Health Insurance 7091 views March 5, 2020

HDFC ERGO Health Optima Restore

Anxiety, pollution, unhealthy eating, gadget dependency, and indiscipline life have made lifestyle ailments spreading rapidly everywhere. Hence, it is important to buy a proper health insurance plan to handle the increasing medical expenditures due to lifestyle problems. Getting a health plan early will help you face inflation better and do savings as well in the long run.

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HDFC ERGO General Insurance Company Ltd. is a combined undertaking between HDFC Ltd, which is India’s leading Housing Finance Institution, and ERGO International AG, the chief insurance company of the Munich Re Group. The Company provides a variety of general insurance products starting from Health, Motor, Home Travel with Personal Accident plans in the retail sector and tailored products like Marine, Property, and Liability cover in the corporate sector.

Here, we will talk about HDFC ERGO Health Optima Restore, which is much more than a normal health plan as it takes care of your diseases and rewards you as well for staying fit and healthy. The plan provides the facility of the cashless hospitalization at 4000 network hospitals spread across 800 cities in India.

Features and Benefits of HDFC ERGO Health Optima Restore

  1. The benefit of Restoration: Immediate addition of 100% of the Basic Sum Assured on whole or partial use of the prevailing Sum Assured and Multiplier benefit, if appropriate, during the policy year. Therefore, the Total Sum Assured amount – Basic Sum Assured with Restoration Benefit and Multiplier Benefit will be available at your disposal for all the claims under the in-patient hospitalization
  2. The benefit of Multiplier: The plan rewards you with an incentive in case of no claim. In the case of a no-claim year, the sum assured will increase by 50%. Likewise, if in the 2nd year also, there is no claim, the sum assured will be doubled by 100%. Example: if you are having a policy with sum insured of INR 2 lakh and you don’t claim anything during 1st year, the sum assured will increase by INR 3 lakhs, and for the 2nd claim-free year, the sum insured will be INR 4 lakhs, although you will pay the premium for only INR 2 lakh sum insured=
  3. The facility of Health Check-up: HDFC ERGO Health Optima Restore helps you monitor your health through a health check-up at the time of renewal once in 2 years on a Sum Assured of INR 5 lakh and once per year on a Sum Assured of INR 10 lakh and up
  4. The benefit of lifelong renewability: HDFC ERGO Health Optima Restore can be renewed life-long
  5. Zero limits on Room Rent: There is no limit in the room chosen by you under this plan
  6. Nil Loading: There is no loading on premium in case of a claim
  7. Fast Turnaround time: 90% of pre-authorization is being completed within 2 hours, hence there is no longer a waiting time
  8. Hassle-free up-gradation: You have the liberty to enhance your existing plan to the next level at the time of renewal
  9. Option of Rider: Option to cover yourself globally at the network centers for treatment of 8 main diseases – Cancer, Coronary Artery by-pass surgery, replacement or restoration of Heart Valve, Neurosurgery, Bone Marrow Transplant, Live Donor Organ Transplant, Aorta Graft Surgery, and Pulmonary artery graft surgery. The rider provides you the liberty not only to get the finest healthcare amenities worldwide but also compensates all travel expenses for you and any accompanying relation, 2nd opinion-if needed, lodging expenses as well as post-hospitalization expenditures
  10. The facility of Movability: You can easily transfer your health plan of any other company to HDFC ERGO and enjoy the benefits under HDFC ERGO Health Optima Restore health plan
  11. Tax Benefit: You can avail a tax benefit under section 80D of the Income Tax Act

Eligibility under HDFC ERGO Health Optima Restore

Entry age 91 days to 65 years
Child between 91 days till 5 years can be covered, however, one of the parents also needs to be insured under this plan
Term of the Policy (in years)1 /2 and discount of 7.5% is given in the case of 2 years
Type of PlanIndividual or Family Floater
Sum Insured (INR)3 lakhs, 5 lakhs, 10 lakhs, 15 lakhs, 20 lakhs, 25 lakhs, and 50 lakhs
Premium Depends on the age, the sum assured and family size

Exclusions under HDFC ERGO Health Optima Restore

Below are the exclusions under the plan:

  1. Any treatment happening within the first 30 days of the coverage, excluding any accidental injury
  2. Pre-existing diseases under the plan will be covered after a waiting period of 3 years
  3. Diseases like hernia, cataract, joint replacement, hysterectomy, etc will be covered after 2 years
  4. HIV or AIDS-related diseases
  5. Expensed under the influence of alcohol and drugs
    Dental treatment, external aids, pregnancy and appliances
  6. Hospitalization because of any chemical or biological weapon, war or an act of war, nuclear war and any radiation
  7. Inherited outside diseases, mental illness, non-allopathic treatment, weight control treatments, cosmetic surgery, etc.

Claims under HDFC ERGO Health Optima Restore

The claim process for HDFC ERGO Health Optima Restore is simple and easy to understand. You need to submit the necessary documents with KYC and NEFT details of the insured individual and write to for both cashless as well as reimbursement procedure of claim. You will also receive a constant update on the status of your claim on your registered cell number or your email id.

Documents required under HDFC ERGO Health Optima Restore

The list of documents needed for the claim are as below:

  1. Appropriately completed and signed Claim Form mentioning the HDFC ERGO policy number
  2. Summary of Discharge in original
  3. The final bill in original with all the breakups, payment invoices and pharmacy invoices in original with prescriptions
  4. Reports of Investigations in original like a blood report, X-Ray report, etc.
  5. Implant sticker or the invoice, if needed like for stent used in angioplasty, the lens for cataract, etc
  6. After treatment documents, if there are any
    Medico-Legal Certificate or MLC or FIR in case of an accident
  7. Other applicable documents, if needed
  8. Details of NEFT
  9. Claims above INR 1 lakh: KYC form with a duplicate of anyone KYC document like an Aadhaar card, driving license, passport, voter ID and the KYC Form

Now with HDFC ERGO Health Optima Restore, stay energetic and healthy, simply choose your path towards good health and enjoy the benefits. The sooner you take the plan, the better is for you and your family. Lead a healthy and happy life.

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