By Shashank Bhardwaj | Algates Insurance | Last Updated: June 2026 All data is for ₹10 lakh Sum Insured, base plan only. Insurer metrics are FY 2024–25. Add-ons and riders are not included.
Quick Verdict
Choose ICICI Lombard Elevate If:
- You want no disease-wise sub-limits — no caps on cataract, hernia, or knee replacement
- You want superior pre and post-hospitalisation coverage at 90 days pre and 180 days post
- You are above 45 and cataract risk is a real near-term concern
- You prefer a clean hospitalisation-first policy without bundled benefits you may not use
- You want unlimited restoration and a modular structure to customise coverage
Choose Bajaj My Health Care Plan 1 If:
- You are planning a pregnancy in the next 3–4 years — start the 36-month maternity wait now
- You want OPD benefits covering doctor consultations, diagnostics, and pharmacy in the base plan
- You live in a tier-2 or tier-3 city and need broader cashless hospital access (18,400+ hospitals)
- You want annual health check-ups included without buying a rider
- You prioritise smoother claims — Bajaj’s complaint ratio of 3.42 per 10,000 claims is industry-leading
Overall Verdict: There is no single winner. ICICI Lombard Elevate is the stronger choice for hospitalisation depth and long-term structural protection. Bajaj My Health Care Plan 1 is the stronger choice for everyday healthcare bundling, maternity, OPD, and claims experience. Your life stage and usage pattern decide.
Why This Comparison Matters in 2026
India’s medical inflation is running at roughly 14% per year. A hospitalisation that costs ₹3 lakh today could cross ₹8 lakh in a decade. The health insurance plan you buy in 2026 is not just a policy — it is a long-term financial shield.
But not all health plans protect you equally. Two plans can look nearly identical on a brochure and behave very differently when you actually file a claim.
Room rent limits, for example, do not just cap your room cost. They trigger proportionate deductions — reducing your entire hospital bill, including surgery, ICU, and doctor fees, in proportion to how much your room exceeded the allowed category. A single room-category mismatch at a premium hospital can result in a 25–40% out-of-pocket deduction on a ₹5 lakh bill.
Disease-wise sub-limits cap specific procedures regardless of your Sum Insured. If your policy has a ₹1 lakh cataract cap and your surgery costs ₹1.4 lakh, you pay the ₹40,000 difference yourself — even on a ₹10 lakh policy.
This comparison between ICICI Lombard Elevate and Bajaj Allianz My Health Care Plan 1 cuts through the marketing language. We explain every feature in plain English, what it means in real life, and which plan wins — based on your specific needs.

Quick Comparison Table
| Feature | ICICI Lombard Elevate | Bajaj My Health Care Plan 1 | Winner |
|---|---|---|---|
| Special Feature | Modular plan; add-ons for Room Upgrade, Consumables, Indefinite Bonus | Unlimited Restoration, OPD and Maternity Cover | Depends on need |
| Room Rent Limit | Single Private AC Room | Single Private AC Room | Tie |
| Copayment | No copayment clause | No copayment clause | Tie |
| Disease-Wise Limit | No sub-limits | Cataract — 20% of SI, max ₹1 lakh/eye | ICICI Lombard Elevate |
| Pre / Post Hospitalisation | 90 / 180 Days | 60 / 90 Days | ICICI Lombard Elevate |
| Day Care Treatment | Covered up to SI | Covered up to SI | Tie |
| Modern Treatment | Covered up to SI | Covered up to SI | Tie |
| AYUSH Treatment | Covered up to SI | Covered up to SI | Tie |
| Restoration Benefit | Unlimited | Unlimited | Tie |
| No Claim Bonus | Not in base plan (add-on) | 50% per year, max 100% | Bajaj (base plan) |
| Domiciliary Hospitalisation | Covered | Covered | Tie |
| Maternity Benefit | Not Available | Available (36-month wait) | Bajaj |
| Health Check-up | Not Available | Once every year | Bajaj |
| OPD Benefits | Not Available | Available | Bajaj |
| Claim Settlement Ratio (FY25) | 85.82% | 95.04% | Bajaj |
| Incurred Claim Ratio (FY25) | 71% | 74.59% | ICICI (lower = more stable) |
| Complaint Volume (per 10,000) | 13.98 | 3.42 | Bajaj |
| Network Hospitals | 10,600+ | 18,400+ | Bajaj |
Why These Differences Matter
1. Room Rent Limits
What it means: Room rent limits do not just restrict which room you can stay in. They trigger a far more damaging mechanism called a proportionate deduction. When you stay in a room above your policy’s permitted category, the insurer reduces your entire hospital bill — surgery fees, ICU charges, doctor consultation, nursing — in the same proportion as the room cost overage. This is one of the most financially harmful fine-print items in health insurance.
