Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Family Health Optima is sold by Star Health and Family Health Protector is sold by Iffco Tokio. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products are quite basic in their structure. They offer modest protection and aren’t comprehensive enough to cover a wide array of use cases. So if you are looking for something more robust, then both these policies may not cut it.
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 Family Health Optima. The product 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%.
Family Health Protector meanwhile comes from Iffco Tokio’s stable:
Iffco Tokio is a joint venture between Indian Farmers Fertiliser Cooperative Limited (IFFCO), a government-owned fertilizer company, and Japan-based Tokio Marine Group. They have a sizable presence in many rural markets, however, their presence in urban areas isn't exactly extraordinary.
The company has a network of over 7,000 hospitals and its CSR ratio isn’t useful, since they have been settling a lot of pending claims from last year.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Family Health Optima |  Family Health Protector |
|---|---|---|
| Network hospitals | 14,000+ | 7,000+ |
| Claim settlement ratio (avg. of last 3 years) | 83% | 95% |
| Co-payment | 20% (if purchased after turning 61) | No |
| Room rent | Single Private room | Any room (up to 1.5% Sum Insured) |
| Disease sub-limit | Yes | Yes |
| Pre existing diseases waiting | 3 years | 3 years |
| Pre/Post hospitalization | 60/90 days | 60/90 days |
| No claim bonus | 25% per year (up to 100%) | 25% per year (up to 100%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (3 times for different illness) | 100% restoration (unlimited no. of times for any illness) |
| Health check-up | Once every year | Once every 2 years |
| Maternity | ||
| Out Patient Department | ||
| 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, Family Health Optima requires you to co-pay a part of the bill 20% if you purchase after turning 61 whereas Family Health Protector doesn’t impose a co-payment clause
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, Family Health Optima lets you stay in a single private room and Family Health Protector lets you stay in Any room-up to 1.5% Sum Insured. In effect, both policies impose restrictions on the kind of room you can pick.
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, Family Health Optima imposes disease-wise sub-limits on null whereas Family Health Protector imposes sub-limits on 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, Family Health Optima imposes a 3 year waiting period on pre-existing diseases and Family Health Protector 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, Family Health Optima covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Family Health Protector 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. And in this case, Family Health Optima offers a no-claim bonus of 25% and Family Health Protector similarly extends a 25% no-claim bonus.
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, Family Health Optima offers domiciliary cover. And Family Health Protector 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, Family Health Optima covers Ayush procedures and Family Health Protector 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 Family Health Optima offers maternity cover nor does Family Health Protector.
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, neither Family Health Optima extends coverage for outpatient consultations, nor does Family Health Protector.
Final Conclusion
After considering all the features on hand and the claim settlement ratio of Iffco Tokio, we believe that Family Health Protector is a better alternative to Family Health Optima for most use cases that we’ve evaluated so far.
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