Star Health Cardiac Care Platinum vs Star Health Family Health Optima

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

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, Cardiac Care Platinum lets you stay in a single private room and Family Health Optima also lets you stay in a single private room. Nothing fancy.

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 Cardiac Care Platinum imposes disease-wise sub-limits nor does Family Health Optima

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, Cardiac Care Platinum imposes a 4 year waiting period on pre-existing diseases and Family Health Optima will similarly tell you to wait 4 years before making a claim related to your pre-existing diseases

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, Cardiac Care Platinum covers expenses incurred 30 days before hospitalization and expenses incurred 60 days post-hospitalization. Meanwhile, Family Health Optima covers expenses incurred 60 days before hospitalization and expenses incurred 90 after hospitalization, although there may be different sub-limits

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, Cardiac Care Platinum offers a no-claim bonus of 10% whereas Family Health Optima offers a no-claim bonus of 25%. 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, Cardiac Care Platinum doesn’t offer domiciliary protection whereas Family Health Optima offers domiciliary cover.

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 Cardiac Care Platinum doesn’t extend coverage for Ayush treatments whereas Family Health Optima 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 Cardiac Care Platinum offers maternity cover nor does Family Health Optima.

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, Cardiac Care Platinum offers OPD cover whereas Family Health Optima doesn’t offer OPD protection.