ICICI Lombard Elevate: Single Private AC Room in the base plan. A room upgrade add-on is available to remove this restriction entirely. Without the add-on, staying in a higher category room — which happens easily in premium hospitals in Delhi, Mumbai, and Bengaluru — can trigger proportionate deductions.
Bajaj My Health Care Plan 1: Single Private AC Room. No upgrade option in the base plan. The restriction is identical to ICICI Lombard at the base level.
Real-life impact: You are admitted for a cardiac procedure at a premium Mumbai hospital. The room you are allotted is classified above Single Private AC Room. On a ₹5 lakh bill, a 30% proportionate deduction means you pay ₹1.5 lakh out of pocket — not because your coverage ran out, but because of a room category mismatch. Both plans carry this risk at the base level. ICICI Lombard offers a path out via add-on; Bajaj does not.
Winner: Tie at base plan level. ICICI Lombard Elevate wins if you purchase the room upgrade add-on.
2. Disease-Wise Sub-Limits
What it means: A disease-wise sub-limit is a cap on how much the insurer will pay for a specific procedure, regardless of your Sum Insured. It operates independently of your policy limit. A ₹10 lakh policy with a ₹1 lakh cataract sub-limit pays only ₹1 lakh for cataract surgery — even if the actual bill is ₹1.5 lakh.
ICICI Lombard Elevate: No disease-wise sub-limits in the base plan. The full Sum Insured applies to all covered procedures including cataract, hernia, knee replacement, and gallbladder surgery.
Bajaj My Health Care Plan 1: Cataract surgery is capped at 20% of Sum Insured, with a maximum of ₹1 lakh per eye. On a ₹10 lakh policy, both eyes combined receive a maximum of ₹2 lakh. Cataract surgery at a reputed private hospital now routinely costs ₹80,000–₹1.2 lakh per eye for premium intraocular lens implants.
Real-life impact: A 52-year-old policyholder needs cataract surgery on both eyes. Total cost: ₹2.6 lakh. Under Bajaj, the maximum payout is ₹2 lakh — leaving ₹60,000 out of pocket. Under ICICI Lombard Elevate, the full ₹2.6 lakh is covered up to the Sum Insured.
For buyers under 35, cataract is a theoretical concern. For buyers above 45, it is a statistically likely near-term expense. The sub-limit becomes a genuine financial risk for this group.
Winner: ICICI Lombard Elevate
3. Pre & Post Hospitalisation Cover
What it means: Pre-hospitalisation expenses cover diagnostic tests, specialist consultations, and investigations done before you are admitted — often the most expensive phase of diagnosis. Post-hospitalisation expenses cover physiotherapy, follow-up consultations, medications, and rehabilitation after discharge. A longer post-hospitalisation window is critical for surgeries that require extended recovery.
ICICI Lombard Elevate: 90 days pre-hospitalisation and 180 days post-hospitalisation. The 180-day post-hospitalisation window is significantly above the industry standard of 60–90 days and is particularly valuable for cardiac procedures, orthopedic surgeries, and spinal interventions.
Bajaj My Health Care Plan 1: 60 days pre-hospitalisation and 90 days post-hospitalisation. Adequate for most standard hospitalisations but falls short for procedures with extended recovery timelines.
