HDFC Ergo Optima Restore Health Insurance

Brief Overview: HDFC Ergo Optima Restore Health Plan

HDFC Ergo is a general insurance company that was established in the year 2017. A collaboration between HDFC and ERGO International, Germany, HDFC Ergo holds a prominent position in the Indian Insurance Industry as the third-largest General Insurer company in the private sector. 

Over the years, the company has maintained a very high claim settlement record. HDFC Ergo was conferred with an ‘AAAA’ rating by the ICRA. It has a long list of awards and accolades in its name.

HDFC Ergo offers multiple insurance products such as motor, travel, home and health. In this article, we are going to discuss HDFC Ergo Optima Restore Plan and all its features.

Best Features of HDFC Ergo Optima Restore Health Plan

HDFC Ergo Optima Restore Plan has been crafted to meet your medical care requirements. The plan is an affordable health insurance plan that offers cover against expenses on treatment of injuries and diseases. Let us take a quick look at the highlights of this plan:

1. The plan is available with a cover from INR 5 to 50 lakhs
2. Your expenses on hospitalisation because of an illness or an injury are covered
3. All your day-care procedures would be covered
4. Ambulance costs up to INR 2,000 are covered
5. The plan offers complete coverage on room rent
6. The plan offers 100% of restoration of the sum insured, in case it gets exhausted
7. If you do not make a claim,  you can benefit from renewal incentives you can get till 100% of cover enhancement
8. Avail of preventive health check-ups up to INR 5,000
9. The expenses that are incurred 60 days prior and 180 days post hospitalisation would be covered
10. Get a cash benefit of up to INR 1,000 per day and up to INR 6,000 per hospitalisation
11. With HDFC Ergo Optima Restore Plan you can save up to INR 75,000 as tax benefits
12. Procedures such as robotic surgeries, oral chemotherapy and stem cell therapy are covered
13. You can avail of discounts on the premium that goes up to 10%

Benefits of HDFC Ergo Optima Restore Health Plan

1. In Hospital Benefits
   The Optima Restore Health Plan covers your hospitalisation which could be due to an illness or an injury.
2. Restoration Benefit
   After the first claim, you can claim 100% of the sum insured when there is partial or full utilization of your cover. This benefit can come in very handy in case your medical expenses get exhausted
3. Ambulance Charges
   Emergency Ambulance charges up to INR 2,000 are covered in case an insured has to be rushed to a hospital.
4. Multiplier Benefit
   You can avail of a multiplier benefit of 2X when you do not make a claim. You can get up to 100% of cover increase as a no claim benefit.
5. Daily Hospital Cash
   When admitted to a hospital there are numerous out-of-the-pocket expenses that can burden your finances. You can get a daily cash benefit of up to INR 1,000 every day and INR 6,000 per hospitalisation.
6. Pre and Post-hospitalisation 
   The cost of follow-up and diagnosis before and after the hospitalisation are also covered in the Optima Restore Health Plan. Expenses 60 days prior and 180 days post hospitalisation are covered.
7. Day-care Procedures
   Treatments that require hospitalisation of less than 24 hours are also covered under the HDFC Ergo Optima Restore Plan.
8. Organ Donation
   Medical and surgical expenses for organ donation are covered at the time of organ harvesting a major organ.
9. Lifetime Renewal
   Your health cover can protect you for life without the hassle of regular renewals. Optima Restore Plan offers you eligibility for a lifetime.
10. Room Rent
    HDFC Ergo Optima Restore Plan puts no sub-limit on the room rent, which helps you to have a comfortable stay in the hospital room.
11. Health Check-ups
    With the Optima Restore Health Plan, you can avail health check-ups up to INR 5,000, to keep a check on your health and well-being.
12. Modern Treatments
    Advanced treatments such as robotic surgeries, oral chemotherapy and stem cell therapy are also covered under the Optima Restore plan.
13. Discounts
    • When you add 2 or more members to an Optima Restore Policy, you can get a discount of up to 10% on the premium amount.
    • By opting for the plan for 2 years, you can get a premium discount of 7.5%.
    • Get a Stay Active Benefit and avail of up to 8% discount at the time of renewal. You need to walk a daily average of steps which is accounted for on the Health Jinn mobile app.
14. Tax Benefits
    The health insurance premiums that you pay towards the HDFC Ergo Optima Restore Plan are eligible for a tax-exemption that can go up to INR 75,000.
15. Recovery Benefit
    With HDFC Ergo Optima Restore Plan, if you are hospitalised for over 10 days consecutively, a lump sum amount would be paid to help you recover from the financial losses you may have incurred due to your stay at the hospital.

