HDFC ERGO Health Insurance

HDFC Ergo Optima Secure Plan

Let’s Know The Plan Better!

Optima Secure by HDFC Ergo is a health insurance policy that provides you with comprehensive coverage and protects you against high medical costs. With HDFC Ergo Optima Secure, you can enjoy 2X coverage from day 1, which completely transforms the value you receive from your health insurance. This policy not only protects your present but also safeguards your future. The abundant discount options and wide range of benefits and features make Optima Secure an irresistible choice for your health insurance needs.

Are You Eligible?

Minimum Entry Age

  • Adults: 18 years
  • Dependent Children: 91st day from birth

Maximum Entry Age

  • Adults: 65 years
  • Dependent Children: 25 years

 

An Overview Of The Plan’s Benefits & Limits

The plan covers inpatient hospitalisation expenses i.e. the costs incurred while you are admitted to a hospital for more than 24 hours, including room boarding and nursing charges, medical practitioner's fees, the cost of prescribed medicines and drugs, ICU charges, and other related expenses.

Additionally here is a summary of other expenses that are covered under HDFC Ergo's Optima Secure Plan -

  • Pre & Post Hospitalisation Expenses: If the doctor requires multiple diagnostic tests before or after your admission to the hospital, your insurer will provide the necessary coverage. They will pay for these expenses up to the sum insured for a reasonable period of time - 60 days before hospitalisation and 180 days after discharge. Just remember, the insurer will only cover these costs if they are directly related to the medical condition that led to your hospitalisation and your claim is approved as part of your inpatient coverage.
     
  • Daycare Treatment Coverage: You can now undergo quick daycare treatments for conditions that previously necessitated an extended hospital stay. This innovative approach enables patients to complete their treatment within a span of 24 hours. With the HDFC Ergo Optima Secure Plan, all daycare procedures are covered without any limit, ensuring that your expenses will be taken care of up to the sum insured.
     
  • Domiciliary Treatment Coverage: In the case that you are very ill or injured and cannot be safely transported to a hospital, or if there are no hospital beds available nearby, domiciliary treatments become necessary. These are medical procedures for illnesses or injuries that require immediate medical attention but are administered at home instead of in a hospital. The HDFC Ergo Optima Secure Plan provides coverage for domiciliary treatment costs up to the sum insured.
     
  • Organ donor coverage: The HDFC Ergo Optima Secure Plan also covers organ donor expenses. It will take care of the inpatient costs related to the the organ donor for harvesting the organ for transplantation (where the insured is the recipient), up to the sum insured you choose under your policy.
     
  • Modern Treatment Coverage: In the ever-changing world of healthcare, technological prowess has led to the development of modern treatments like robotic surgeries, deep brain stimulation, etc. that were once deemed unimaginable. The HDFC Ergo Optima Secure Plan is specifically crafted to keep up with these advancements and provides coverage for the expenses associated with these modern treatments, up to the sum insured.
     
  • Non-Medical Expenses: If you choose the Protect Benefit add-on, the HDFC Ergo Optima Secure Plan will cover your non-medical expenses as well. These include gloves, gauze, bandages, nebulization kits, oxygen masks, and other treatment necessities. Consumables can be pricey and can quickly accumulate to a substantial sum. The HDFC Ergo Optima Secure Plan offers coverage for these expenses up to the sum insured, provided that you opt for the add-on.
     
  • Room Rent Limit: The room rent limit is the maximum amount your insurance company will cover for the room you stay in while hospitalised. By choosing a room that is within your plan's limit, you won't have to pay anything out of your own pocket. But if you choose a room that exceeds your eligibility, you will be subject to a proportionate deduction. You will be accountable for paying a proportionate amount of the entire bill, rather than solely the difference in the room rent.

    However, under HDFC Ergo Optima Secure Plan, you have the freedom to choose any room you desire, whether it's a shared room, single room, Suite, or any available option without any restrictions.
     
  • No Claim Bonus: The No Claim Bonus is only applicable to the Optima Suraksha plan offered by the insurer. You will be rewarded with a No Claim Bonus irrespective of whether you make a claim in the policy year under Optima Secure. Your sum insured by 50%, up to a maximum of 100% of the sum insured.
     
