Oriental Insurance Happy Family Floater Policy Diamond vs Niva Bupa HeartBeat Gold
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Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Happy Family Floater Policy Diamond is sold by Oriental Insurance and HeartBeat Gold is sold by Max Bupa. 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. Happy Family Floater Policy Diamond is quite basic. It offers little protection and may not be entirely suitable if you are looking for robust protection. However, HeartBeat Gold is a premium policy tailored to cover as many use cases as possible. So in all honesty, you are 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 Happy Family Floater Policy Diamond. The product comes from Oriental Insurance’s stable:
Oriental Insurance is a government-owned company that offers health, vehicle, business, and farmer insurance. The company is a fully-owned component of the Oriental Government Security Life Assurance Company Ltd.
Now because it is a government-owned insurance firm, you can’t expect operational efficiencies across the board. Although, the company does boast a fairly high claim settlement ratio with over 3,264 network hospitals across the country.
HeartBeat Gold meanwhile comes from Niva Bupa (erstwhile Max Bupa)’s stable:
Founded in 2008, Niva Bupa (erstwhile Max Bupa) is one of the leading health insurance companies in India. While they have had a bit of a tumultuous time with their promoters, they still sell an impressive suite of products across multiple categories.
And they also boast a claim settlement ratio of 91%, with a network of more than 10,000+ hospitals.
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Compare Insurances Insurance Parameters Recommended Not Recommended | Happy Family Floater Policy Diamond | HeartBeat Gold |
|---|---|---|
| Network hospitals | 3,264 | 10,000+ |
| Claim settlement ratio (avg. of last 3 years) | 96% | 91% |
| Co-payment | No | No |
| Room rent | Any Room (up to 1% of sum insured) | Any Room (Except suite) |
| Disease sub-limit | Yes | No |
| Pre existing diseases waiting | 3 years | 2 years |
| Pre/Post hospitalization | 30/60 days | 60/90 days |
| No claim bonus | 10% per year (up to 100%) | |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for any illness) | |
| Health check-up | Once every year | |
| Maternity | Available (2.5% of Sum Insured) | Available (up to ₹40,000 after 2 years) |
| 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, Happy Family Floater Policy Diamond doesn’t impose a co-payment clause. And neither does HeartBeat Gold.
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, Happy Family Floater Policy Diamond only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured, whereas HeartBeat Gold lets you stay in any room except a Suite.
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, Happy Family Floater Policy Diamond imposes disease-wise sub-limits on Modern treatments whereas HeartBeat Gold doesn’t impose a disease wise sub-limit.
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, Happy Family Floater Policy Diamond imposes a waiting period of 3 years on pre-existing diseases while HeartBeat Gold extends a waiting period of 2 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, Happy Family Floater Policy Diamond covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, HeartBeat Gold 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, Happy Family Floater Policy Diamond doesn’t offer a no-claim bonus whereas HeartBeat Gold offers 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, Happy Family Floater Policy Diamond offers domiciliary cover. And HeartBeat Gold 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, Happy Family Floater Policy Diamond covers Ayush procedures and HeartBeat Gold 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, Happy Family Floater Policy Diamond offers maternity cover and HeartBeat Gold offers maternity cover too, although the sub-limits for normal delivery and C-section procedures may be different, including the waiting period.
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 Happy Family Floater Policy Diamond extends coverage for outpatient consultations, nor does HeartBeat Gold.
Final Conclusion
It should be obvious that HeartBeat Gold offers substantially better features when compared to Happy Family Floater Policy Diamond. But considering Niva Bupa (erstwhile Max Bupa) has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that Oriental Insurance has to offer.
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