Introduction

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

Both products are marketed by different insurance companies. Optima Restore is sold by HDFC Ergo and ReAssure is sold by Max Bupa. So any meaningful comparison should include a comparison of the product alongside the insurers 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.


Let’s start with Optima Restore. 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%, with a network of 13,000+ hospitals

All in all, an impressive resume.


ReAssure meanwhile comes from Niva Bupa (Max Bupa)’s stable:

Founded in 2008, Niva Bupa (erstwhile Max Bupa) is one of the leading health insurance companies in India. While they have had a bit of a tumultuous time with their promoters, they still sell an impressive suite of products across multiple categories.

And they also boast a claim settlement ratio of 90.68%, with a network of more than 8,600 hospitals.

Compare Insurances

Network hospitals13,000+8,600+
Claim settlement ratio97%90.68%
Co-payment

No

No

Room rent

Any Room

Any Room

Disease sub-limit

No

No

Pre existing diseases waiting

3 years

3 years

Pre/Post hospitalization

60/180 days

60/180 days

No claim bonus

50% per year

(up to 100%)

50% per year

(up to 100%)

Domiciliary
Ayush treatments
Restoration benefit

100% restoration

(once for any illness)

100% restoration

(unlimited no. of times

for any illness)

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

Feature Comparison

co_pay

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, Optima Restore doesn’t impose a co-payment clause. And neither does ReAssure.

room_rent

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, Optima Restore doesn’t impose any restrictions on the kind of room you can pick. And ReAssure also doesn’t impose any restrictions on this front. You can pick any room you want.

disease_sublimit

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, neither Optima Restore imposes disease-wise sub-limits nor does ReAssure

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. 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 ReAssure will similarly tell you to wait 3 years before making a claim related to your pre-existing diseases

pre_post

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, ReAssure covers expenses incurred 60 days before hospitalization and expenses incurred 180 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. And in this case, Optima Restore offers a no-claim bonus of 50% and ReAssure similarly extends a 50% no-claim bonus.

domiciallary

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, Optima Restore offers domiciliary cover. And ReAssure 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 Optima Restore doesn’t extend coverage for Ayush treatments whereas ReAssure covers 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 Optima Restore offers maternity cover nor does ReAssure.

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 Optima Restore extends coverage for outpatient consultations, nor does ReAssure.

Final Conclusion

After considering all the features on hand and the claim settlement ratio of HDFC Ergo, we believe that Optima Restore is a better alternative to ReAssure for most use cases that we’ve evaluated so far.

Ditto
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