Real-life impact: Knee replacement surgery requires 4–6 months of physiotherapy. ICICI Lombard’s 180-day post-hospitalisation window captures months 1–6 of recovery costs. Bajaj’s 90-day window covers only months 1–3. Physiotherapy sessions at a reputed centre cost ₹800–₹1,500 per session. Over 3 additional months, this difference is worth ₹25,000–₹50,000 out of pocket.
Winner: ICICI Lombard Elevate
4. Maternity Benefit & OPD
What it means: These are the two features that most directly affect everyday healthcare costs — not just hospitalisation emergencies. Maternity benefit covers delivery costs (normal and C-section), newborn cover, and pre/postnatal expenses. OPD benefit covers routine doctor consultations, diagnostic tests, and pharmacy bills without requiring hospitalisation.
ICICI Lombard Elevate: Maternity benefit is not available in the base plan. OPD coverage is not available in the base plan.
Bajaj My Health Care Plan 1: Maternity benefit is included after a 36-month continuous waiting period. It covers normal delivery, C-section, and newborn baby cover. OPD benefits covering consultations, diagnostics, and pharmacy are included as a base feature. Annual health check-ups are included once per year.
Real-life impact: A couple spending ₹18,000–₹25,000 per year on OPD consultations, blood tests, and pharmacy bills gets direct monetary offset from Bajaj’s OPD cover — reducing the effective net premium meaningfully. A hospital delivery at a private facility in a tier-1 city costs ₹1.5–₹2.5 lakh. Having it covered in the base plan is a structural financial advantage for young families.
Winner: Bajaj My Health Care Plan 1 for families needing maternity and OPD
5. No Claim Bonus
What it means: No Claim Bonus (NCB) increases your effective Sum Insured every claim-free year without increasing your base premium. It is how your coverage grows passively over time and how long-term policyholders build meaningful protection against medical inflation.
ICICI Lombard Elevate: NCB is not available in the base plan. The Indefinite Bonus Feature is available as an add-on. Without the add-on, your Sum Insured does not grow in claim-free years.
Bajaj My Health Care Plan 1: NCB is included in the base plan at 50% of Sum Insured per claim-free year, capped at 100% of the base Sum Insured. Starting at ₹10 lakh, your cover can reach ₹20 lakh after two consecutive claim-free years and stays there.
Real-life impact: Over 10 claim-free years, a Bajaj policyholder starting at ₹10 lakh reaches the ₹20 lakh ceiling at year 2 and holds it. An ICICI Lombard Elevate policyholder without the add-on stays at ₹10 lakh throughout. Medical inflation at 14% per year means ₹10 lakh of coverage today has the purchasing power of roughly ₹3.7 lakh in 10 years. NCB matters enormously for long-term protection.
Winner: Bajaj My Health Care Plan 1 in the base plan. ICICI Lombard Elevate’s add-on changes this equation — verify the Indefinite Bonus Feature’s accumulation ceiling before purchasing.
6. Restoration Benefit
What it means: If your Sum Insured is fully exhausted during the policy year, the restoration benefit replenishes it for subsequent claims in the same year. For families and individuals with serious or recurring illnesses, this is a critical safety net.
ICICI Lombard Elevate: Unlimited restoration in the base plan.
Bajaj My Health Care Plan 1: Unlimited restoration in the base plan.
Important verification: Restoration mechanics vary between policies — some restore only for a different illness than the one that exhausted the cover, others restore even for the same illness. Verify the specific trigger conditions in the policy wording for both plans before purchasing. This clause is frequently misunderstood at the point of sale.
Winner: Tie — both deliver unlimited restoration. Verify trigger conditions.
7. Modern Treatments
What it means: Modern treatments include robotic surgeries, stem cell therapy, deep brain stimulation, oral chemotherapy, and other advanced procedures that cost significantly more than conventional equivalents. These are increasingly common at major hospitals.
