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Home arrow Health Insurance arrow Best Health Plans arrow HDFC Ergo Optima Restore vs Bajaj Allianz Health Guard (Gold)

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HDFC Ergo Optima Restore vs Bajaj Allianz Health Guard (Gold)

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Notes

1- The health insurance data was last updated in July 2024. All data has been sourced from product brochures, policy wordings, prospectus, public disclosures (Q4, FY 2023-2024), insurer websites, and the IRDAI website. 

2- The Claims Settlement Ratio data is taken from NL-37, insurer public disclosures (Q4, FY 2023-2024). It is calculated by dividing the number of claims settled by the sum of claims outstanding at the beginning of the year and claims reported during the year.

3- The data related to claim complaints and policy purchase complaints is taken from NL-45, insurer public disclosures (Q4, FY 2023-2024).

4- The Solvency Ratio data is taken from NL-26, insurer public disclosures (Q4, FY 2023-2024).

5- The data related to claims settled within 30 days is taken from NL-39, insurer public disclosures (Q4, FY 2023-2024).

6- The Claims Incurred Ratio data is taken from NL-4 and NL-5, insurer public disclosures (Q4, FY 2023-2024). It is calculated by dividing the Net Claims Incurred by the Net Earned Premium.

7- For now, we have considered the most comprehensive plans from leading insurance companies. We will keep updating the product pages with new plans in the coming days.

8- We have rated only those plans that can be serviced by individual advisors. This is because of our strong belief that health insurance customers need professional assistance from individual advisors before and after purchase. We do not recommend and hence do not rate direct-to-customer health insurance plans or plans where there aren't enough advisors available to service. 

9- Affordability assessment of plans: 

  • The affordability of comprehensive plans is assessed using premiums for a family of two adults (30 years old) and one child (1 year old) residing in Zone 1, opting for a cover of ₹10 Lakhs. And, the premiums are as of 30th September 2023.
  • The affordability of Care Freedom Plan is assessed using premiums for a 30-year-old male residing in Zone 1, opting for a cover of ₹5 Lakhs. And, the premium is as of 30th September 2023.
  • The affordability of Acko Platinum Health Insurance is assessed using premiums for a family of two adults (30 years old) and one child (1 year old) residing in Zone 1, opting for a cover of ₹25 Lakhs. And, the premium is as of February 2024.
  • The affordability of ICICI Lombard MaxProtect (Premium) is assessed using premiums for a family of two adults (30 years old) and one child (1 year old) residing in Zone 1, opting for a cover of ₹1 Crore. And, the premium is as of February 2024.
  • The affordability of Aditya Birla Activ One (VIP+) is assessed using premiums for a family of two adults (30 years old) and one child (1 year old) residing in Zone 1, opting for a cover of ₹50 Lakhs. And, the premium is as of March 2024.
  • The affordability of Aditya Birla Activ One (VIP) is assessed using premiums for a family of two adults (30 years old) and one child (1 year old) residing in Zone 1, opting for a cover of ₹50 Lakhs. And, the premium is as of April 2024.
  • The affordability of Care Advantage Plan is assessed using premiums for a family of two adults (30 years old) and one child (1 year old) residing in Zone 1, opting for a cover of ₹25 Lakhs. And, the premium is as of April 2024.
  • The affordability of Reliance General Health Global (Elite) Plan is assessed using premiums for a family of two adults (30 years old) and one child (1 year old), opting for an India cover of ₹1.5 Crores and global cover of $0.15 Million. And, the premium is as of August 2024.

10- We have considered the Inflation Protection benefit under Acko’s Platinum and Standard Health Plan instead of the No Claim Bonus Benefit.

11- We have only considered features, benefits, and limits of ‘India Cover’ under Reliance General's Health Global (Elite) Plan.  

12- The product benefits section is based on a sum insured of ₹10 Lakhs and only highlights the top benefits and features of health insurance plans. 

13- Only those hidden and special conditions that apply to the benefits and features we have considered are included on the product pages. 

