Family Health Optima

Family Health Optima is a pretty decent policy. It's fairly inexpensive. It has decent coverage. But they will make you wait 4 years before they start covering pre-existing diseases (like diabetes). So it might be prudent to read the fine print before you buy this policy, considering they have a few extra conditions

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What's good here?

You most likely don't have to split the bill

If you bought this policy after you turned 61, you have to pay 20% of the bill every time you make a claim. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.

If you bought this policy after you turned 61, you have to pay 20% of the bill every time you make a claim. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.

You can pick a Single Private room but nothing fancy

You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.

Good Restoration Benefit

Once you exhaust your entire cover, you will have 100% of the cover restored for a maximum of 3 times in a policy year, if you are hospitalized again in a bid to treat a different complication. In the same year, by the way.

Special Bonus for being healthy and not claiming insurance

Your sum insured increases by 25% on first year, so long as you make no claims during this period. But you get this exorbitant benefit only for 1st year. After that, it’ll grow at 10% each year until your bonus cover tallies up to 100% of the sum insured. So if you start with a cover of ₹100. Then it’ll keep growing till it reaches ₹200.

Full coverage even if you are forced to hospitalize at home

The insurer will bear the costs even if you are hospitalized at home due to a condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.

Pre & Post hospitalization expenses covered

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 - 60 days before you are hospitalized and 90 days after discharge. This includes the cost of medication by the way.

Day Care treatments covered

If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.

Free Health Checkups every year

If you’re planning on getting a full body checkup every year just to make sure you’re in fine working condition, the insurer will cover the costs.

What's bad here?

Long waiting period for pre-existing diseases

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 only after 4 long years. It could be much shorter you know? Like 2 years perhaps!

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 only after 4 long years. It could be much shorter you know? Like 2 years perhaps!

What's okay here?

Your insurer won’t pay the full bill for certain diseases

Your insurance cover won’t be fully available in case you are treated for eye related diseases, max. of 50,000 will be covered per eye. In case of 5 Lakh sum insured, 60,000 will be covered per policy year. Additionally, there are various sub-limits.

Some Cover for Alternative Medicine

Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will pay up to ₹15,000 of the cover in case you have a 10L cover and you’re availing these treatments. This limit varies from ₹10,000 to ₹20,000 depending on the cover amount taken.

Frequently Asked Questions

Does Family Health Optima 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 4-year waiting period for any pre-existing disease you may have while buying the policy.

Does Family Health Optima have room rent restrictions?

Does Family Health Optima offer a restoration benefit?

Does Family Health Optima cover AYUSH treatments?

Does Family Health Optima offer a bonus?

Does Family Health Optima offer maternity benefits?

Does Family Health Optima offer international coverage?

Does Family Health Optima offer dental protection?

Does Family Health Optima offer coverage for outpatient consultations?

How are the premiums calculated for Family Health Optima?

Can I avail myself of a discount on Family Health Optima?

Does Family Health Optima have entry and exit restrictions?

How do you file a claim if you have Family Health Optima?

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