  • Restore Benefit: Once your sum insured is depleted within a policy year, it will be fully restored to its original amount under this benefit. With the HDFC Ergo Optima Secure plan, you can enjoy 100% restoration of your basic sum insured. The benefit activates on full or partial use of your basic sum insured. This benefit is applicable to subsequent claims under the in-patient benefit and protection benefit (if applicable). You can use the restore benefit once per policy year for your entire lifetime, as long as you continue to renew your policy. However, if you choose the Unlimited Restore (optional benefit), you will receive unlimited restorations throughout the policy year at some extra cost.

 

Some Noteworthy Features You Should Be Aware Of

  • Secure Benefit: The Secure Benefit ensures that your health insurance coverage is instantly doubled from the very beginning, without any additional steps or costs. So, you get 2X the cover you purchased, giving you a sense of extra peace and security.
     
  • Plus Benefit: With the HDFC ERGO Optima Secure Plan comes an exceptional feature known as Plus Benefit, expanding your base cover over time, and thereby providing you with extra protection and reassurance. Under this feature, regardless of any claims you make, your base cover will increase by 50% after one year & by 100% after two years.
     
  • Monthly premium option: The plan allows you to pay your health insurance policy premiums on a monthly basis - an option not many plans in the market provide.
     
  • Global Health Cover: This add-on cover is designed to provide you with unmatched protection for both emergency and planned medical treatments, no matter where you are located. You can be confident that you will be protected from unforeseen medical costs, whether you need urgent care during unexpected emergencies or planned treatments abroad.

 

Understanding Waiting Periods

After purchasing a health insurance policy, you will need to wait for a specific period before the coverage for certain conditions becomes effective. This period is known as the waiting period. Once this period is over, you can make claims for these conditions.

Here are some of the various types of waiting periods -

  • Initial Waiting Period: You'll need to wait for 30 days before you can make a claim for any medical condition, except accidents. This means that during the initial 30 days of purchasing your policy, you won't be able to claim hospitalisation unless it's because of an accident.
     
  • Waiting Period For Pre-Existing Diseases: Any medical condition or illness you have had in the last 48 months prior to issuance of your health insurance policy is known as a pre-existing disease. You should be aware that there is a waiting period of 36 months for pre-existing conditions under the HDFC Ergo Optima Secure Plan. This means that any expenses related to any pre-existing conditions will not be covered by the policy during this time.
     
  • Waiting Period For Specific Diseases: Insurers will impose a waiting period for certain medical conditions or illnesses, apart from your pre-existing conditions. This waiting period applies regardless of whether you have previously had these diseases or not. The insurer decides the duration of this waiting period and it is not influenced by your current health status. Under the HDFC Ergo Optima Secure Plan, there is a waiting period of 24 months for specific diseases.

 

What The Plan Does Not Cover!

Certain situations that your health insurance policy does not provide coverage for are called exclusions. These include -

  1. Standard Permanent Exclusions: You need to be aware that the IRDAI has enforced a set of 'standard permanent exclusions' that all insurance companies must abide by. Some of the exclusions include:
  • Investigation and evaluation:  Hospital admissions for observation or monitoring purposes
  • Obesity/weight control: Treatments or surgeries for weight control or obesity.
  • Change of gender treatment: Treatment that aims to change your body's characteristics to match those of the opposite sex.
  • Rest cure, rehabilitation, and respite care: Admission to a facility for bed rest, without any active treatment, is not covered.
  • Profession in hazardous or adventure sports: Expenses incurred as a result of engaging in adventurous activities as a professional.
  • Breach of law: Expenses related to the treatment if you have committed or attempted to commit a breach of law with criminal intent.
  • Plastic/cosmetic surgery: Treatment or surgery that aims to alter your body characteristics or appearance is excluded.
  • Excluded providers: Treatment from a medical practitioner or hospital excluded by the insurer.
  • Narcotics: Treatments related to addictive conditions such as alcohol addiction or drug usage.
  • Treatments in establishments arranged for domestic purposes:  Treatment received at health spas, nursing homes, or similar establishments that were arranged completely or partially for domestic reasons.
  • Dietary supplements, substances purchased without prescription: Vitamins, minerals, or other supplements that haven’t been prescribed by a medical practitioner.
  • Expenses related to birth control, sterility, infertility: Some treatments like contraception methods, sterilisation procedures, artificial insemination techniques, as well as advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, and gestational surrogacy are excluded.
  • Maternity expenses: Pre/post-natal costs, expenses related to childbirth hospitalisation, are excluded.
  • Unproven treatments: Surgeries, medical procedures, or treatments that have not been proven to be effective.
  • Refractive error: Expenses related to correcting refractive errors of up to 7.5 diopters to improve your eyesight.
  1. Additional Permanent Exclusions: Along with the standard permanent exclusions mentioned earlier, insurance companies may also include specific exclusions for particular situations or medical conditions in your policy. If you have specific diseases or severe medical conditions that insurers consider risky to insure, they may opt to permanently exclude them from your policy. Insurers in India have a mandatory requirement to adhere to a specified list of illnesses provided by the Insurance Regulatory and Development Authority of India (IRDAI). They cannot exclude anything beyond this list.
     