Plan Details of HDFC Ergo Optima Restore Health Plan

• Waiting Period
  1. Other than accidental hospitalisation, no treatment is covered in the first 30 days of policy issuance
  2. During the first 24 months of policy inception, certain treatments such as hernia, cataract, hysterectomy etc, are not covered
  3. Declared/ Pre-existing conditions are covered only after 3 years of continuous renewals
• Free Look Period
  With the Optima Restore plan, you get a 15-day free-look period which starts from the date of purchase. Within this period, you can review the terms and conditions of the policy. If in case you feel that the policy is not well-suited to your requirements, you can return it, provided no claims have been made. A refund will be processed once the stamp duty charges and proportionate risk premium is deducted from the premium that has been paid by you.

What is not Covered in HDFC Ergo Optima Restore Health Plan?

When you invest in a health insurance policy, there are certain exclusions. These exclusions are the situations under which you would not be able to make a claim when you are hospitalised. Some common exclusions are:

1. The policy does not cover accidents that you may encounter while participating in adventure sports
2. Self-inflicted surgeries that are inflicted by the insured member are not covered
3. Abuse of intoxicating drugs/ alcohol is not covered
4. Claims that are caused because of war would not be accepted
5. HIV Infection/ AIDS are not included in HDFC Ergo Optima Restore Health Plan
6. Diseases that are venereal or sexually transmitted are not covered
7. Cosmetic surgeries or treatment of obesity would not be covered

Renewal Process of HDFC Ergo Optima Restore Health Plan

Depending on the term that you have picked for yourself 1 year or 2 years, you would have to renew the policy. For the renewal of your policy you can follow any of the given options:

1. You can renew your policy online through the official website of the company. Visit www.hdfcergo.com, go to ‘Online Renewal’ and renew the policy instantly
2. You can renew your policy online through an insurance aggregator website
3. Call on 022-6234 6234, OR 0120-6234 6234 and speak to a customer care executive, who would guide you through the renewal process
4. You can also email your renewal request to care@hdfcergo.com
5. Send a Cheque or a Demand Draft to HDFC General Insurance, D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078

HDFC Ergo Optima Restore Health Plan - Claim Process

When you invest your hard-earned money in a health insurance policy, it would be your primary concern that at the time of need, you are able to make a claim. HDFC Ergo strives to help all customers in a quick and easy settlement procedure, however, it is your responsibility as a policyholder to follow all the guidelines carefully. Let us see the different aspects of the claim process. 

• Cashless Claim 
  If you want to avail the benefit of cashless health insurance treatment, keep in mind that you would have to get the treatment at a network hospital. A network hospital is a hospital that has a collaboration with the hospital. The cost of your treatment, as per the policy and the sum insured would be paid by the insurance company directly. Depending on the plan option that has been selected by you, you will have to pay your share for the services that are not covered in the plan. 
  Remember, when going for planned cashless treatment, you need to obtain pre-authorisation at least 48 hours before the treatment. Once the pre-authorization is received, the treatment has to be carried out within a set number of days. 
  However, in case it is an emergency treatment the company must be informed within 24 hours after hospitalisation or treatment for pre-authorising the treatment.
• Reimbursement Claim 
  Due to lack of time or of unavailability of a particular treatment, if you could not get treated in a network hospital, you can still be compensated for your medical expenses. At a non-network hospital, you can make the payments up-front for the treatment that is taken and once the treatment is complete,  you can request reimbursement. 
  Do make sure that you inform the insurance company within 48 hours of hospitalisation. You would have to fill in and submit the claim form along with other documents that have been asked for. Generally, the documents listed below are required when making a claim.
• Required Documents
  1. Health Card issued by Company, along with KYC papers
  2. Claim Form - duly filled and signed
  3. Nature of Illness and the Treatment required
  4. Doctor’s prescriptions - medicines or/and diagnostic tests
  5. Detail of Individual Medical services
  6. Original Payment Receipts
  7. All diagnostic and pathological reports
  8. Original discharge summary
  9. Invoice of transplants, if any

HDFC Ergo Optima Restore Health Plan - Policy Network Hospitals

HDFC Ergo Optima restore plan helps you to have access to over 10,000 hospitals where you can avail treatment on a cashless basis. With such a wide network, you can make cashless claims almost anywhere in the country. As the company has its own claim settlement cell, the executives are available at the hospital and will assist you in the claim formalities. The claim would be settled at the earliest without letting you go through any trouble.

Review of HDFC Ergo Optima Restore Health Plan

You may not always be able to plan your hospitalisation expenses, and for such unforeseen situations, you need to have a health insurance policy that not only helps you in avoiding a financial set-back but also offers wide coverage. HDFC Ergo Optima Restore Health Plan offers you and your family complete health care coverage. You can buy the plan with minimum formalities in just a few minutes. 

When it comes to claims, the company has maintained a great track record of claim settlements from the last 16 years of its establishments. As HDFC Ergo has an in-house claim settlement cell, the process is transparent and quick. If you are looking for an easy-to-understand health insurance plan that offers comprehensive coverage along with an affordable premium, the HDFC Ergo Optima Restore Health Plan is surely a plan worth considering.