ICICI Lombard Elevate: Covered up to Sum Insured. No internal cap — your full ₹10 lakh (or NCB-enhanced cover) is available for advanced procedures.
Bajaj My Health Care Plan 1: Covered up to Sum Insured. No internal cap on modern treatments. This is a clear advantage over some competitors that restrict modern treatments to a sub-limit.
Real-life impact: Robotic knee replacement at a tier-1 hospital can cost ₹3.5–₹5 lakh. Both plans cover this up to the full Sum Insured — no internal cap. This is a genuine tie and a strong feature in both plans relative to many competitors.
Winner: Tie
Waiting Period Comparison
| Waiting Period Type | ICICI Lombard Elevate | Bajaj My Health Care Plan 1 |
|---|---|---|
| Initial Waiting Period | 30 Days | 30 Days |
| Pre-Existing Disease (PED) | 36 Months | 36 Months |
| Specific Illness Waiting Period | 24 Months | 24 Months |
| Maternity Waiting Period | Not Applicable | 36 Months |
Both plans share identical standard waiting periods across all three categories. Neither plan has any structural advantage on waiting periods for hospitalisation cover.
The only difference: Bajaj’s maternity benefit carries its own 36-month waiting period on top of the base policy’s standard waiting periods. This is standard industry practice for policies that include maternity in the base plan — and it carries a critical implication.
The maternity wait starts from policy purchase date — not from when you confirm a pregnancy. If you are planning a child in the next 3–4 years, buying Bajaj My Health Care Plan 1 today means the clock starts now. Waiting until pregnancy is confirmed means waiting another 36 months from that date.
Winner: Tie on hospitalisation. Bajaj only if maternity matters and you buy early enough.
Insurer Metrics Comparison (FY 2024–25)
| Metric | ICICI Lombard | Bajaj Allianz | What It Means |
|---|---|---|---|
| Claim Settlement Ratio | 85.82% | 95.04% | % of claims settled — higher is better |
| Incurred Claim Ratio | 71% | 74.59% | % of premiums paid out as claims |
| Complaints per 10,000 claims | 13.98 | 3.42 | Lower is better |
| Network Hospitals | 10,600+ | 18,400+ | Higher = more cashless access |
Source: IRDAI Annual Report FY 2024–25
How to Read These Numbers
Claim Settlement Ratio (CSR): Bajaj Allianz settles 95.04% of all claims filed, compared to ICICI Lombard’s 85.82%. The 9.2-percentage-point gap is meaningful. In practical terms, if 100 people file claims with ICICI Lombard, approximately 14 are rejected. With Bajaj, approximately 5 are rejected. Fewer rejections mean less financial stress and fewer disputes at the worst possible moment.
Incurred Claim Ratio (ICR): This measures the percentage of premiums collected that the insurer pays out as claims. ICICI Lombard’s 71% is lower than Bajaj’s 74.59%. A lower ICR suggests more financial headroom — the insurer is collecting more relative to what it pays, which typically means less pressure to increase premiums. Neither figure is in an unhealthy range, but ICICI Lombard’s lower ICR is a mild positive signal for long-term premium stability.
Complaint Volume: This is where Bajaj stands apart dramatically. 3.42 complaints per 10,000 claims versus ICICI Lombard’s 13.98 — Bajaj receives approximately 4X fewer complaints per claim. Fewer complaints mean smoother cashless approvals, faster reimbursements, fewer disputes during claims, and a less contentious experience when you actually need the insurance. For buyers who prioritise a hassle-free claims process, this is Bajaj’s single strongest metric.
Network Hospitals: Bajaj wins decisively with 18,400+ hospitals versus ICICI Lombard’s 10,600+. In metro cities, both networks provide adequate coverage. The gap matters most in tier-2 and tier-3 cities, where Bajaj’s broader network means more cashless options and more hospital choices during emergencies. Always verify that your preferred hospital is in the insurer’s cashless network before purchasing either plan.
Who Should Buy Which Plan?
