Introduction
Before we start comparing these two policies we have to set out some ground rules.
Both products are marketed by different insurance companies. Energy Silver is sold by HDFC Ergo and Family Health Optima is sold by Star Health. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.
Second, we know that both products have massive differences in their core structure. Energy Silver is specifically designed for people suffering from diabetes/hypertension. However, Family Health Optima is quite basic. It offers little protection and it’s a generic policy that anybody could pick off the shelf. So in many ways, you’re comparing apples and oranges here.
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.
Let’s start with Energy Silver. The product comes from HDFC Ergo’s stable:
Founded in the year 2002, the company is a joint venture between India’s HDFC and Germany’s ERGO International AG. It offers policies across motor, travel, health and other sectors. And it also happens to be one of the largest insurers in the country.
More importantly, HDFC Ergo boasts a claim settlement ratio of 97.55%, with a network of 11,300+ hospitals
All in all, an impressive resume.
Family Health Optima meanwhile comes from Star Health’s stable:
Star Health Insurance is India's first standalone health insurance firm. And with an army of retail advisors pushing their products across the country, they’ve managed to capture a fair share of the Indian market.
The company also boasts a network of over 13,000+ hospitals and a decent claim settlement ratio of 83.07%.
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Compare Insurances Insurance Parameters |  Energy Silver |  Family Health Optima |
|---|---|---|
| Network hospitals | 11,300+ | 14,000+ |
| Claim settlement ratio (avg. of last 3 years) | 97.5% | 82.01% |
| Co-payment | No | 20% (if purchased after turning 61) |
| Room rent | Any Room | Single Private room |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 2 years | 4 years |
| Pre/Post hospitalization | 30/60 days | 60/90 days |
| No claim bonus | 10% per year (up to 100%) | 25% per year (up to 100%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for any illness) | 100% restoration (3 times for different illness) |
| Health check-up | Once every year | |
| Maternity | ||
| Out Patient Department | ||
| Day care |
Feature Comparison
Co payment
With a co-payment clause, the insurer will mandate that you pay a part of the bill. So if the bill adds up to Rs. 2,00,000 and the co-payment is set at 20% then you could be asked to pay Rs. 40,000 from the bill. In this case, however, Energy Silver doesn’t impose a mandatory co-payment clause whereas Family Health Optima imposes a co-payment clause of 20% if you purchase after turning 61.
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, you can pick any room you want with Energy Silver but Family Health Optima only lets you stay in a single private room. Nothing fancy.
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, Energy Silver doesn’t impose a disease wise sub-limit whereas Family Health Optima imposes disease-wise sub-limits on null.
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, Energy Silver imposes a waiting period of 2 years on pre-existing diseases while Family Health Optima extends a waiting period of 4 years on existing conditions.
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, Energy Silver covers expenses incurred 30 days before hospitalization and expenses incurred 60 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
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, Energy Silver offers a no-claim bonus of 10% whereas Family Health Optima offers a no-claim bonus of 25%. And the no-claim bonus may be capped at different levels too.
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, Energy Silver doesn’t offer domiciliary protection whereas Family Health Optima offers domiciliary cover.
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 Energy Silver doesn’t extend coverage for Ayush treatments whereas Family Health Optima covers Ayush treatments.
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, neither Energy Silver offers maternity cover nor does Family Health Optima.
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, neither Energy Silver extends coverage for outpatient consultations, nor does Family Health Optima.
Final Conclusion
If you’re specifically looking to buy a policy for people suffering from diabetes/hypertension, Energy Silver makes a lot of sense. But considering Star Health has a claim settlement ratio that can only be considered sub-par at best, we would still recommend going with anything that HDFC Ergo has to offer, if the policy is made available to you.
Other HDFC Ergo Energy Silver Comparisons
Other Star Health Family Health Optima Comparisons
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