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Over the past few years, it has been well-established that a health insurance plan is nothing less than a basic necessity. When you buy a health plan, you will realise that there are several factors that can influence your insurance premium, but did you know that the city you live in also influences your premium? Your zone in health insurance also affects the amount of the premium. Read on as we discuss what is zone in health insurance, and how a zone based health plan works.
Health insurance companies offer a zone based health premium in order to make it more accessible to people in small cities and towns. The differences can be seen clearly when it comes to metros and non-metros. For example, a health insurance plan with ₹5 lakh coverage will cost a 25-year-old who lives in Mumbai around 10% to 15% more as compared to someone of the same age in Amritsar.
What is a Zone in Health Insurance?
The Indian cities are divided into 3 different zones. This division is done, typically, on the basis of the population of a city. Let us take a look at the 3 zones in health insurance:
| Zone A | Zone B | Zone C |
|---|---|---|
| Delhi, Mumbai (including Thane), Faridabad, Ghaziabad, Noida, Gurugram, Ahmedabad, Surat, Baroda | Bangalore, Nasik, Pune and all remaining cities in Gujarat | Rest of India |
Please keep in mind that health insurance companies may divide the cities into zones as per their own classifications. Therefore, the premiums of different health insurance plans can vary. It is recommended that you confirm the zone based health coverage from your insurer.
How Does Zone in Health Insurance Affect the Health Insurance Premium?
As we discussed earlier, your region can reduce or increase your health insurance premium by 10% to 20%. This is because the healthcare costs in different parts of the country also show dramatic variations. The cost of the same treatment could cost almost 30% to 60% more in a metro than in a smaller town. It has also been observed that people living in Tier 2 and 3 cities have a much lower claim ratio than people in Tier 1 cities.
Does Zone Based Health Plan Help Me As A Policyholder?
If you live in Zone B or C, then as compared to your city counterparts, you will be paying a much lower premium. Let us take a look at this example to see how zone based health plan helps you as a policyholder:
Ravi Kumar is a 30-year-old bank employee. He has a health insurance plan worth ₹5 lakh. It's a family floater plan where Ravi, his 27-year-old wife, his 3-year-old daughter and his 58-year-old father are also covered. Let us take a look at the given illustration in 2 different scenarios:
| Details of treatments taken in 1 policy year | Ravi Lives in Kolkatta (Zone A) | Ravi Lives in Agra (Zone C) |
|---|---|---|
| Ravi undergoes hernia surgery. Cost: | ₹1.2 lakhs | ₹70,000 |
| Father undergoes Bypass Surgery. Cost: | ₹4 lakhs | ₹1.2 lakhs |
| Ravi’s wife was hospitalised for 3 days post-injury. Cost: | ₹80,000 | ₹30,000 |
| Total medical expenses | ₹6 lakhs | ₹2.2 lakhs |
These numbers are for illustration purposes only.
It is, therefore, very clear that when you opt for health insurance in Zone B or C, then the scope of your coverage increases as compared to Zone A. The given example shows that with a ₹5 lakh policy, Ravi in Agra could easily get adequate coverage. However, the same sum insured in a place like Kolkata, which comes under Zone A, will not be sufficient. Ravi had to bear the out-of-pocket expense, as his sum insured had been exhausted.
I Live in Zone B. Can I Get Treatment in Zone A?
When it comes to seeking treatment, your health insurance provider will typically not restrict you to a city. If you are keen on getting treatment in a bigger city or a better hospital in Zone A, then it is best recommended that you get in touch with your insurance provider. In some cases, if a policyholder from Zone C takes treatment in Zone A or B, there may be a co-payment clause.
In such a scenario, because of a zone based health plan, you will have to bear some portion of the claim amount, but your treatment would not be denied and neither will be a cashless claim. Only a portion of your claim might have to be borne by you in case of a zone based co-payment clause!
Things to Keep in Mind When Opting for Zone Based Health Cover
There is no denying that when you buy a health plan according to the zones in health insurance, as a policyholder, you will get to enjoy certain benefits. However, at the same time, there are certain things you must keep in mind when opting for zone based health cover. Take a look:
- In case you are planning to move to another city, make sure you inform your health insurance provider.
- If you are porting your health insurance plan, your premium may fluctuate.
- When you opt for a zone based health plan, only the premium prices of your health insurance plan will change. The coverage will typically stay the same.
How to Get a Zone Based Health Plan?
Getting a zone based health plan becomes very easy and simple with Care Classic health insurance. This comprehensive health insurance plan by Care allows you a sum insured of ₹15 lakhs. While factors such as your age, medical condition, and pre-existing diseases influence the premium, it will also be determined by the place where you reside. With Care zone based health insurance, you will be able to save quite a lot on your health insurance premium
Over To You!
With the unpredictabilities that hover over us, investing in a suitable plan that is not just affordable but also offers adequate cover is essential. Care Classic health insurance can be the ideal way to safeguard yourself as well as your family members. This plan offers the perfect combination of affordability and extensive coverage, ensuring that you and your family members are protected against unforeseen medical expenses. If you haven't already, invest in suitable health insurance today.
>> Also Read: How Your Locality Affects Health Insurance Premium
Disclaimers: All plan features, benefits, coverage, and claims underwriting are subject to policy terms and conditions. Kindly refer to the brochure, sales prospectus, and policy documents carefully.
