Page 47 - The Insurance Times September 2025

be recouped in a single claim paid by the insurer including ing cover is by opting for Star Health's Super Star policy (Rs.
the consumables. 8,300 for a Rs. 5 lakh cover) that allows to claim an unlim-
ited amount for a single claim in the policy lifetime. This
The cost vs cover for most OPD riders is sub-optimal. By pur- should cover the critical healthcare needs once.
chasing a rider that costs Rs. 2,000 on top of the base policy,
the OPD covers are a meagre Rs. 5,000 or so per year. Niva Apart from these, restoration of covers and renewal bonuses
Bupa and Manipal Cigna have a better proposition in this allow for the sum insured to increase to seven times over
regard. Niva Bupa's Aspire Gold includes a OPD rider that costs five years (Care Supreme Direct).
Rs. 5,730 and covers an overall Rs. 22,500 OPD cover that is
split over the three: consultations, diagnostics and pharmacy. Manipal Cigna Lifetime with a cover of Rs. 50 lakh (Rs.
Similarly, Health 360-OPD rider from Manipal Cigna costs Rs. 14,250) allows unlimited restorations and Rs. 7.5 lakh per
1,760 but covers a similar amount across any of the three. year renewal of bonus without prescribing a maximum limit.

Expanded Covers The health insurance market place offers many other op-
Health insurance covers have expanded and have done so tions to cover healthcare. Prospective policyholders should
without substantially increasing the cost for the policyhold- identify their primary need and filter options.
ers; Rs. 1 crore covers are on offer from most insurers. Com-
pared to Rs. 9,000-11,000 per year for a Rs. 5 lakh cover, One can add adjacencies to improve the use-case but with-
the most inexpensive Rs. 1 crore cover options can start out diluting the primary need or being overwhelmed by the
from Rs. 12,000 for Aditya Birla's Activ One. ICICI Pru's El- available options. For a holistic cover, Tata AIG Medicare or
evate Combo policy even offers Rs. 5 crore covers at a cost ICICI Pru Elevatae are comprehensive offerings. (Source:
of Rs. 15,000 for a 40-year-old male. Another way of increas- BusinessLine)

CGHS to be replaced with Insurance-Based Scheme under 8th Pay

Commission Reform

The Central Government Health Scheme (CGHS), which has provided healthcare benefits to government employees for
decades, is set to be phased out under the proposed 8th Pay Commission reforms. According to officials familiar with the
development, the government plans to replace CGHS with a comprehensive insurance-based healthcare scheme aimed
at modernizing employee benefits and reducing administrative overhead. The move is expected to offer wider hospital
networks, faster claims, and potentially more inclusive coverage through public-private insurer partnerships.
The new model would align healthcare benefits with global best practices, with digital claim tracking and policy portabil-
ity under consideration. While the plan is still under evaluation, stakeholders anticipate the change to streamline service
delivery and address longstanding complaints of CGHS inefficiencies. However, concerns have been raised about the tran-
sition process, premium sharing structure, and safeguarding benefits for pensioners and lower-income staff. Detailed
guidelines are expected to be released in the coming months.

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The Insurance Times September 2025 43