Scenario 1: 28-Year-Old Salaried Professional, No Health Issues, No Maternity Plans
This buyer visits a doctor once or twice a year and wants strong hospitalisation protection with clean insurer metrics and a plan that grows with them.
ICICI Lombard Elevate’s no disease sub-limits, 90/180-day pre/post hospitalisation, and unlimited restoration fit this profile well. At 28, cataract and complex procedures are distant concerns — the structural hospitalisation strength is what matters.
The absence of OPD and maternity in the base plan is not a drawback for this buyer. They are not paying for benefits they will not use, and the modular structure allows selective add-on activation as needs evolve.
The gap in complaint ratio (13.98 vs 3.42) is a genuine consideration. This buyer should verify that their preferred hospitals — particularly for specialist consultations and emergencies — are within ICICI Lombard’s cashless network before committing.
Verdict: ICICI Lombard Elevate
Scenario 2: Married Couple, Both 30 Years Old, Planning First Child in 2–3 Years
This is Bajaj My Health Care Plan 1’s strongest use case. The 36-month maternity waiting period means buying now is essential — waiting until pregnancy is confirmed means waiting another 3 years from that date.
Bajaj’s OPD cover directly reduces the out-of-pocket cost of prenatal consultations, diagnostics, and pharmacy bills that begin well before hospitalisation for delivery. The 18,400+ hospital network provides better cashless access across cities and towns for delivery. Annual health check-ups add further value during pregnancy planning.
The cataract sub-limit is completely irrelevant for a 30-year-old couple. The room rent restriction is a reasonable trade-off for the maternity, OPD, and check-up bundling at this life stage.
Verdict: Bajaj My Health Care Plan 1 — buy now so the 36-month maternity wait is already running.
Scenario 3: Family With One or Both Parents Above 45, Past Maternity Stage
Long-term hospitalisation protection is the priority here. Cataract risk is real and emerging for parents above 45 — ICICI Lombard Elevate’s zero cataract sub-limit is the correct structural call for this group.
The 180-day post-hospitalisation window is valuable for procedures like joint replacements and cardiac surgeries that require extended physiotherapy and recovery. Any-room flexibility via the ICICI Lombard add-on matters more for this age group — premium hospitals in metro cities frequently price standard rooms above Single Private AC Room thresholds, triggering proportionate deductions at exactly the wrong moment.
Note: ICICI Lombard’s complaint ratio of 13.98 is significantly higher than Bajaj’s 3.42. Buyers in this scenario should verify that their preferred hospitals — particularly for cardiac and orthopedic procedures — are within ICICI Lombard’s cashless network before purchasing.
Verdict: ICICI Lombard Elevate
Scenario 4: Individual or Family With Frequent Doctor Visits and Diagnostic Tests
This buyer gets blood tests quarterly, visits specialists for chronic condition management, and spends ₹15,000–₹25,000 per year on outpatient consultations and diagnostics.
Bajaj’s OPD reimbursement as a base plan feature directly reduces this out-of-pocket spend — no additional rider required. Annual health check-ups add further value. The effective net premium is lower than the sticker price once OPD reimbursements are factored in.
ICICI Lombard Elevate’s unlimited online doctor consultations are useful but are a different product from physical OPD reimbursement that covers diagnostics and pharmacy costs.
Verdict: Bajaj My Health Care Plan 1
Scenario 5: Buyer Seeking Maximum Pure Hospitalisation Protection
For pure hospitalisation depth — no OPD, no maternity — ICICI Lombard Elevate is structurally stronger on every hospitalisation-specific metric:
- No disease sub-limits (no cataract, hernia, or knee replacement cap)
- 90 days pre and 180 days post hospitalisation
- Unlimited restoration
- Modular flexibility to add room upgrade and NCB as needs evolve
The trade-offs are real: ICICI Lombard’s complaint ratio of 13.98 is significantly higher than Bajaj’s 3.42, its CSR of 85.82% is meaningfully lower than Bajaj’s 95.04%, and its hospital network at 10,600+ is smaller. These are operational gaps in claims experience that cannot be dismissed.
