Oriental Insurance Health of Privileged Elders vs HDFC Ergo Optima Restore

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, Health of Privileged Elders imposes a mandatory co-payment of 20% . And Optima Restore doesn’t impose a co-payment clause.

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, Health of Privileged Elders only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured but you can pick any room you want with Optima Restore.

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, Health of Privileged Elders imposes disease-wise sub-limits on Accident Injury, Knee Replacement, Cardio Vascular Diseases, Chronic Renal Failure, Cancer, Hepato-Biliary Disorders, Chronic Obstructive Lung Diseases, Stroke, Benign Prostrate, Orthopaedic Diseases, Opthalmic Diseases whereas Optima Restore doesn’t impose a disease wise sub-limit.

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, Health of Privileged Elders imposes a waiting period of 2 years on pre-existing diseases while Optima Restore extends a waiting period of 3 years on existing conditions.

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, Health of Privileged Elders covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Optima Restore covers expenses incurred 60 days before hospitalization and expenses incurred 180 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, Health of Privileged Elders doesn’t offer a no-claim bonus whereas Optima Restore offers 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, Health of Privileged Elders offers domiciliary cover. And Optima Restore 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, Health of Privileged Elders covers Ayush procedures and Optima Restore 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, neither Health of Privileged Elders offers maternity cover nor does Optima Restore.

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 Health of Privileged Elders extends coverage for outpatient consultations, nor does Optima Restore.