14- The product pages only include the most significant specific exclusions under each plan, which we've simplified for better understanding.

15- The product pages do not include any generic terms, conditions, or exclusions (those that are the same and apply to all health insurance plans).

16- If the policy wording, brochure, or prospectus states that a benefit/feature is available with a specific plan but it is not available online when generating the premium quote, we have not considered that benefit/feature to be available with the plan.

17- The response time on Twitter was calculated using a sample set of tweets from February 2023 to August 2023 (analyzed in September 2023).

18- The metrics like claim complaints, policy purchase complaints, response time on Twitter and toll-free are not related to a specific product but are related to the overall performance of the insurance company.

19- The network hospitals' data was last updated on 1st October 2024.

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Compare HDFC Ergo Optima Restore and Bajaj Allianz Health Guard (Gold)

Claims Track Record:

HDFC Ergo Optima Restore

HDFC ERGO General Insurance Company Limited has a claim settlement ratio standing at 83.31% and a claims incurred ratio of 83.53%. The company has settled 95.75% of claims within 30 days. The company has received fewer complaints related to claims, as compared to other insurers.

Bajaj Allianz Health Guard (Gold)

Bajaj Allianz General Insurance Company Limited has settled 99.38% of claims in less than 30 days. It has a claim settlement ratio of 72.14% and a claims incurred ratio of 81.10%. Moreover, it has received fewer complaints related to claims as compared to other insurers.

Service Experience:

HDFC Ergo Optima Restore

HDFC ERGO General Insurance Company Limited offers customer assistance through their toll-free helpline and their Twitter handle. Please note that their response time is average on both the toll-free and Twitter handle.

Bajaj Allianz Health Guard (Gold)

Bajaj Allianz General Insurance Company Limited offers customer service via a toll-free number and Twitter. They both have average response rates. If you have questions or issues, you can get in touch with the company through either of these channels.

Product Benefits:

HDFC Ergo Optima Restore

The HDFC Ergo Optima Restore Plan provides  comprehensive coverage including hospitalisation costs, pre-hospitalisation and post-hospitalisation expenses. Please note that the pre-hospitalisation expenses are covered for a period of up to 60 days before admission and the post-hospitalisation expenses are covered up to 180 days after discharge – up to the sum insured. Furthermore, the policy offers a comprehensive range of benefits, encompassing all day care treatments, domiciliary treatments, harvesting expenses related to organ donation, and modern treatments up to the sum insured. And, consumables are also covered up to the sum insured if you choose to include this as an add-on to your policy. The HDFC Ergo Optima Restore Plan offers flexibility with no room rent limit, allowing you to select any room without constraints. Also, there is no ICU rent limit, copayment, or deductible limit. Notably, the policy does not impose any restrictions on common medical treatments or surgeries, such as cataract treatment, joint replacement surgery, etc. This means they are covered up to the sum insured. Please bear in mind that pre-existing diseases have a 36-month waiting period, while specific diseases have a 24-month waiting period under this plan.

Bajaj Allianz Health Guard (Gold)

The Bajaj Allianz Health Guard (Gold) Plan covers hospitalisation expenses as well as pre and post-hospitalisation expenses. Pre-hospitalisation expenses are covered for 60 days before hospitalisation and post-hospitalisation expenses are covered for 90 days after discharge, both up to the sum insured. The plan covers 399 daycare treatments and all modern treatments up to the sum insured. The cost of harvesting the organ from the donor is also covered up to the sum insured. In the Bajaj Allianz Health Guard (Gold) plan, you can choose any room type - there's no restriction on room rent. Furthermore, there's no limit on ICU rent and no deductible. However, the plan comes with an optional copayment of 10% or 20%. Cataract surgery is covered up to 20% of the sum insured per eye per policy year (up to a maximum of Rs 1 lakh) and joint replacement surgery is covered up to the sum insured. There's a 36-month waiting period for pre-existing conditions and a 24-month waiting period for specific diseases, out of which some conditions come with a 36-month waiting period.