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 Medicare Senior is sold by TATA AIG. 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. Family Health Optima is quite basic. It offers little protection and it’s a generic policy that anybody could pick off the shelf. However, Medicare Senior is specifically designed for null. So in many ways, you’re comparing apples and oranges here.
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%.
Medicare Senior meanwhile comes from TATA AIG’s stable:
Tata AIG Health Insurance company is a joint venture between the Tata Group and American International Group. It was founded in 2001 and it’s one of the few companies that market products that are truly comprehensive, albeit expensive.
The company also boasts a claim settlement ratio of 96% with over 10,000 network hospitals across India.
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Compare Insurances Insurance Parameters Recommended Not Recommended |  Family Health Optima |  Medicare Senior |
|---|---|---|
| Network hospitals | 14,000+ | 10,000+ |
| Claim settlement ratio (avg. of last 3 years) | 83% | 96% |
| Co-payment | 20% (if purchased after turning 61) | 15% |
| Room rent | Single Private room | Shared Room |
| Disease sub-limit | Yes | Yes |
| Pre existing diseases waiting | 3 years | 4 years |
| Pre/Post hospitalization | 60/90 days | 30/60 days |
| No claim bonus | 25% per year (up to 100%) | |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (3 times for different illness) | |
| Health check-up | Once every year | |
| 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 imposes a co-payment clause of 20% if you purchase after turning 61 whereas Medicare Senior imposes a mandatory co payment of 85% if you opt for shared room and 70% if you opt for any other room.
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, Family Health Optima lets you stay in a single private room and Medicare Senior only lets you stay in a shared room. 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 Medicare Senior imposes sub-limits on Cataract, Joint Replacement, Hernia, Hysterectomy, Benign Prostate surgery
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. In this case, Family Health Optima imposes a waiting period of 3 years on pre-existing diseases while Medicare Senior extends a waiting period of 4 years on existing conditions.
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, Medicare Senior covers expenses incurred 30 days before hospitalization and expenses incurred 60 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, Family Health Optima offers a no-claim bonus whereas Medicare Senior doesn’t offer a 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 Medicare Senior 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 treatments whereas Medicare Senior doesn’t extend 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 Medicare Senior.
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 Medicare Senior.
Final Conclusion
If you’re specifically looking to buy a policy for null, Medicare Senior makes a lot of sense. But considering Star Health has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that TATA AIG has to offer, if the policy is made available to you.
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