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Introduction

Before we start comparing these two policies we have to set out some ground rules.

For starters, both policies, Comprehensive and Family Health Optima are marketed by the same insurance company. So in some ways, a lot of the differences within the product will be limited to the features themselves.

Second, we know that both products have massive differences in their core structure. Comprehensive is more comprehensive. It covers a lot more use cases and doesn’t have any egregious conditions. However, Family Health Optima is quite basic. It offers little protection and may not be entirely suitable if you are looking for robust protection. So fundamentally, they’re two very different products.

And finally, any comparison is ultimately futile without considering the use case. Who are you buying this policy for? You, your family, your parents?

That’s something you’ll need to answer before using this guide. So with that introduction out of the way, we can get to comparing the actual policies themselves.

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Insurance Parameters

Network hospitals
14,000+
14,000+
Claim settlement ratio

(avg. of last 3 years)

82.01%
82.01%
Co-payment

10%

(if purchased after turning 61)

20%

(if purchased after turning 61)

Room rent

Single Private room

Single Private room

Disease sub-limit

No

Yes

Pre existing diseases waiting

3 years

4 years

Pre/Post hospitalization

60/90 days

60/90 days

No claim bonus

50% per year

(up to 100%)

25% per year

(up to 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for any illness

after complete exhaustion of sum insured)

100% restoration

(3 times for different illness)

Health check-up
Once every year
Once every year
Maternity

Available

(up to ₹20,000 after 2 years)

Out Patient Department

Up to ₹1,200

(cap of ₹300 on each consultation)

Day care

Feature Comparison

roomRent

Room rent

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, Comprehensive lets you stay in a single private room and Family Health Optima also lets you stay in a single private room. Nothing fancy.

diseaseSublimit

Sub limits

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, Comprehensive doesn’t impose a disease wise sub-limit whereas Family Health Optima imposes disease-wise sub-limits on null.

ped

Waiting periods for pre-existing diseases

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, Comprehensive imposes a waiting period of 3 years on pre-existing diseases while Family Health Optima extends a waiting period of 4 years on existing conditions.

prePost

Pre and post Hospitalization expenses

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, Comprehensive covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, Family Health Optima covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits

ncb

No claim bonus

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, Comprehensive offers a no-claim bonus of 50% whereas Family Health Optima offers a no-claim bonus of 25%. And the no-claim bonus may be capped at different levels too.

domiciliary

Domiciliary

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, Comprehensive offers domiciliary cover. And Family Health Optima also coves domiciliary expenses.

ayush

Ayush treatments

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, Comprehensive covers Ayush procedures and Family Health Optima also extends coverage for Ayush treatments.

maternity

Maternity benefits

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, however, Comprehensive offers maternity cover whereas Family Health Optima doesn’t offer protection for maternity-related hospitalizations.

opd

Out Patient Department (OPD)

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, Comprehensive offers OPD cover whereas Family Health Optima doesn’t offer OPD protection.

Final Conclusion

After considering all the features on hand, we believe that Comprehensive is a better alternative to Family Health Optima for most use cases that we’ve evaluated so far.

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