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Introduction

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

Both products are marketed by different insurance companies. Family Health Optima is sold by Star Health and iHealth is sold by ICICI Lombard. So any meaningful comparison should include a comparison of the product alongside the insurers themselves.

Second, we know that both products are quite basic in their structure. They offer modest protection and aren’t comprehensive enough to cover a wide array of use cases. So if you are looking for something more robust, then both these policies may not cut it.

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 Family Health Optima. The product 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 14,000+ hospitals and a decent claim settlement ratio of 83%.


iHealth meanwhile comes from ICICI Lombard’s stable:

ICICI Lombard Health Insurance company is a joint venture between India's ICICI Bank and Canada's Fairfax Holdings. They are one of the leading insurance companies with over 270 branches spread across India.

However, with a claim settlement ratio of 85% and a measly network of 7,500+ hospitals, their performance needs significant improvement.

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Insurance Parameters

Recommended
Not Recommended
Network hospitals
14,000+
7,500+
Claim settlement ratio

(avg. of last 3 years)

83%
85%
Co-payment

20%

(if purchased after turning 61)

No

Room rent

Single Private room

Any Room

Disease sub-limit

Yes

No

Pre existing diseases waiting

4 years

2 years

Pre/Post hospitalization

60/90 days

30/60 days

No claim bonus

25% per year

(up to 100%)

10% per year

(up to 50%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(3 times for different illness)

100% restoration

(once for different illness)

Health check-up
Once every year
Once every year
Maternity
Out Patient Department
Day care

Feature Comparison

coPay

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, Family Health Optima requires you to co-pay a part of the bill 20% if you purchase after turning 61 whereas iHealth doesn’t impose a co-payment clause

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, Family Health Optima only lets you stay in a single private room but you can pick any room you want with iHealth.

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

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, Family Health Optima imposes a waiting period of 4 years on pre-existing diseases while iHealth extends a waiting period of 2 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, Family Health Optima covers expenses incurred 60 days before hospitalization and expenses incurred 90 days post-hospitalization. Meanwhile, iHealth covers expenses incurred 30 days before hospitalization and expenses incurred 60 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, Family Health Optima offers a no-claim bonus of 25% whereas iHealth offers a no-claim bonus of 10%. 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, Family Health Optima offers domiciliary cover whereas iHealth doesn’t offer domiciliary protection.

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, Family Health Optima covers Ayush procedures and iHealth 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, neither Family Health Optima offers maternity cover nor does iHealth.

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, neither Family Health Optima extends coverage for outpatient consultations, nor does iHealth.

Final Conclusion

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

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