Overview
The Navi Health Plan is designed to provide financial protection against hospitalization expenses to individuals and families. Its key features include coverage for inpatient care, pre- and post-hospitalization costs, ambulance charges, and AYUSH treatments. The plan also includes benefits like online doctor consultations and a cumulative bonus to increase the sum insured for each claim-free year, along with automatic restoration of the base sum insured.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Navi Health Plan aims to cover the essentials, with coverage for inpatient care, pre- and post-hospitalization expenses, and ambulance charges. The inclusion of AYUSH treatments and online doctor consultations reflects its added focus on catering to a broader range of healthcare needs.
The cumulative bonus, which increases your sum insured for each claim-free year, is a nice feature for encouraging responsible healthcare usage. Additionally, the automatic restoration of the base sum insured provides an extra layer of financial security. The plan also provides an in-built, personal accident cover that pays out 100% of the base sum insured in the event of the policyholder’s demise in an accident.
There are some caveats to the plan. Firstly, it's important to note that certain expenses are non-payable, so it's worth reviewing the list to know what's covered. Also, the maternity expenses coverage is capped at Rs. 30,000, which may not be sufficient for everyone. Above all, Navi, as an insurer, has a less than ideal claim settlement ratio, average complaint volume, and incurred claim ratio. This makes purchasing a policy from the insurer seem like a gamble.
Pros
Feature set is satisfactory.
Metrics are in line with industry average.
Offers Personal Accident Cover, which makes this policy stand out.
Cons
No Bonus for being healthy and not claiming insurance, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some. Need to opt add-on for maternity cover.
Doctor consultations are not covered, which is a key feature.
Navi
Key Insights
Founded
2018
Navi was established 7 years ago, making it a relatively new entrant with a developing track record.
Claims Experience
71% claims settled in 30 Days
Navi settles only 71% of claims it receives, which is relatively low and may raise concerns about reliability during claim payouts.
Network Hospitals
12,000+
Navi has a strong network with over 12,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
239 complaints per 10,000 claims registered
Navi has a relatively high volume of complaints, which may point to ongoing issues in customer service or claim handling.
Features
All
Great
Good
Personal Accident Cover
STANDOUT
Lump sum payout up to 100% of base cover in case the insured person passes away in an accident.
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Add-ons
Maternity
Maternity expenses covered up to ₹30,000 after a waiting period of 3 years, with newborn coverage up to ₹10,000 for 90 days.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Services for terminally ill individuals addressing non-medical needs are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Sinusitis
Chronic Suppurative Otitis Media (CSOM)
Tonsillectomy
Adenoidectomy
Mastoidectomy
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Bonus for being healthy and not claiming insurance.
Maternity benefits not offered. Need to opt add-on for maternity cover.
Doctor consultations are not covered.
Customer Reviews
R
Rohit Sharma
Online doctor consultations are very convenient and save a lot of time for small issues.
R
Ruby Verma
Cumulative bonus to increase sum insured for claim-free years is a good incentive.
S
Sachin Gupta
Automatic restoration of base sum insured provides an extra layer of financial security.
S
Sunil Joshi
Navi's claim settlement ratio and complaint volume are not ideal. Makes me a bit nervous.
S
Shanti Khan
Certain expenses are non-payable, so had to review the list carefully.
S
Sarika Patel
Covers inpatient care, pre- and post-hospitalization, and ambulance charges – all essentials are there.
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Frequently Asked Questions
Does Navi Health have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Navi Health have room rent restrictions?
Does Navi Health offer a restoration benefit?
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