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Family Health Optima Insurance Plan vs Health Insurance (Gold)

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Specifications side by side

Spec
Family Health Optima Insurance Plan
Health Insurance (Gold)
Cover
Plan type
Family floater
Individual and family floater
Sum insured options
5 lakh, 10 lakh, 15 lakh, 20 lakh, 25 lakh
5 lakh, 7.5 lakh, 10 lakh, 15 lakh, 20 lakh
Highest sum insured
25 lakh
20 lakh
Entry age
18 years (adults); 16 days (dependent children) to 65 years
3 months to 65 years
Room rent
Single Private A/C Room
Standard Single Private Room; no capping on ICU accommodation
Co-payment
20% of each and every claim for Insured Persons whose age at entry is 61 years and above
Compulsory 20% for each Insured Person aged above 60 Years
Waiting periods
Initial waiting period
30 days
30 days
Pre-existing disease waiting
36 months
36 months
Specific illness waiting
24 months
24 months
Benefits
Pre-hospitalisation
60 days
60 days
Post-hospitalisation
90 days
90 days
Day-care treatment
Yes
Yes
AYUSH treatment
Yes
Yes
Restore benefit
Automatically restored 3 times in a Policy Year by 100% each time upon exhaustion; usable only for illness unrelated to earlier claims (not for Modern Treatment)
100% of the Sum Insured once in a policy year (in-built in Gold and Platinum); not triggered on the first claim; unrelated illness only
No-claim bonus
Loyalty Bonus 10% of expiring Sum Insured per year (irrespective of claims), up to maximum 100% of Sum Insured
50% of Sum Insured per claim-free year, maximum 100% (Gold); reduces at same rate on claim
Maternity
—
Up to Rs 50,000; waiting period of 4 years (Gold)
OPD
Not covered (unlimited tele-consultation only)
—
Insurer
Health incurred claim ratio (insurer)
70.3%
90.12%
Claims figures for
FY 2024-25: health incurred claim ratio including personal accident, IRDAI Annual Report (Statement 10)
FY 2024-25: health incurred claim ratio including personal accident, IRDAI Annual Report (Statement 10)
Network hospitals (insurer)
16,000+
10000+
IRDAI UIN
SHAHLIP26046V092526
ZUNHLIP26040V042526

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Pros and cons

Family Health Optima Insurance Plan

  • Con: Co-payment: 20% of each and every claim for Insured Persons whose age at entry is 61 years and above

Health Insurance (Gold)

  • Pro: No room-rent cap
  • Con: Lower maximum sum insured than 82% of the 52 health insurance plans on Comparezi that state it (₹20 lakh)
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