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 Senior Citizen Mediclaim is sold by New India Assurance. 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. Optima Restore is quite comprehensive. It offers considerable protection and it doesn’t impose as many restrictions. However, Senior Citizen Mediclaim is specifically designed for senior citizens. 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 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 97.50%, with a network of 11,300+ hospitals
All in all, an impressive resume.
Senior Citizen Mediclaim meanwhile comes from New India Assurance’s stable:
New India Assurance, is a government-owned insurance firm that was established in 1919. Their insurance portfolio includes Health, Motor, Travel, and Marine products. But despite being in the business for so long, they’re not the most efficient when it comes to processing your application and dealing with your claims.
And that means, even with a relatively high claim settlement ratio and 3,139 network hospitals, the company isn’t exactly a stellar performer.
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Compare Insurances Insurance Parameters |  Optima Restore |  Senior Citizen Mediclaim |
|---|---|---|
| Network hospitals | 11,300+ | 3,139 |
| Claim settlement ratio (avg. of last 3 years) | 97.5% | 99.88% |
| Co-payment | No | No |
| Room rent | Any Room | Any Room (up to 1% of sum insured) |
| Disease sub-limit | No | Yes |
| Pre existing diseases waiting | 3 years | 1.5 years |
| Pre/Post hospitalization | 60/180 days | 30/60 days |
| No claim bonus | 50% per year (up to 100%) | 5% per year (up to 30%) |
| Domiciliary | ||
| Ayush treatments | ||
| Restoration benefit | 100% restoration (once for any illness) | |
| Health check-up | Once every year | Once every 3 years |
| 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, Optima Restore doesn’t impose a co-payment clause. And neither does Senior Citizen Mediclaim.
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 Optima Restore but Senior Citizen Mediclaim only lets you stay in a room whose rent doesn’t exceed 1% of the total sum insured.
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, Optima Restore doesn’t impose a disease wise sub-limit whereas Senior Citizen Mediclaim imposes disease-wise sub-limits on Appendicectomy, Angiography, Tonsillectomy, Hysterectomy.
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, Optima Restore imposes a waiting period of 3 years on pre-existing diseases while Senior Citizen Mediclaim extends a waiting period of 1.5 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, Optima Restore covers expenses incurred 60 days before hospitalization and expenses incurred 180 days post-hospitalization. Meanwhile, Senior Citizen Mediclaim covers expenses incurred 30 days before hospitalization and expenses incurred 60 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 Senior Citizen Mediclaim offers a no-claim bonus of 5%. 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, Optima Restore offers domiciliary cover whereas Senior Citizen Mediclaim doesn’t offer domiciliary protection.
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 Senior Citizen Mediclaim 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 Optima Restore offers maternity cover nor does Senior Citizen Mediclaim.
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 Senior Citizen Mediclaim.
Final Conclusion
Since this isn’t a fair comparison, to begin with, we will only tell you this much. If you want something that’s comprehensive, you could go for Optima Restore. However, if you are specifically looking to buy a policy for senior citizens, then you may want to consider Senior Citizen Mediclaim.
Other HDFC Ergo Optima Restore Comparisons
Other New India Assurance Senior Citizen Mediclaim Comparisons
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