Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Care Plus Complete is sold by Care and Family Health Optima is sold by Star Health. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have massive differences in their core structure. Care Plus Complete is more comprehensive. It covers a lot more use cases and doesn’t have any egregious conditions. However, Family Health Optima is quite basic. It offers little protection and may not be entirely suitable if you are looking for robust protection. So fundamentally, they’re two very different products.
And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?
That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.
Let’s start with Care Plus Complete. The product comes from Care’s stable:
Care Health Insurance (formerly Religare Health Insurance) was founded in 2012. And in that time, they’ve managed to corner a large part of the Indian Insurance market.
What’s more impressive?
Care Health Insurance has a remarkable claim settlement ratio of 90% and a network of more than 16,000+ hospitals.
Family Health Optima meanwhile comes from Star Health’s stable:
Star Health Insurance is India's first standalone health insurance firm. And with an army of retail advisors pushing their products across the country, they’ve managed to capture a fair share of the Indian market.
The company also boasts a network of over 14,000+ hospitals and a decent claim settlement ratio of 83%.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Care Plus Complete |  Family Health Optima |
|---|---|---|
| Network hospitals | 16,000+ | 14,000+ |
| Claim settlement ratio (avg. of last 3 years) | 90% | 83% |
| Co-payment | No | 20% (if purchased after turning 61) |
| Room rent | Single Private room | Single Private room |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 3 years | 3 years |
| Pre/Post hospitalization | 60/90 days | 60/90 days |
| No claim bonus | 50% per year (up to 200%) | 25% per year (up to 100%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (unlimited no. of times for any illness) | 100% restoration (once for different illness after complete exhaustion of sum insured) |
| Health check-up | Once every year | Once every year |
| Maternity | ||
| Out Patient Department | Up to ₹1,500 (cap of ₹350 on each consultation) | |
| Day care |
Feature Comparison
Co payment
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Care Plus Complete doesn’t impose a co-payment clause whereas Family Health Optima requires you to co-pay a part of the bill 20% if you purchase after turning 61
Room rent
If the policy does impose room rent restrictions then the insurer may only let you stay in a room of a certain specification or impose a cap on the total room rent. If you were to breach either criterion then the insurance company may ask you to pay a portion of all the expenses you incurred while staying in the room. In this case, however, Care Plus Complete lets you stay in a single private room and Family Health Optima also lets you stay in a single private room. Nothing fancy.
Sub limits
Some policies will tell you that they will cover all medical expenses up until the sum insured, but then impose caps on the total costs you can incur while dealing with a very specific list of diseases. We call these caps “Disease Wise Sub Limits.” In this case, Care Plus Complete doesn’t impose a disease wise sub-limit whereas Family Health Optima imposes disease-wise sub-limits on Cataracts, Modern Treatments.
Waiting periods for pre-existing diseases
If you’re suffering from a lifestyle condition or if you’ve had surgery in the past, or if you’re dealing with an acute or chronic illness at the time of buying the policy, then the insurer may classify this as a pre-existing disease. And they may tell you that they will only cover these illnesses after some time. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Care Plus Complete imposes a 3 year waiting period on pre-existing diseases and Family Health Optima will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases
Pre and post Hospitalization expenses
Most people aren’t hospitalized right off the bat. Instead, they’ll have to go through a whole series of diagnostic tests before hospitalization and take medication post-discharge. These costs are outlined as pre-hospitalization expenses and post-hospitalization expenses respectively. In this case, Care Plus Complete covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Family Health Optima covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits
No claim bonus
Some policies will tell you that they will incentivize you for not making a claim in any given year. And they offer such incentives by offering extra cover on top of the existing sum insured. This extra cover is categorized as a no-claim bonus. In this case, however, Care Plus Complete offers a no-claim bonus of 50% whereas Family Health Optima offers a no-claim bonus of 25%. And the no-claim bonus may be capped at different levels too.
Domiciliary
Imagine you are forced to treat yourself at home because you don’t find a hospital bed, or you have a chronic condition that prevents you from visiting one, then, insurers may choose to cover your treatment even if you’re hospitalized at home. And such costs are collectively categorized as domiciliary treatment costs. In this case, however, Care Plus Complete offers domiciliary cover. And Family Health Optima also coves domiciliary expenses.
Ayush treatments
Most policies only cover treatments administered in a registered medical facility. However, on some occasions, you may want to pursue alternative treatments including homoeopathy, Ayurveda, Unani and Siddha. These treatments are collectively categorized as Ayush treatments. And in this case, Care Plus Complete covers Ayush procedures and Family Health Optima also extends coverage for Ayush treatments.
Maternity benefits
If you’re hospitalized during childbirth, then you may have to incur significant costs during delivery of your newborn, child care and other related matters during the course of the hospitalization. These costs are collectively termed maternity costs. And in this case, neither Care Plus Complete offers maternity cover nor does Family Health Optima.
Out Patient Department (OPD)
Doctor visits and regular consultations aren’t usually covered by health insurance policies. They are categorized as Outpatient consultations (or OPD treatments) and patients have to bear the cost on their own. In this case, however, Care Plus Complete offers OPD cover whereas Family Health Optima doesn’t offer OPD protection.
Final Conclusion
After considering all the features on hand, we believe that Care Plus Complete is a better alternative to Family Health Optima for most use cases that we’ve evaluated so far.
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