Optima Senior is a good choice if you’re 60+, with pre-existing complications or if nobody is willing to insure you. However, if you have other alternatives, this policy could be a letdown, considering, they'll make you wait 3 years before they start covering pre-existing complications. Also you will have to split the bill in the event you contract certain specific diseases. So do read more below.
What's good here?
You can pick any room you like
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
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 - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
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.
What's bad here?
You will have to pay a portion of the bill
The policy will cover only 85% of the bill in case you opt for a shared room. And 80% in case you opt for anything fancier than a shared room. The rest is on you. They call this mandatory co-payment.
Your insurer won’t pay the full bill for certain diseases
Your insurer won’t bear the full costs if you are treated for Angiography, Joint Replacement and a few other complications. In fact, you will have to bear 30% of the cost in the event you are hospitalized for these illnesses.
Reasonable 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 after you wait for 3 years.
Day Care treatments covered up to a certain limit
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover 85% of these costs and you have to bear the rest. Think dialysis, chemotherapy or minor surgeries.
What's lacking here?
No Restoration Benefit
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
No Bonus for being healthy and not claiming insurance
Some policies offer you extra cover if you go an entire year without claiming your insurance. This policy, however, offers no such benefit.
Your insurer doesn’t provide free health check-ups
If you want to get a full-body checkup just to make sure you’re in fine working condition, be ready to pay for it yourself.
No Cover for Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatment to cure an illness. Tough Luck!!! Your insurer won’t cover this expense.
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