crore for surgeries.
The other plan 2 comes with a premium of ₹14,107 for the same coverage as mentioned above.
Plan 1 requires you to pay ₹2,000 per day as deductible for all claims, including surgeries and non-surgical, in-patient treatments.
However, opting for plan 2 means you will not have to pay ₹2,000 per day as deductible for surgeries, though you will have to pay for non-surgical procedures.
No co-pay is required for treatment at Narayana Hrudayalaya hospitals.
However, a 10 per cent co-payment applies if treatment is taken at non-network hospitals and intimation is not given 48 hours before prior admission in the case of regular treatments or within 24 hours of admission in the case of emergencies.
Should you opt for it?
As such, the policy is currently available in only a few districts of Karnataka. The rest of the country should wait for it to be rolled out across India.
Given that Narayana Hrudayalaya has extensive capabilities in surgical and non-surgical medical treatments over a wide gamut of ailments, most diseases can be treated in the chain.
Also, if the hospital chain owns the insurance company, cashless settlement can be smooth for policyholders.
The premiums are also reasonably priced; covering consumables is another attractive policy addition. The absence of a waiting period requirement also adds to the trust factor.
However, the restriction on non-network treatments, co-pay clauses, and daily deductibles are minor irritants. Also, with tests mandated, those with pre-existing ailments or other medical conditions may find that their premiums are higher.
All said, Narayana Aditi is still a reasonably sound health insurance policy for those with easy access to the network hospitals.