  2. Non-Standard Exclusions (Specific Exclusions) The HDFC Ergo Optima Secure Plan comes with specific exclusions beyond the standard permanent exclusions set by the IRDAI. It's crucial for you to note that these exclusions may vary among insurance companies and are subject to the specific terms and conditions of your policy.

    Here are some of the specific exclusions -
  • War, invasion, nuclear, chemical or biological attack or weapons, etc.
  • Intentionally harming yourself or attempting suicide.
  • Participation in naval/military/air force operations.
  • Investigative treatment for sleep apnoea, general debility, or exhaustion commonly referred to as the "run-down condition."
  • Congenital external diseases, defects, or anomalies.
  • Stem cell harvesting.
  • Investigative treatments involving the analysis and adjustments of spinal subluxation, diagnosis and treatment through skeletal structure manipulation, or muscle stimulation methods, except for the treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
  • Circumcisions unless they are necessary due to illness or injury and are part of your treatment.
  • Vaccinations, including inoculations and immunizations (except for post-animal bite treatment).
  • Treatments or expenses related to alopecia or baldness. This includes wigs, toupees, hair pieces, non-surgical hair replacement methods, and optometric therapy.
  • Expenses related to artificial limbs, prosthetics, wheelchairs, crutches, etc. Additionally, the cost of cochlear implants is not covered unless it is necessary due to an accident.

 

A Quick Recap Of The Benefits & Limits

Product Benefits

Coverage Limits

Pre-Hospitalisation Expenses

60 days up to the sum insured

Post-Hospitalisation Expenses

180 days up to the sum insured

Daycare Treatment Coverage

Sum insured

Domiciliary Treatment Coverage

Sum insured

Organ Donor Coverage

Inpatient expenses for harvesting the organ up to the sum insured

Non-Medical Expenses

Sum insured, if you opt for an add-on

Modern Treatment Coverage

Up to the sum insured

Room Rent Limit

No restrictions

No Claim Bonus

50% increase in sum insured every year irrespective of claims, subject to a maximum of 100%.

Restoration Benefit

100% of the sum insured on full/partial use of the sum insured.

Pre-Existing Diseases

Covered after a 36-month waiting period

Specified Treatment

Covered after a 24-month waiting period

 

Some OG reading Material for your Reference

    • Brochure:

https://www.hdfcergo.com/docs/default-source/downloads/brochures/optima-secure-brochure.pdf

    • Policy Wording:

https://www.hdfcergo.com/docs/default-source/downloads/policy-wordings/health/optima-secure-revision-pw.pdf

 

FAQs

  1. What is the maximum coverage you can choose under the HDFC Ergo Optima Secure Plan?
    With HDFC Ergo Optima Secure Plan, you can now enjoy comprehensive health coverage of up to Rs 2 Crores.

     
  2. Are there any room rent restrictions under the HDFC Ergo Optima Secure Plan?
    No! With the HDFC Ergo Optima Secure Plan, you have the freedom to choose any room available in the hospital - be it a Single Private Room, a Share Room, or even a Deluxe Room.

     
  3. Does HDFC Ergo Optima Secure Plan provide coverage for AYUSH treatments?
    Absolutely! The HDFC Ergo Optima Secure Plan provides comprehensive coverage for AYUSH treatments, which include alternative and non-allopathic treatments.

     
  4. Is consumables coverage included in the HDFC Ergo Optima Secure Plan?
    Yes, coverage for consumables is available with HDFC Ergo Optima Secure.

     
  5. How many times can you claim the Secure Benefit in a policy year or your lifetime?
    You can use the Secure Benefit once in every policy year for a lifetime, as long as you keep renewing your policy. Additionally, if you choose the Unlimited Restore (optional benefit), you will receive unlimited restorations in a policy year at a certain extra cost.

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