Health Insurance 327 views March 22, 2021

HDFC ERGO Optima Super Health Insurance Plan is a combined top-up plan that enhances your sum insured at a low-cost premium. This plan allows you to convert this top-up plan into a regular health insurance plan. HDFC ERGO Optima Super Health Insurance Plan covers in-patient treatment, pre-hospitalization, post-hospitalization, daycare procedures, organ donor expenses and ambulance service expenses. The policy will pay for the covered benefits if the opted deductible exceeds. Read further to learn more about HDFC ERGO Optima Super Health Insurance Plan.

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Coverage Under HDFC ERGO Optima Super Health Insurance Plan

The insurer will pay for the following expenses only under this HDFC ERGO top-up plan.

  1. In-patient Treatment Hospitalization expenses for illness or accident
  2. Pre-Hospitalisation Medical expenses up to 60 days before the date of hospitalization for the same illness/injury.
  3. Post-Hospitalisation Medical expenses up to 90 days after discharge from the hospital
  4. Daycare procedures that do not require 24 hours of hospitalization
  5. Medical expenses for the harvesting of the organ
  6. Ambulance Service expenses up to INR 2,000 per hospitalization

Eligibility for HDFC ERGO Optima Super Health Insurance Plan

If you want to increase your existing individual health insurance coverage or are looking for coverage over a specified amount, check out the HDFC ERGO Optima Super Health Insurance Plan and see whether you are eligible for it or not.

  1. Age entry should be between 91 days to 65 years.
  2. Dependent children between the age of 91 days to 5 years can be covered if either parent is covered under the same HDFC ERGO health insurance policy.
  3. Issued both on an individual or family floater basis
  4. The premium for the family floater plan will be computed considering the age of the eldest insured member.
  5. In an individual policy, a maximum of 6 members can be added. Of which a maximum of 4 adults and a maximum of 5 children can be included in the policy. The 4 adults can be Self, Spouse, Father and Mother.

HDFC ERGO Optima Super Health Insurance Plan Switch Option

HDFC ERGO General Insurance provides you a unique option of converting into a full-fledged NIL deductible Optima Super plan using which, you will get a Waiver of Deductible benefit. It is easy to do and there are no underwriting or medical tests for the same. And this comes with advantages like:

  1. Reduced Waiting Period: All the waiting periods will be reduced by the number of years you have completed with HDFC ERGO.
  2. Deductible Waiver: Your deductible will be waived off and you are starting to be covered from the first rupee.

Note – You can exercise this switch option only at the time of renewal between the age of 55 and 60 years or at the beginning of the sixth policy year, provided you have purchased this policy before 50 years of age and renewed this continuously without any interruption.

Sum Insured & Deductible Option Under HDFC ERGO Optima Super Health Insurance Plan

You can choose your top-up plan sum insured and deductible from the following. Check out the table below to choose the preferred amount as per your need.

Sum Insured (in INR)Deductible (in INR)

  1. 5,00,000

  2. 7,00,000

  3. 10,00,000


  1. 1,00,000

  2. 2,00,000

  3. 3,00,000

  4. 4,00,000

  5. 5,00,000

  6. 6,00,000

  7. 7,00,000

  8. 10,00,000

A deductible is a cost-sharing requirement where HDFC ERGO will not be liable for medical expenses incurred up to a specified rupee amount in a policy year if you opt for it. A deductible won’t reduce the Sum Insured, as HDFC ERGO General Insurance will only be liable for payment where the Medical Expenses are above the deductible amount.

Illustration

Mr. Mehra purchased HDFC ERGO Optima Super Health Insurance Plan and the policy will cover him from 1st January 2021 to 31st December 2021. For his top-up plan, Mr. Mehra has chosen a sum insured of INR 5 lakh and a deductible of INR 5 lakh as well. Now let’s see how the claim settlement will work when a risk arises.

For Multiple Claims in a Year

Suppose in May 2021, Mr. Mehra is hospitalized and he filed for a claim of INR 4 lakh. As you can see the claim amount is below the deductible limit, so the claim will not be admissible under HDFC ERGO Optima Super Health Insurance Plan. Later that year, Mr. Mehra is again hospitalized and filed for a claim of INR 2 lakh, as per the total number of claim in a year Mr. Mehra has filed up to INR 6 lakh (4 lakh + 2 lakh), which means he can get a claim for INR 1 lakh from HDFC ERGO.

For Single Claim in a Year

In case Mr. Mehra is hospitalized only once during the policy period and the filed claim amount is INR 8 lakh, you can see it exceeds the deductible which means Mr. Mehra would get a claim amount of INR 3 lakh from the insurance company.

HDFC ERGO Value Added Services

Under the HDFC ERGO Optima Super Health Insurance Plan, the insurance company offers a range of value-added services that promote your well-being, prevent illnesses and make hospitalization stress-free.

Cashless Hospitalisation – You can avail of this claim service at over 10,000+ network hospitals, as listed in the guide book or on HDFC ERGO’s official website.

Health Risk Assessment – You get access to a health risk assessment tool that helps make a profile of each insured member’s health status. Upon assessment of the member’s health status, HDFC ERGO will offer personalized wellness recommendations on diet, lifestyle and nutrition regimen.

Exclusion From HDFC ERGO Optima Super Health Insurance Plan

  1. All treatments within the first thirty days from the date of inception, except for any accidental injury
  2. Any pre-existing condition (until the expiry of the waiting period of 4 years)
  3. Congenital external disease
  4. Cosmetic surgery
  5. Abuse of drugs and alcohol
  6. Injury/Illness due to war, an act of war, or nuclear, chemical or biological weapon and radiation
  7. Pregnancy
  8. Dental treatment
  9. External aids and appliances
  10. cataract, hernia, joint replacement surgeries, surgery of hydrocele, etc. (until the expiry of the waiting period of 2 years)
  11. Non-medical expenses
  12. Experimental, investigative and unproven treatments

Free Look Period

A free look period of fifteen days shall apply to new individual health insurance policies only. During this period, you can review the policy document terms and conditions and return the same if not acceptable.

In case you haven’t claimed during the free look period, you will be entitled to a refund of the paid premiums after a deduction of medical examination charges and stamp duty charges. If the risk has already commenced and you returned the policy, a deduction towards the proportionate risk premium for a period of cover will be made. Whereas if only a part of the risk has commenced, such proportionate premium commensurate with the insurance coverage during such period will be given.

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