Verdict: ICICI Lombard Elevate for hospitalisation depth, with the caveat to verify network coverage for your specific hospitals.
Pros and Cons
ICICI Lombard Elevate
Pros:
- No disease-wise sub-limits — full Sum Insured applies to all covered procedures
- Superior pre/post hospitalisation at 90/180 days
- Unlimited restoration in base plan
- Modular structure — add only what you need
- No copayment clause
- Modern treatments covered up to full Sum Insured
Cons:
- No maternity benefit in base plan
- No physical OPD coverage (only online consultations)
- No Claim Bonus only via add-on — does not accumulate in base plan
- Smaller cashless network at 10,600+ vs Bajaj’s 18,400+
- Significantly higher complaint ratio: 13.98 vs Bajaj’s 3.42
- Lower Claim Settlement Ratio: 85.82% vs Bajaj’s 95.04%
Bajaj My Health Care Plan 1
Pros:
- Maternity benefit in base plan (after 36-month wait) — rare in mid-premium plans
- OPD coverage included — reduces out-of-pocket routine healthcare costs
- Annual health check-up as a base feature
- Industry-leading complaint ratio at 3.42 per 10,000 claims
- Highest Claim Settlement Ratio at 95.04% — fewer claim rejections
- Largest hospital network at 18,400+ — best cashless access especially in smaller cities
- Modern treatments covered up to full Sum Insured — no ₹1 lakh internal cap
- No copayment clause
Cons:
- Cataract sub-limit at 20% of SI, max ₹1 lakh per eye — meaningful risk for buyers above 45
- Post-hospitalisation window shorter at 90 days vs ICICI Lombard’s 180 days
- No Claim Bonus capped at 100% (max 2X cover) — far lower ceiling than some competitors
- Room rent restricted to Single Private AC Room with no upgrade option in base plan
- Maternity requires 36-month wait — must plan well in advance
Final Verdict Table
| Your Priority | Best Plan |
|---|---|
| Hospitalisation coverage depth | ICICI Lombard Elevate |
| Maternity coverage | Bajaj My Health Care Plan 1 |
| OPD coverage | Bajaj My Health Care Plan 1 |
| Cataract / disease sub-limit protection | ICICI Lombard Elevate |
| Claim Settlement Ratio | Bajaj My Health Care Plan 1 |
| Complaint volume / claims experience | Bajaj My Health Care Plan 1 |
| Network hospitals | Bajaj My Health Care Plan 1 |
| Buyers above 45 years | ICICI Lombard Elevate |
| Young families planning a child | Bajaj My Health Care Plan 1 |
| Long recovery procedures (ortho/cardiac) | ICICI Lombard Elevate |
| Everyday healthcare bundling | Bajaj My Health Care Plan 1 |
| Annual health check-up | Bajaj My Health Care Plan 1 |
| Modular / customisable structure | ICICI Lombard Elevate |
| Smaller cities / broader cashless access | Bajaj My Health Care Plan 1 |
| Premium stability (lower ICR) | ICICI Lombard Elevate |
Our Verdict
Think of these two plans as built for different life chapters.
ICICI Lombard Elevate is a hospitalisation-first policy that removes the most common hidden costs — disease sub-limits, short recovery windows — and gives buyers the modular flexibility to build coverage around their specific needs. The 90/180-day pre/post hospitalisation window is among the best available in this segment. The absence of a cataract sub-limit is a genuine structural advantage that becomes more valuable every year as the policyholder ages. For buyers above 40 who want clean hospitalisation protection without bundled features they will not use, Elevate is a strong choice.
Its weaknesses are not fine print — they are real. A Claim Settlement Ratio of 85.82% means roughly 1 in 7 claims is rejected, which is meaningfully higher than Bajaj’s 1 in 20. The complaint ratio of 13.98 per 10,000 claims is approximately 4 times higher than Bajaj’s 3.42 — this translates to more cashless approval disputes, more follow-up required during hospitalisation, and a less smooth claims experience. For a buyer managing a hospitalisation from a hospital bed, this operational gap matters.
