Summary
Good Features
Missing Features
Pricing
Insurer Performance​
Product Benefits
In Patient Hospitalisation
ICU Room Rent Limit | No Limit |
Room Rent Limit | No Limit |
Pre & Post Hospitalisation
Pre Hosipitalization Expenses covered | 60 Days |
Post Hosipitalization Expenses covered | 180 Days |
Day Care Treatment
Financial Limit | No Limit |
No. of treatments covered | All are covered |
Organ Donor
Expenses covered upto | Sum Insured |
Domiciliary Treatment
Expenses covered upto | Sum Insured |
No. of illnesses not covered | 0 |
Modern Treatment
Financial Limit | No Limit |
BonusÂ
Max Bonus | 100% |
Reduction in bonus post claim | No |
% of Bonus added every year | 50% (Irrespective of the claim) |
Super BonusÂ
Max Bonus | Not Available |
Reduction in bonus post claim | Not Available |
% of Bonus added every year | Not Available |
Restoration BenefitÂ
No. of times refill can be applied | Unlimited |
Claim in which refill of cover can be applied | Subsequent claims |
When does restoration trigger ? | Partial exhaustion of Sum Insured |
Illness for which refill will be eligible | Related and unrelated illness |
Consumables Cover (Non-Medical Expenses Cover)
Limit on Non Medical Expenses | No limit |
Cover on Non Medical Expenses | Available |
Additional Features
Alternate Medicine (AYUSH) | Sum Insured |
Worldwide Coverage | Not Available |
Animal Bite Vaccination | Not Available |
Daily Cash Allowance | Rs 800 per day and maximum upto Rs 4,800 (for shared accommodation) |
Discount on Renewal | Not Available |
Free Health CheckUps | Up to Rs. 2,000 for Individual policies; Up to Rs. 5,000 per policy for Family Floater policies on each continuous renewal |
Out patient consultation benefits | Available (Add-on) |
Maternity Benefits
Parenthood Add-on (24 months waiting period) | Available cover options : Rs. 50K, 1 Lakh, 1.5 lakhs, 2 Lakhs |
Limits
Cataract treatment expenses covered up to | Sum Insured |
Joint replacement surgery expenses covered up to | Sum Insured |
Pre-existing Disease Waiting Period | 36 months ( ABCD Chronic Care, Asthma, BP, Cholesterol and Diabetes coverage from 31st day)Â |
Specified Treatment Waiting Period | 24 months |
Co-payment | No co-payment |
Deductible | 25K / 50K / 100K / 200K / 300K (Add-on) |
Add-Ons
Optima Wellbeing- Unlimited In-person consults with general physician
- Unlimited Tele Consults with general physician and routine specialties
- Unlimited Home sample collection
- Upto 50% discount on lab tests, scans , checkups and medicines and many more
Unlimited Restore
Get 100% of base sum insured on complete or partial utilization of your sum insured; unlimited times for all subsequent claims in a policy year
Hospi Cash
Get Hospital Daily Cash of Rs 1000/Rs 2000 to cover your out-of-pocket expenses
ABCD Chronic Care
Get coverage for Asthma, Blood pressure, Cholesterol and Diabetes from 31st day
Limitless
Get one claim of infinite value during the lifetime of the policy
Parenthood (Maternity) : 24 Months Waiting Period
Covers : Normal and C-Section delivery, Pre and Post Natal Expenses, IVF Treatment, & Embryo Freezing Expenses.
Discounts
Aggregrate Discount :Â Get a discount on your insurance premium when you agree to pay a certain aggregate deductible amount.ÂDeductible Amount Options : Rs.25,000, Rs.50,000, Rs.1,00,000, Rs. 2,00,000, & Rs. 3,00,000
Exclusions
1.  Expenses related to stem cell harvesting2. Treatment for alopecia and baldness
3. Prosthesis & external durable equipments, unless needed to treat an accidental injury
4. Investigative procedures for sleep apnea, general weakness, run-down condition, etc.
5. Investigative treatment for spine, bones, and muscles - except fracture treatment (excluding hairline fractures)Insurer Performance
% of claims settled in less than 30 days Speed of settling valid claims | 96.63%​ |
Claim Settlement Ratio (No. of claims) % of the claims received were paid | 95.19% |
Claim Rejection Ratio % of claims rejected & repudiated by the insurer | 2.47% |
Amount Settlement Ratio % of the claim amount received was paid | 77.69% |
% of Complaints received on overall claims % customers dissatisfied with claims | 0.15% |
Incurred Claim Ratio % of premium collected was paid out as claims (ideal : 70-90%) | 87.04% |
No. of Cashless Hospitals | 16,000+ |
Taxes
GST : ZEROIncome Tax Benefits (Old Tax Regime) : Under Section 80D, premium paid for Health Insurance is tax exempted. Limit is upto Rs. 25,000