Oriental insurance company is a leading public sector insurance company that offers an array of health insurance products. Happy family floater policy of oriental insurance is one of the best selling health insurance policy. Oriental has revised this product in 2021. Earlier the product name was happy family floater policy 2015 now it is renamed as Happy Family Floater 2021.
Some new features have been added and the premium has been revised accordingly.
Distinctive features of Happy family floater 2021
1. Maternity coverage in diamond and platinum plans
2. New born baby cover from day 1
3. Sum insured options from 1 lakh to 50 lakh
4. Assisted reproduction treatment coverage
5. Daily hospital cash allowance and attendant allowance
6. Organ donor expense coverage when insured person is either a donor or recipient.
7. Additional 10% sum insured in case of accidental death or permanent total disability (platinum plan only)
8. OPD coverage for dental and ophthalmic consultation, medicine charges and diagnostics in a block of 3 years with max limit 5k.
9. No copayment if you opt sum insured more than 5 lakh.
10. Good optional covers like
- Restoration of sum insured 50% or 100% as per the option you opt for
- Personal accident cover
- Life hardship survival benefit – 15-25% lump-sum payment in case insured person survives from a critical illness for a stipulated number of days
- Enhancement of room rent charges form 1% sum insured per day to 1.5 to 2 percent of sum insured by paying additional premium
- waiver of 10% copay clause in up to 5L sum insured policy if you pay additional premium
These are the some of salient features of this policy. However this must be noted that maximum of these features are available in diamond and platinum plans.
Plans of Happy Family Floater Policy
This policy comes in 4 plans – Silver, Gold, Diamond & Platinum.
Silver plan is available in 1 to 5 lakh sun insured options
Gold plan sum insured options are 5 to 10lakh
Diamond plans comes with 12, 15, 18 and 20L sum insured options.
Platinum plans comes in 25,30,40 and 50 lakh sum insured options.
If you chose a sum insured option 12 to 50 lakh i.e Diamond or platinum plan then your coverage enhances significantly.
Therefore, If you have planned to buy this policy then opt at least 12 lakh sum insured.
Organ transplant cover
Due to increasing lifestyle related disease organ transplantation is now a must have feature in your health insurance policy. This policy covers insured person when he/she is a recipient or donor. However in case of organ donation maximum coverage is 10% of sum insured. But you will rarely find this cover in other health insurance policies.
Other than this happy family floater 2021 by oriental insurance also covers HIV/AIDS related medical expenses including pre and post hospitalisation up to sum insured.
Mental Health illness cover
Policy defines what constitutes mental illness, mental health establishment and mental health professional. It covers the mental illness related hospitalisation expenses up to sum insured.
Premium chart of Happy Family Floater Policy
Good thing about happy family floater policy is, it explicitly provides premium table and calculation of premium for additional optional covers.
Customer must have access to premium table in a health insurance policy. Because that brings the clarity and trust.
But sadly most of health insurance policies are not including premium table in their product or not making it available to customers.
Implementation of IRDA guidelines
Being a government run insurance company, these companies are fast in implementation of latest IRDA (insurance regulator) guidelines and circulars.
One of the best example of this is IRDA released guidelines on standardisation of exclusions in health insurance contracts vide circular no. IRDA/HLT/REG/CIR/177/09/2019.
As per these guidelines waiting period for lifestyle conditions namely hypertension, diabetes and cardiac conditions can not be more than 90 days except if these conditions are pre existing and disclosed at the time of policy purchase
Very few health insurance companies have implemented these guidelines. You can check your own health insurance product. But in oriental insurance happy family floater policy waiting period for diabetes, hypertension is just 90 days if these are not pre existing conditions at the time of policy buying.
Congenital disease cover
Policy covers the congenital internal diseases after a waiting period of 2 years. Congenital internal disease are the abnormalities which occurs by birth and which are not visible externally like birth defects in in heart, kidney etc.
You will rarely find a policy that covers these conditions. But as I said earlier these public sector insurance companies abide by the regulators guidelines, therefore offer these coverages.
Modern treatment cover
Policy also covers Modern treatment or advanced treatment however with sub limits.
I have deliberately avoided discussion on other coverage like ambulance, Air ambulance , geographical extension cover to SAARC countries etc. you can go through prospectus part of this policy to know about these cover.
Bariatric surgery coverage
However obesity/ weight control clause is kept under exclusions but policy defines the conditions under which obesity related surgeries/ Bariatric surgery is not covered.
But if BMI of insured person is greater than 40 or less than 35 in conjunction with sever comorbidity – obesity related cardiomyopathy, coronary heart disease, severe sleep apnea, uncontrolled diabetes (Type 2) then Bariatric surgery related hospitalisation expenses are covered.
Considering the cost of such treatment and astronomical rise in lifestyle related disorders this coverage may provide a great relief to policyholders.
Clarity and simplicity of terms
Happy family floater policy terms are simple and clear. For example you won’t find a term on enhancement of sum insured in many health insurance products. Insurance companies give a very little or no information on the conditions under which they approve increase of sum insured.
Copayment
Copayment is applied on each and every claim only in silver plan of happy family floater policy 2021. Means, if you chose sum insured more than 5 lakh then no copayment is applied, which is a very good feature.
Moreover even for silver plan, you can get a waiver for this clause if you pay additional premium.
Less favourable features Happy Family Floater Policy
Now the obvious question is – what are some ‘not so good’ features of this policy ? Obviously there are some features in this policy also that are dampener.
48 months waiting period for pre existing diseases.
This is a long waiting periods considering other health insurance policy offering 12-36 months waiting period.
Room rent capping on hospital room
Hospital room rent is limited to 1% of sum insured. This is restricting clause. But this has both pros and cons.
If you chose a 5 lakh policy the maximum daily room rent this policy can pay during hospitalisation is just 5k. Now getting a single private AC room at this price in a hospital in metro cities is quite difficult. You may get sharing room private or general category.
However there is an option to increase this limit to 1.5 to 2% of sum insured by paying additional premium.
if outgo on room rent is less then sum insured can be utilised for treatment and in patents of future claims. If you have a low sum insured policy then restricting the outgo on room rent makes sense. However same is not required in a higher sum insured policy, where you have an option to enhance this limit.
Claim servicing by Third party administrator
As PSGIC ( public sector general insurance companies) rely on TPA( third party administrators) for claim processing and settlement, therefore, you can face a bit delay in servicing of claim. However, all your genuine claims are honoured.
No bonus for claim free years
Policy doesn’t incentivise the customer who are doing renewals without any claims in previous policies. Therefore, you have to opt for decent sum insured while buying this policy.
Should you buy this policy?
Considering the coverage offered by oriental insurance happy family floater policy this can be good choice for health insurance. It offers more than it advertise unlike other health insurance policies. Moreover track record of oriental insurance in terms of claim settlement is also very good. You can consider this policy if you are looking for a comprehensive health insurance policy.
For any query on this policy or any other health insurance policy please comment in the comment section of post.
