Optima Restore has for long been one of the best selling health insurance plan. Over 10 years ago when Apollo Munich introduced “restore” as part of Optima Restore it was kind of a revolution. Many insurers since then have tried to replicate some features or all of it. Niva Bupa (formally Max Bupa) introduced the plan ReAssure in middle of Aug 2020 and it soon became one of the favorites. Both plans have many common features as well as differences as well. Here we do a detailed comparison of the two plans and understand their differences and similarities.
| Plan Benefits | HDFC Ergo Optima Restore | Niva Bupa ReAssure |
|---|---|---|
| About | A base health policy offering plans from 3 Lacs to 50 Lacs | A base health policy offering in plans from 3 Lacs to 1 cr |
| Eligible Age | Entry Age 91 days – 65 yrs. Renewal for life time. A dependent Child can be upto the age of 25 yrs | Entry Age 91 days – 65 yrs. Renewal for life time. A child can be upto the age of 30 yrs |
| Variants | NA | NA |
| USP | No capping or Restriction on any disease. | Unlimited SI re-instate & homecare benefit |
| Coverage | Over 24 hrs hospitalisation in in-patient department | Over 24 hrs hospitalisation in in-patient department |
| Cashless/ Re-imbursement | Cashless in network. Reimbursement in non-network hospital. | Cashless in network. Reimbursement in non-network hospital. |
| Day Care Procedures | Covered | Covered |
| Type of Room | Any | Any (Except Suite) |
| Pre & Post Hospitalisation | 60 & 180 days | 60 & 180 days |
| Cumulative Bonus (CB) | 50% of SI for every claim free year max upto 100% of SI. Incase of claim there is a reduction in the same proportion in subsequent year | 50% of SI for every claim free year max upto 100% of SI. Incase of claim there is a reduction in the same proportion in subsequent year |
| Disease/Treatment/ Procedure based Capping | None | Specific Robotic Surgeries have a max limit of Rs 1 Lac |
| Co-payment | None | None |
| AYUSH (Ayurveda, Siddha, Unanni, Homeopathy) | NA | Covered upto Sum Insured in a Govt recognised hospital |
| Organ Donor Expenses – For harvesting the organ from donor’s body | Covered upto SI | Covered upto SI |
| Domiciliary Treatment | Covered incase the condition of patient is such when he/she can not be transported to a Hospital or no bed is available. Coverage will not be provided if treatment is for less than 3 days | Covered incase the condition of patient is such when he/she can not be transported to a Hospital or no bed is available. Coverage only if treatment is done for 3 consecutive days |
| Restore/ Re-instate / Reinstatement (Often mis-sold as 10+10 cover) | Upto 100% of SI can be Restored once in a policy year. Active from 2nd claim onwards. Valid for same person same illness. Will be available only once in a yr. Single claim amount will never exceed basic SI | Available from 2nd claim in a year. A single claim will not exceed base SI. Sequence – base SI, SI Safeguard, Cumulative Bonus, Reassure Benefit. Unlimited no of times in a year upto 100% of SI |
| Ambulance Cover | Upto Rs 2000 per hospitalisation | Upto Rs 2000 per hospitalisation |
| Other Benefits | (i)Shared Room Benefit of Rs 800 for maximum of 6 days (ii)Air Ambulance cover of upto 2.5 laces per hospialisation, max upto SI in a a policy yr. (iii)Second Medical Opinion | (i)HomeCare Treatment for Chemotherapy & Dialysis. (ii)Shared Room Benefit of ₹ 800 / ₹1000 for maximun of 6 days depending on SI selected. (iii)Air Ambulance cover of upto SI on Cashless basis or ₹ 2.5 lacs per on reimbursement. (iv))Second Medical Opinion |
| Renewal Condition | NA | Change in Health Condition at time of Renewal needs to be disclosed at time of renewal |
| Waiting Periods | ||
| a) Basic | 30 days | 30 days |
| b) Specific Surgeries/ Procedures | 2 years | 2 years |
| c) Pre Existing Condition/ illness | 3 years | 3 years |
| Preventive Health Check-up | Annually as per SI – Rs 2500/ 5000/ 8000/ 10000 | Once in a year. Rs 500 per Lac max Rs 5000 for individual & Rs 10000 for Floater Adult member s only |
| Discounts | ||
| a) Advance Premium Discount | 7.5% discount if 2 yr premium is paid in advance | 7.5% discount on 2nd yr premium if 2 yr premium is paid in advance. For a 3 yr policy 7.5% discount on 2nd yr premium, 15% discount on 3rd yr premium |
| b) Renewal Discount | NA | 2.5% discount if ECS is submitted for Renewal |
| Good Health /Wellness Discount at Renewal | Yes- Discount of upto 8% at time of renewal. One needs over 10K steps per day | Renewal premium discount of up to 30% basis the heath points collected by you on Max Bupa Health App |
| Riders Available (on additional Premium) | ||
| a) Hospital Cash | Rider allows one to receive cash on basis of per day hospitalisation. Max 30 days in a year. Min 24 hrs hospitalisation required. Incase of hopitalisation in ICU the amount received is 2X. Option to choose ₹1000 or ₹ 2000 or ₹ 3000 | Rider allows one to receive cash on basis of per day hospitalisation. Max 30 days in a year. Min 48 hrs hospitalisation required. Rs 2000/- per day |
| b) Consumable & Inflation Protector | Protector Rider offers 3 benefits: No need to pay consumable expenses – gloves , PPE kits bandages etc. Protects against inflation by adding CPI inflation to sum insured at time of renewal. No impact on cumulative bonus if claim in a year is less than Rs 50,000 | a.Claim Safeguard: Non-payable items paid up to Sum Insured b.Booster Benefit Safeguard: No impact on Booster benefit if claim in a policy year is less than Rs. 50,000 c.Sum Insured Safeguard: CPI linked increase in Base Sum Insured |
I am hoping this comparison between two plans will help you arrive at a informed decision. Before you choose a plan you may also look for hospital network in your city.
Incase you wish to know what factors you should keep in mind while selecting a health insurance plan read Things to Know Before Buying Health Insurance.
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