How good is L & T’s Health Insurance plan, Medisure Prime – a Preview

Just yesterday, we realized that L&T Insurance has finally received long pending approval from IRDA, and are launching their Health Insurance Product. Being in this industry for a long time now, its very interesting to observe what innovation, an admired group like L&T would bring to a product like Health Insurance in India. After going through the material including the policy wordings of the product, I must say, I was not let down. In fact, I am very excited about the product, looking at the fresh and new experience they aspire to bring to a market mired with dissatisfied customers.

We all agree, that the single biggest pain point a customer buying Health Insurance is wary of is Claims settlement. The product "Medisure Prime launched by L&T Insurance is an attempt to fill this gap, through a host of service promises.

Here's a preview of the product. We will keep updating this space, as and when we get more information.

Highlight of the L&T Health Insurance product

If we have to pick a single innovation this product brings to customers, it has to be the Service Promises. The  L & T Health Insurance product offers a host of unique service promises as a part of the mediclaim policy, without any additional costs attached:  

• Cashless Claims Service Assurance

• The plan assures a decision (approval or denial) on Cashless Requests, failing which a fixed compensation of Rs. 1,000 will be paid to the insured.
  • Requests raised on working days between 9 am to 9 pm will be provided a decision within 6 business hours.
  • Requests raised during non-working hours will be provided a decision within 8 hours. 

• Reimbursement Claims Service Assurance
  

• Reimbursement claim settlement has been assured within 6 working days of receipt of complete documents, failing which a fixed compensation of Rs. 1000 will be paid to the insured.

• Cashless Concierge service
  

• Any individual who has gone through a cashless settlement on his own would know, that it is a toilsome process, involving coordination with the Hospital and the Insurance Company’s Processing centre. L&T’s concierge service is a step to help customers to get a cashless request smoothly settled. A representative of L&T Health Insurance would be available on request in select cities, to personally assist the customer during the Cashless procedure between 9 am to 9 pm on working days. Interestingly, it’s important to note that Medimanage has been offering this service to its customers since the last 2 years. 

• Case manager:

• In selected cities, customers would have access to a Policy manager who would be available on call and meet customers to explain the benefits and clarify any doubts on the Policy.

Notable good features in L&T Medi Insure Prime:

• Double Critical Illness Cover: 
  

• In case of hospitalization under any of the 9 Critical illnesses like Cancer, Bypass, First Heart Attack, Kidney Failure etc. mentioned in the policy, the maximum amount you can claim (the sum insured) would be doubled for the treatment of this critical illness. This feature does exist in the Reliance’s Healthwise Gold product.

• Full Sum Insured Cover always for Accident:  

•  This is a unique feature, the customer would enjoy in this product, a full sum insured under the policy, for any hospitalization due to an accident, irrespective of any sum insured already consumed in the policy term. Which means, if in a Family Floater with a sum insured of Rs. 2 Lakhs, there has been a claim for say Rs. 1.50 Lakh for Angioplasty, and in a month or two, another family member meets with an unfortunate accident, the accident claim would be entitled to full sum insured of Rs. 2 Lakhs, in spite of the fact that a sum insured of Rs. 1.50 Lakhs has already been consumed.

• Pre-existing cover from 3^rd Year:
  

• Unlike most products, which have a 4 year waiting period for Pre-existing ailments, the L&T Health insurance product has only 2 years waiting periods. Of course, it remains to be seen how the company treats adverse or existing chronic health cases like Cancer, Cardiac, and Kidney like diseases.
  

• Lifetime Renewal:
  

• Like most Health Insurance products recently launched, this product also guarantees renewal of the policy across the lifetime of the insured customers. With other Health Insurance companies following suit, this is great news for consumers. 

Exclusions you need to know:

The Exclusions of the product are pretty standard to all other products in the market. 

One important exclusion, you need to note

before going with this product is the 25 % Copay for claims made by any Insured Person above 70 years. So remember, though, the policy is for lifetime, you need to know that 25% of the claim payable as per the policy would be deducted for claims made after the age of 70. 

Price Point:

OK, this looks like an expensive product.

Let's do a simple comparison for a family, Husband 30 years, Wife 29 years, Kid 2 years for a Rs. 3 Lakh Cover.

Note, we have taken the lowest product category in all Companies. L&T has only one product.

This comparison shows that L&T Medisure is the most expensive product in the Health Insurance market today. Ofcourse, as mentioned earlier it does provide certain differential features, which need to be taken into account, before you rule out the product. For instance, as discussed above, for certain ailments, this product provides double sum insured, so when you are paying for a Rs. 3 Lakhs cover, you are also buying a Rs. 6 Lakhs Cover for treatment of certain major ailments. Such benefits are valuable in the long run, and hence the price is bound to be higher. 

Now it depends on us, the customers, whether we find enough value in the additional benefits to pay the additional premium. For instance, the difference between Apollo Munich and L&T above is Rs. 4243/-. You need to evaluate whether the differentials like "Reinstatement of Sum Insured", "Double Cover for Critical Illness", "Assurance of Response". etc. are worth the 4K difference. If, yes, please go ahead and signup.

In case you have any questions, please feel free to use the comments section. 

Here are links to details on the product:

L&T Health Insurance Policy Wordings.pdf (195.53 kb)

L&T Health Insurance Brochure.pdf (1.16 mb)