Overview
The Oriental Insurance Happy Family Floater Platinum plan is a family health insurance policy offering sum insured options from ₹25 lakhs to ₹50 lakhs. Its distinct features include outpatient dental and ophthalmic care reimbursements, additional sum insured for critical illnesses, and personal accident cover. With lifelong renewability and cashless treatment at network hospitals, it aims to provide enhanced protection for families.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Happy Family Floater Platinum plan offers a notable maternity and assisted reproductive treatment coverage of up to ₹2 lakhs after a three-year waiting period, one of the highest limits in the industry. It also reimburses outpatient dental and ophthalmic expenses up to ₹5,000 every three years, a rare benefit among family floaters. The plan provides an additional 10% sum insured for critical illnesses and includes personal accident cover, enhancing overall protection.
However, the plan has some drawbacks. It imposes disease-wise sub-limits that may restrict claim amounts for certain treatments. There is no no-claim bonus or restoration of sum insured, which limits financial flexibility in case of multiple claims. The waiting period for pre-existing diseases is three years, which is longer than some competitors. Additionally, the relatively limited network of hospitals may affect cashless claim convenience. Premiums for the Platinum plan are generally 20-30% higher than the Gold variant, reflecting its enhanced benefits but making it a pricier option.
Pros
Insurer has a solid track record with great claim and service metrics.
Offers Extended coverage for Assisted Reproductive Treatments, which makes this policy stand out.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, which is a key feature.
Oriental Insurance
Key Insights
Founded
1947
Oriental Insurance was established 78 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
94% claims settled in 30 Days
Oriental Insurance settles 94% of all claims it receives demonstrating strong credibility.
Network Hospitals
4,000+
Oriental Insurance has a limited network of 4,000 hospitals, which may restrict access to cashless services for policyholders.
Complaints
7 complaints per 10,000 claims registered
Oriental Insurance maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Bad
Maternity
STANDOUT
The insurer will also cover expenses related to maternity— Think hospitalization expenses incurred while giving birth. But they’ll only pay upto 2.5% of the sum insured and make you wait 2 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
Extended coverage for Assisted Reproductive Treatments
STANDOUT
This plan offers coverage for assisted reproductive treatments upto 2 lakhs and make you wait 3 years before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Add-ons
Life Hardship Survival Benefit
Lump sum payment in the event insured is diagnosed with listed 11 critical illnesses outlined in the policy document.
Geographical Extension To SAARC Countries
Extends the base coverage for insured members to SAARC countries without charging any additional premiums for planned and emergency treatments. The insured member needs to make a written request to the insurer to avail of this benefit.
Personal Accident Cover
Paid out as a lump sum amount for Accidental Death, Total Permanent Disability, Permanent Partial Disability up to defined limit.
Waiver of Proportionate Deduction Clause
Enhances the clause of proportionate deduction of the room rent benefit by 50% or 100%.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Hormone Replacement Therapy
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 3 years.
Benign ENT disorders and surgeries (e.g. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty)
Polycystic ovarian diseases
Surgery of hernia
Surgery of hydrocele
Non-infective Arthritis
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
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Frequently Asked Questions
Does Happy Family Floater Policy Platinum have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 1 to 3-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 2-year waiting period before you can make claims related to pregnancy and childbirth.
Does Happy Family Floater Policy Platinum have room rent restrictions?
Does Happy Family Floater Policy Platinum offer a restoration benefit?
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