Overview
The Oriental Insurance Health of Privileged Elders (HOPE) plan is designed exclusively for senior citizens aged 60 and above, offering sum insured options from ₹1 lakh to ₹5 lakhs. It covers specific diseases such as knee replacement, cancer, stroke, and cardiovascular conditions. The policy also features a relatively short two-year waiting period for pre-existing diseases, compulsory 20% co-payment, and cashless claims up to ₹1 lakh, making it a focused solution for elderly individuals with existing health concerns.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Oriental Insurance Health of Privileged Elders (HOPE) plan is a targeted health insurance product catering specifically to senior citizens, particularly those with pre-existing conditions. Its standout feature is the relatively short two-year waiting period for pre-existing diseases—shorter than the typical three years—making it a viable option for seniors managing chronic ailments like diabetes or cardiovascular disease.
The policy covers a range of specified illnesses, such as cancer, stroke, and knee replacement surgeries. However, HOPE enforces a compulsory 20% co-payment, requiring policyholders to bear a significant portion of treatment costs, which can add financial strain during hospitalization.
In addition, the plan lacks both a cumulative bonus and restoration of the sum insured, limiting potential coverage enhancements available on other policies. There are also disease-wise sublimits that cap the amount claimable for major ailments, further restricting payout even within the modest overall sum insured ceiling of ₹5 lakhs.
Cashless claims are limited to ₹1 lakh, meaning reimbursement claims are required for expenses beyond this threshold and can lead to substantial out-of-pocket payments.
While premiums are generally competitive, they reflect the plan’s restricted coverage, mandatory co-payment, absence of bonus/restoration, and disease-wise limits.
Pros
Insurer has a solid track record with great claim and service metrics.
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.
Maternity benefits not offered, 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
Co-payment
The policy will only cover 80% of the final bill. The rest is on you. They call this a co-payment.
Customisable
Choose a co-payment between 10% and 50% to reduce premiums.
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 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 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.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Voluntary Co-Payment
Choose a co-payment between 10% and 50% to reduce premiums.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
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.
Services for terminally ill individuals addressing non-medical needs are 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 2 years.
Non-infective Arthritis
Cataract
Surgery of benign prostatic hypertrophy
Surgery of gallbladder and bile duct (excluding malignancy)
Surgery of genito-urinary system (excluding malignancy)
Waiting Period
30 days Initial waiting period
2 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.
Maternity benefits not offered.
Doctor consultations are not covered.
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Frequently Asked Questions
Does Health of Privileged Elders 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 2-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.
Does Health of Privileged Elders have room rent restrictions?
Does Health of Privileged Elders offer a restoration benefit?
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