Before we start comparing these two policies we have to set out some ground rules.
For starters, both policies, Optima Restore and myHealth Suraksha Gold 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 are reasonably comprehensive. They do the basics quite well, but they won’t have all the bells and whistles (Think extensive coverage for international, dental, maternity and other such matters). So if you are looking for something else entirely, 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.
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|Claim settlement ratio|
(avg. of last 3 years)
|Pre existing diseases waiting|
|No claim bonus|
50% per year
(up to 100%)
10% per year
(up to 100%)
(once for any illness)
(once for any illness)
Once every year
Once every year
|Out Patient Department|
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, Optima Restore doesn’t impose a co-payment clause. And neither does myHealth Suraksha Gold.
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, Optima Restore doesn’t impose any restrictions on the kind of room you can pick. And myHealth Suraksha Gold also doesn’t impose any restrictions on this front. You can pick any room you want.
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, neither Optima Restore imposes disease-wise sub-limits nor does myHealth Suraksha Gold
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. This cooling period is referred to as the Pre-existing-disease waiting period. In this case, Optima Restore imposes a 3 year waiting period on pre-existing diseases and myHealth Suraksha Gold will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases
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, Optima Restore covers expenses incurred 60 days before hospitalization and expenses incurred 180 days post-hospitalization. Meanwhile, myHealth Suraksha Gold covers expenses incurred 60 days before hospitalization and expenses incurred 180 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, Optima Restore offers a no-claim bonus of 50% whereas myHealth Suraksha Gold offers a no-claim bonus of 10%. And the no-claim bonus may be capped at different levels too.
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, Optima Restore offers domiciliary cover. And myHealth Suraksha Gold also coves domiciliary expenses.
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 Optima Restore doesn’t extend coverage for Ayush treatments whereas myHealth Suraksha Gold covers Ayush treatments.
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 Optima Restore offers maternity cover nor does myHealth Suraksha Gold.
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 Optima Restore extends coverage for outpatient consultations, nor does myHealth Suraksha Gold.
After considering all the features on hand, we believe that Optima Restore is a better alternative to myHealth Suraksha Gold for most use cases that we’ve evaluated so far.
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