Zone-Based Health Insurance - Demystified

If you think your age, health and sum insured are the only factors deciding your health insurance premium, think again. The city where you reside also determines the cost of health insurance. While metro cities fall in Zone 1, tier 1 cities are in Zone 2 and the rest of India is in Zone 3. Know more about zone-based health insurance premiums in this article.

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      Zone based health insurance pays premium as per the treatment cost prevailing in your city. Here are the details:

       
      1. Premium: - It is based on the medical costs prevailing in a particular city. All cities are classified under Zone 1, 2 and 3.  The advantage of zone-based pricing is that it can lower your premium by up to 10-20%. For instance, if you are 30 years old living in Delhi (under Zone 1), you would have to spend Rs 10,043 to buy Rs 10 lakh coverage under Health Insurance Plan. However, if you buy the same plan in Agra (falls under Zone 3) the premium will come down to Rs 8995. At present, premium structure by zone is offered by L&T Health Insurance, Niva Bupa (Formerly known as Max Bupa), Star Health Insurance, SBI General Insurance, New India Assurance, and Cigna TTK.

      2.  Change in Residence: - If the policyholder changes his residence address from a metro to a small city, the same has to be informed to the insurer so that appropriate zone pricing can be worked out. There will be an endorsement and the insured can take a complete refund. Today, people prefer to avail healthcare facilities in metros. If a customer shifts to a small city but wants to continue treatment in a metro city, he can opt for it by paying for the extra premium.

      3. Advanced treatment: - Some insurers restrict the coverage if a policyholder from a Zone 3 city moves to a Zone 1 city for advanced treatment. For instance, in SBI General Health Insurance, if a person having Zone 2 coverage moves to a Zone 1, he will get 80% of the claim amount. There are policies that insert a co-payment clause for undergoing treatment in bigger cities.  The quantum of restriction varies from policy to policy. Find out how your insurance policy will work if you need advanced treatment.

      The Final Word

      City-based health insurance policies reduce premium cost. But before deciding in on a policy, you need to understand how payouts are made for the treatment carried outside the residence city. In higher age brackets, it is advised to pay an extra premium to get Pan India coverage. Make your decision after weighing in all the options.

      Disclaimer : *Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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      *We will respond in the first instance within 30 minutes of the customers contacting us. 30-minute claim support service is for the purpose of giving reasonable assistance to the policyholder in pursuance of the claim. Settlement of claim (including cashless claim) is the responsibility of the insurer as per policy terms and conditions. The 30- minute claim support is subject to our operations not being impacted by a system failure or force majeure event or for reasons beyond our control. For further details, 24x7 Claims Support Helpline can be reached out at 1800-258-5881.

      *Product information is authentic and solely based on the information received from the Insurer. Policybazaar is acting only as a facilitator and claims settlement shall be at the sole discretion of the Insurer. Policybazaar does not provide any medical or surgical advice or diagnosis and is not responsible for your interactions / treatment by a medical practitioner/hospital. Please consult a registered medical practitioner for any medical or surgical advice. The Information that you obtain or receive from Policybazaar, and its employees, or otherwise on the Website is for informational purposes only. As per the Insurance guidelines, you are allowed to cancel the policy with-in 30 days from the date of Issuance of policy.This option is available incase of policies with a term of one year or more.

      *All the health insurance plans cover hospitalization expenses including COVID-19 treatment cover up to the specified limits. You can also buy specific COVID-19 health insurance policies such as Corona Kavach Policy and Corona Rakshak policy.

      **All savings and online discounts are provided by insurers as per IRDAI approved insurance plans. #Tax Benefits are subject to changes in tax laws. GST Exemptions depend on fulfilment of qualification criteria and submission of relevant documents.

      *₹1748/month is the starting price for a 1 crore health insurance for an 18-year-old male, with no pre-existing diseases. Discount on renewal premium is subject to the number of wellness points earned in the health insurance policy. For more details about the plans, please read the sale brochure carefully to get upto 100% discount on renewal premium.

      *₹400/month is the starting price for ₹ 5 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹541/month is the starting price for ₹ 10 lakh Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹762/month is the starting price for ₹ 1 Crore Health insurance for a 30 year old male & 29 years old female, living in Delhi with no pre-existing diseases

      *₹243/month(₹ 8/day) is the starting price for a 5 lakh health insurance for a 20-year-old male, non-smoker, living in Bengaluru with no pre-existing diseases

      *₹2020/month is the starting price for ₹ 1 Cr Health insurance for a 50 year old male & 50 years old female, living in Bangalore with no pre-existing diseases rounded off to nearest 10.

      *₹390/month (₹13 per day) is starting price for 1 cr. Health insurance for 25 years old male, with pre-existing diseases, residing from tier 1 city rounded off to the nearest 10.

      *No medical tests are required unless requested by the insurer’s underwriter. In-case of pre-existing diseases relevant medical proof would be required as per the terms and condition of the policy opted.

      *The values taken for effective cost calculation are indicative values and may change as per the selected plan.

      *Coverage upto double the amount of Sum Insured is available on certain covers for a minimum plan of Rs. 5 Lakh on the first claim only to an individual of upto 45 years of age with no pre-existing diseases. The benefit is available with or without extra cost depending on the plan chosen.

      *Coverage of pre-existing diseases is provided by insurer as per their underwriting policy.

      *The scope of coverage may vary from plan to plan.

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