Zone Based Health Insurance



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All About Zone Based Health Insurance Policies

What Does Zone in Health Insurance Mean?

It is common knowledge that healthcare in larger metropolitan cities cost more than that in smaller cities. That is why, to make seeking healthcare more affordable for those in smaller cities, insurance providers have curated zone-based health insurance policies.

But, what does the word “zone” in this respect mean?

Well, it refers to the three zones that cities in India are classified into, as illustrated in the table below:

Zone A

Zone B

Zone C

Delhi/NCR, Mumbai including (including Navi Mumbai, Thane and Kalyan)

Hyderabad, Secunderabad, Bangalore, Kolkata, Ahmedabad, Vadodara, Chennai, Pune and Surat.

All Cities apart from A & B belong to Zone C

But the classification of cities according to treatment cost may vary from one insurance provider to the other (The above classification is for Digit Insurance).

Now, the cost of treatment borne in Zone A cities is significantly higher than that of Zone B cities. The medical expenses are further reduced for Zone C cities. That is why, with zone-based insurance plans, the cost of premium paid towards them is decided according to the treatment expense in each city.

 

Know more about:

How the Premium is Calculated under Zone-Based Health Insurance Policies?

Zone Based Premium Calculation with an Example

Let us illustrate the example in the table below for better understanding:

Zone C

Zone B

Zone A

Premium is Rs. 5315 with 20% Co-payment

Premium is Rs. 5882 with 10% Co-payment

Premium is Rs. 6448 with 0% Co-payment

NA

Pay Rs. 567 (Zone C -> B) as Zone Upgrade Add-on Charges

Pay Rs. 1133 (Zone C -> A) as Zone Upgrade Add-on Charges

NA

Save 10% Co-payment Charges

Save 20% Co-payment Charges

 

Zone-based pricing of health insurance policies also have to adhere to the following particulars:

Change in the Policyholder’s Residence - Suppose you are a resident of Meerut, but due to work, you will have to relocate to Mumbai. So, if you are planning to buy a Health Insurance policy, you can avail the zone upgrade cover and upgrade your Zone from Meerut to Mumbai.

Since treatment costs are higher in Mumbai (Zone A city) than Meerut (Zone B city), the insurance company will adjust your premium payment accordingly and you will have to pay a higher premium.

On the other hand, if you live in a Zone B or C city but wish to get your treatment done in any of the Zone A cities (due to better hospitals and facilities), then you should avail the Zone Upgrade cover with your health insurance policy.

Advanced Treatment Clause - There are some insurance policies that limit their policy coverage when the policyholder moves from a Zone C city to a Zone B or Zone A city.

In such cases of zone-based health insurance policy, the insurance provider mostly levies a co-payment clause, where the insured individual has to pay a portion of their expenses incurred towards healthcare.

 

Know more about:

How to Upgrade to Zone-Based Health Insurance Plans?

What is Better, Zone A or Zone B?

How does Zone-Based Health Insurance Policy help?

Is it a Good Idea to Buy Zone-Based Pricing?

FAQs about Zone Based Health Insurance