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PremiumNarayana Health Insurance, a venture by Bengaluru-based hospital chain Narayana Health, announced its first product, a ‘family floater’ policy called ‘Aditi’, offering a ‘comprehensive coverage’ of ₹1 crore for a premium of ₹10,000 per year.
The product is being seen as the private sector’s answer to the government’s Ayushman Bharat, which does not cover many critical illnesses and has a sum insured of ₹5 lakh that is considered inadequate for surgeries.
But will the product fit the ‘affordable tag’? Experts who track the industry don’t think so, at least for now, as they believe that it has many gaps to fill. As the hospital chain said during the launch of the product on July 1, the eye-catching ₹1 crore cover is only for surgeries and for medical management the limit is only ₹5 lakh, the same as that of Ayushman Bharat.
For starters, the coverage outside Narayana Health network is quite limited. The policy comes with a daily deductible of ₹2000 per day on all admissible claims for non-surgery or non-surgical procedures.
“The cover is too narrow in terms of hospitals as well as in terms of medical procedures," Nikhil Jha, who follows life and health insurance sectors closely, posted on X (formerly Twitter). “You need insurance without any restrictions and such a plan would be for people who are poor and want an alternative to Ayushman Bharat. Until Narayana Health comes with a better comprehensive cover, this will not move the industry at all," he said.
“Even though it looks attractive in plain, it comes with a lot of ifs and buts," according to BasuNivesh, a provider of certified financial planning services. “Restrictions of treatment only in the Narayana Health network are the biggest hindrance for many."
Though there is no co-payment, a condition where the insured agrees to pay a fixed amount or percentage of the claim out of his pocket, in ‘Aditi’, a 10% co-payment is applicable if the insured person seeks treatment at a non-network hospital and does not inform Narayana within the time stipulated in the policy. Moreover, the plan covers only listed daycare treatments and not all procedures.
The other drawback is that the coverage is restricted to the general ward. “The coverage is applicable only to the general ward. If you take admission to special rooms, then the insurance company will pay on a pro-rata basis applicable to the general ward," according to BasuNivesh. “The plan covers patients being admitted only to the general ward and does not cover medical management," Jha said.
The insured and her/his family need to undergo a free medical examination to check eligibility for Narayana Aditi. Despite the disadvantages Narayana Aditi has quite a few things going for it. Here is the list of positives.
The product is currently available only in Mysuru, Chamraj Nagar, Coorg, Mandya and Hassan districts of Karnataka and Narayana plans to expand the reach. The principal insured must have a proof of address from these districts.
Allirajan M is a journalist with over two decades of experience. He has worked with several leading media organisations in the country and has been writing on mutual funds for nearly 16 years.
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