Age-point premium
Most health insurance products in India follow the slab-based premium pricing. It means the premium remains the same for those in 31-35 years age group and changes when the policyholder turns 36 years old. The sudden premium hike in most plans may appear steep to policyholders. What is unique about Optima Secure is that the product has an age-point premium pricing. It means the premium increases by a small percentage every year so that it does not burden your pockets. “This increases affordability especially for senior citizens” says Parthanil Ghosh, president-retail business at HDFC ERGO General Insurance.
Extensive coverage
The product is designed in a way that your coverage is four times the base policy cover in two years and five times if you pay the premium for three years in one go. For example, if you buy a base cover of ₹10 lakh in Optima Secure, its ‘secure benefit’ will provide you coverage of ₹20 lakh the very same day. So if you get hospitalized in the first policy year, even as the base cover is ₹10 lakh, you will still be entitled to make a claim of up to ₹20 lakh. When you renew the plan the second year and the third year, the base coverage will increase by 50% and 100%, respectively, with the ‘plus benefit’. It means, in the example cited above, the Plus Benefit and Secure Benefit together will take the total coverage to ₹25 lakh in the second year and ₹30 lakh in the third year. “This increase is irrespective of any claims made,” says Ghosh.
The policy also has a ‘restore benefit’, which says that if a claim, partial or total, is made any time during the year, then 100% of the base cover gets restored in the policy cover automatically at no additional cost. This is how the coverage becomes four times the base cover together with secure and plus benefit.
All-inclusive policy
Most health plans come with a hospital room rent limit of, say, ₹5,000. So, If you get hospitalized in a room costing ₹10,000 a day, the insurer will only approve the claim as per the defined room rent limit. Other costs such as doctor’s visit, consultation fees are also linked to the type of room. That said, buying a policy without any room rent limit is important. Optima Secure is one such policy. Policyholders can stay in a shared, single, deluxe or any room that’s available in the hospital.
Optima Secure has an additional advantage called protect benefit. Notably, even comprehensive health plans do not cover non-medical items (also called consumables) such as gloves, hand sanitizers, masks, nebulizer and personal protection equipment, among others. “Non-medical expenses during hospitalization add up to 10-20% of the total bill amount. The coverage for the same is in-built in Optima Secure at no extra charge,” says Ghosh.
The policy does not have any disease specific limit either. Besides, it covers the pre-and-post hospitalization bills of 60 and 180 days, respectively.
Additional benefits
The policy offers preventive health check-up coverage as well. In a ₹10 lakh base cover policy, it is ₹2,000 for an individual policy and ₹5,000 for a family floater policy (cumulatively for all insured persons).
While most comprehensive policies offer free preventive health check-up, the take-up, or sales, rate is too low across the industry. This is probably because policyholders feel that in case health parameters are not up to the mark, the insurer may hike the premium on renewal or cancel the policy altogether. “Regulations don’t allow insurers for any mid-term changes to policy terms for individual policyholders if the policyholder had disclosed all their pre-existing diseases. I encourage policyholders to opt for health check-ups so that they stay fit and can undertake timely treatment if any disease/ailment is detected,” says Ghosh.
The cost of expert opinion is covered in the base cover. This cover provides consultation for 51 major illnesses which include cancer, heart attack, kidney failure, etc.
Optima Secure comes with an ‘early discharge’ service feature which has been launched with multiple hospitals in which a policyholder can inform the insurance company right after the doctor gives an informal intimation about a planned discharge. “If Optima Secure policyholders intimate us about their planned discharge from the hospital in time, they will not have to wait for the bill settlement and they can go back home as soon as the doctor signs the discharge advise” he says.
Another service benefit is giving approval for chronic disease treatment in one go. For example, if a policyholder has to go for dialysis multiple times in a year, in a general scenario, they will have to initiate the insurance procedure for each visit separately. “We now provide onetime pre-approved cashless facility for these policyholders to cover all the sessions of these chronic disease treatment sessions,” says Ghosh.
Should you buy it?
Beshak.org says this is a good plan if someone wants a comprehensive coverage as well as a variety of unique benefits and features. “From the first day of coverage, your base sum insured is doubled. It allows you to pay your premiums monthly and covers several costs, including the cost of consumables as well as dental treatment,” says Mahavir Chopra, founder, beshak.org.
On the flip side, however, Optima Secure is more expensive in comparison to the other plans in the market, he adds. “So far as complaints data is concerned, the insurer has received fewer claim settlement complaints but a higher number of policy purchase complaints.”
To make the premium affordable, one can opt for deductibles in the policy. A deductible is an amount you agree to pay at the time of claim once in a policy year, post which its coverage kicks in. For example, if you opt for a deductible of ₹25,000, you get a discount of 25% in premium if the base cover is less than or equal to ₹20 lakh and 15% if it is more than ₹20 lakh.
There are discounts if you opt for a policy period of more than one year. You will be entitled to receive a discount of 7.5% and 10% if the policy is for a 2-year and 3-year tenure, respectively.