Bajaj My Health Care Plan 1 is a full-life healthcare bundler. It covers maternity, OPD, annual check-ups, and hospitalisation in one base policy. Its 18,400+ hospital network gives meaningfully broader cashless access, particularly in cities and towns beyond the top metros. The complaint ratio of 3.42 is industry-leading — Bajaj consistently demonstrates smoother claims processing than most competitors. Its Claim Settlement Ratio of 95.04% means 19 out of 20 claims are settled.
Its structural vulnerabilities are two: the room rent restriction without an upgrade option, and the cataract sub-limit. Both become more significant as policyholders age. A 30-year-old couple is unlikely to encounter either problem in the near term. A 50-year-old buying this plan for long-term coverage should model both risks explicitly.
There is no universally better plan between ICICI Lombard Elevate and Bajaj My Health Care Plan 1. There is only the plan that is right for your current life stage and healthcare usage pattern.
If your primary goal is hospitalisation depth, disease sub-limit protection, and superior recovery coverage — choose ICICI Lombard Elevate.
If your primary goal is maternity coverage, everyday OPD value, a smooth claims experience, and broader cashless network access — choose Bajaj My Health Care Plan 1.
Frequently Asked Questions
Which plan is better — ICICI Lombard Elevate or Bajaj My Health Care Plan 1? There is no single answer. ICICI Lombard Elevate is better for hospitalisation depth — no disease sub-limits, 90/180-day pre/post hospitalisation, and modular flexibility. Bajaj My Health Care Plan 1 is better for everyday healthcare value — maternity, OPD, annual check-ups, broader hospital network, and a significantly lower complaint ratio. Your life stage and usage pattern should decide.
Does ICICI Lombard Elevate cover maternity? No. Maternity benefit is not available in ICICI Lombard Elevate’s base plan. If maternity coverage is a requirement, Bajaj My Health Care Plan 1 is the only option between these two plans, covering normal delivery, C-section, and newborn baby expenses after a 36-month continuous waiting period.
Does Bajaj My Health Care Plan 1 cover OPD? Yes. Bajaj My Health Care Plan 1 covers OPD expenses — including doctor consultations, diagnostics, and pharmacy costs — as a base plan feature. No additional rider is required. ICICI Lombard Elevate does not include physical OPD reimbursement in the base plan.
Which plan has a better Claim Settlement Ratio? Bajaj Allianz has a higher Claim Settlement Ratio at 95.04% compared to ICICI Lombard’s 85.82% for FY 2024–25. The 9.2-percentage-point gap means Bajaj rejects significantly fewer claims. Both data points are sourced from the IRDAI Annual Report FY 2024–25.
Which plan has more network hospitals? Bajaj Allianz has significantly more network hospitals at 18,400+ compared to ICICI Lombard’s 10,600+. Bajaj’s network advantage is most meaningful in tier-2 and tier-3 cities where cashless access points matter more during emergencies.
Does ICICI Lombard Elevate have disease-wise sub-limits? No. ICICI Lombard Elevate has no disease-wise sub-limits in the base plan. The full Sum Insured applies to all covered procedures including cataract, hernia, knee replacement, and gallbladder surgery. Bajaj My Health Care Plan 1 caps cataract surgery at 20% of Sum Insured, maximum ₹1 lakh per eye.
Which plan is better for senior citizens or buyers above 45? ICICI Lombard Elevate is generally the stronger choice for buyers above 45. The absence of a cataract sub-limit is a meaningful financial advantage as cataract surgery risk increases with age. The 180-day post-hospitalisation window also matters more for orthopedic and cardiac procedures common in this age group. Verify that your preferred hospitals are in ICICI Lombard’s cashless network before purchasing.
