Star Health Family Health Optima vs National Insurance National Parivar Mediclaim Plus policy

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, Family Health Optima imposes a co-payment clause of 20% if you purchase after turning 61 whereas National Parivar Mediclaim Plus policy imposes a co-payment clause of 10% if you’re hospitalized in a non-network medical facility.

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 National Parivar Mediclaim Plus policy only lets you stay in a room whose rent doesn’t exceed 1% of the sum insured. In effect, both policies impose restrictions on the kind of room you can pick.

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 Cataracts, Modern Treatments whereas National Parivar Mediclaim Plus policy imposes sub-limits on Cataracts, Modern treatments

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 National Parivar Mediclaim Plus policy will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases

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, National Parivar Mediclaim Plus policy covers expenses incurred 30 days before hospitalization and expenses incurred 60 after hospitalization, although there may be different sub-limits

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 National Parivar Mediclaim Plus policy doesn’t offer a no-claim bonus.

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 National Parivar Mediclaim Plus policy also coves domiciliary expenses.

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 National Parivar Mediclaim Plus policy also extends coverage for Ayush treatments.

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, however, Family Health Optima doesn’t offer protection for maternity-related hospitalizations whereas National Parivar Mediclaim Plus policy offers maternity cover.

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 National Parivar Mediclaim Plus policy.