Explained Zone wise Co pay Waiver the new optional cover in Magma HDI s OneHealth insurance

Explained: Zone-wise Co-pay Waiver, the new optional cover in Magma HDI’s OneHealth insurance  30th June 2022

OneHealth, Magma HDI’s flagship health insurance is an all-encompassing solution with five plans tailormade to suit a customer’s needs. With state-of-the-art features and a bucket of add-ons, OneHealth provides a solid financial shield in case of a health exigency.

What is zone-wise pricing in health insurance?

Insurers offer zone-wise pricing to strike a fair balance in health insurance premiums, especially for customers in smaller cities. Hence, it may so happen that premium for a similar health plan differs as per cities, especially between metros and non-metros. There can be multiple reasons for this.

a) Hospitalization costs are relatively lower in smaller cities vis-à-vis metros
b) In most instances, the insured will opt for treatment only in their home city / town
c) Moreover, it may be assumed that people living in metros or tier 1 cities could be more susceptible to lifestyle diseases, and thus the higher premium

Hence, insurers try to pass on the benefit of lower cost of hospitalization to customers hailing from smaller cities. Having said that, most of the insurers offering zone-wise premiums have a co-pay clause for policyholders who want to avail treatment from a higher zone, which they bear during their claim settlement.

Zone-wise Co-pay Waiver Optional Cover

In Magma HDI’s OneHealth insurance, the zones are classified into Zone 1, 2 and 3:

  • Zone 1: Delhi including National Capital Region, Mumbai including Thane, Navi Mumbai, Vasai-Virar, Bangalore, and Gujarat
  • Zone 2: Coimbatore, Pune, Hyderabad, Chandigarh, Chennai, Kolkata, and Kerala
  • Zone 3: Rest of India

One of the latest optional covers added in OneHealth is the Zone-wise Co-pay Waiver. As mentioned above, the premium rates of a health insurance product are fixed as per the zone opted for in the policy (Zone 1, 2 or 3). Zone 1 calls for the highest premium, followed by Zone 2 and Zone 3. If the insured undergoes a treatment in a zone higher than the one opted for in the policy, he must pay an additional co-pay amount which is charged as a fixed percentage of the claim amount. The existing OneHealth insurance plan has the following co-pay:

Premium paid as per zone Zone where treatment is taken Co-pay
Zone 2 Zone 1 25%
Zone 3 Zone 2 20%
Zone 3 Zone 1 35%

Now, with the Zone-wise Co-pay Waiver Optional Cover, the insured can get this co-pay amount waived off if their treatment occurs in a zone higher than the one opted for in the policy. The cover is available across all plans and sum insureds.

Let us understand with an example.

• Mr. Parag, a 40-year-old from Amritsar plans to buy the OneHealth Secure plan for himself, his wife and two children, with a sum insured of INR 10 lakh.

• As Amritsar falls in Zone 3, Mr. Parag would have to pay INR 12,997 + GST as premium but would have to bear 35% co-pay on his claim amount if he ever gets a medical treatment done in Delhi (which falls in Zone 1).

• To avoid this, Mr. Parag can also opt for a Zone 1 premium i.e., INR 16,154 + GST for any eventuality. However, even this is 24% higher than the Zone 3 premium.

• Thanks to the Zone-wise Co-pay Waiver optional cover, Mr. Parag would only have to pay INR 14,362 + GST and get a Pan India coverage.

  Premium Amount Additional Amount
Premium paid on buying policy in Amritsar (Zone 3) INR 12,997 + GST 35% Co-pay levied on claim amount if treatment taken in Zone 1 areas
If opted for Zone 1 premium INR 16,154 + GST 24% higher premium
If opted for Zone-wise Co-pay Waiver Optional Cover INR 14,362 + GST Only 11% higher premium, and 0% Co-pay levied

An insured can also opt for this optional cover at the time of renewal. However, a waiting period of 1 year shall be applicable for renewed policies. No waiting period is applicable for this optional cover, if opted while buying OneHealth for the first time as fresh or portability policy. In case this cover is discontinued by the customer, and again opted for subsequently, the 1-year waiting period shall start afresh.

Know more about Magma HDI’s OneHealth on www.magmahdi.com/onehealth-insurance