Which plan is better for young families? For young families planning a child in the next 3–4 years, Bajaj My Health Care Plan 1 is the stronger choice. It includes maternity (after 36-month wait), OPD cover, and annual health check-ups in the base plan. The 18,400+ hospital network provides broader delivery access across cities and towns. Buy as early as possible — the 36-month maternity wait starts from the policy purchase date.
What is the waiting period for both plans? Both plans have identical standard waiting periods: 30 days initial waiting period, 36 months for pre-existing diseases (PED), and 24 months for specific illnesses. Bajaj My Health Care Plan 1 has one additional 36-month waiting period specific to maternity benefit. There is no waiting period advantage for hospitalisation cover between these two plans.
Which plan has a better complaint ratio? Bajaj Allianz has dramatically fewer complaints at 3.42 per 10,000 claims versus ICICI Lombard’s 13.98 for FY 2024–25. Bajaj receives approximately 4 times fewer complaints per claim, indicating a smoother cashless approval process and fewer disputes during claim settlement.
Can I port my existing health insurance to either of these plans? Yes, health insurance portability is permitted under IRDAI guidelines. You can port to ICICI Lombard Elevate or Bajaj My Health Care Plan 1 from another insurer, retaining waiting period credits for the time spent with your previous insurer. Contact the insurer or your insurance advisor at least 45 days before your renewal date to initiate portability.
What happens to the waiting period if I port to these plans? Under IRDAI portability rules, the waiting period credit from your previous policy is carried forward. If you have completed 2 years with your previous insurer, you get 2 years of PED waiting period credit with the new plan — meaning only 1 more year of PED waiting period remains on a 3-year PED clause. This applies to both ICICI Lombard Elevate and Bajaj My Health Care Plan 1.
Does ICICI Lombard Elevate offer lifelong renewability? Yes. ICICI Lombard Elevate offers lifelong renewability. The policy can be renewed indefinitely regardless of age or health condition, provided premiums are paid and the policy is not lapsed. Verify the exact renewal terms in the policy document before purchase.
Which plan offers better value for money? Value depends entirely on what you need. For a buyer who needs maternity, OPD, and annual check-ups, Bajaj My Health Care Plan 1 offers better value — the bundled features offset the premium cost, and the claims experience is significantly smoother. For a buyer who wants pure hospitalisation protection without bundled benefits, ICICI Lombard Elevate’s base plan offers better value per rupee of hospitalisation-specific cover.
Is the restoration benefit in both plans the same? Both plans offer unlimited restoration of Sum Insured in the base plan. However, the trigger conditions — whether restoration applies to the same illness or only a different illness — can vary between policies and can affect how useful the benefit actually is. Verify this specific clause in the policy wording for both plans before purchasing.
How We Compared These Plans
All data in this comparison is based on the base plan only for a ₹10 lakh Sum Insured. Add-ons and riders are excluded from the feature comparison. Insurer metrics — Claim Settlement Ratio, Incurred Claim Ratio, complaint volume, and network hospital count — are sourced from the IRDAI Annual Report for FY 2024–25.
We reviewed publicly available product brochures and policy wordings for both plans. Features were cross-verified against insurer websites and regulatory disclosures. Where policy wording introduces ambiguity (particularly around restoration trigger conditions), we have flagged this explicitly and recommended buyers verify before purchase.
This comparison is not sponsored by either ICICI Lombard or Bajaj Allianz. Algates Insurance is an IRDAI-registered Insurance Marketing Firm (IMF Registration: IMF1872506009 20210470). Our recommendations are based on feature analysis and publicly available insurer metrics — not commercial arrangements with any insurer.
Disclaimer
This comparison is based on publicly available product features and insurer metrics for FY 2024–25. All data is for a base plan with ₹10 lakh Sum Insured. Features, waiting periods, sub-limits, and insurer metrics may change at the time of purchase. Premium amounts, add-on availability, and policy terms may vary based on age, city, underwriting decisions, and policy variant. Verify the current policy wording directly with the insurer or from official policy documents before purchasing. This article does not constitute personalised insurance advice.







Get on a call
WhatsApp Us
