Health Insurance 108 views January 16, 2021

HDFC ERGO OptimaSENIOR Health Insurance Plan is offered on an individual basis where a person aged 61 years and above will be covered. There is no maximum coverage ceasing age in this HDFC ERGO policy, which means you are covered for life. HDFC ERGO OptimaSENIOR Health Insurance Plan is available with the cover options INR 2 lakhs, INR 3 lakhs and INR 5 lakhs for 1 or 2 years. Read this page further and know about HDFC ERGO OptimaSENIOR Health Insurance Plan coverages, exclusions and more.

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HDFC ERGO OptimaSENIOR Health Insurance Plan Details

ParticularsDetails
Sum InsuredINR 2 lakh, INR 3 lakh and INR 5 lakh
Policy Period1 and 2 years
Grace PeriodYou will get a grace period of 30 days from the due date of renewal on failing to pay the renewal premium
Free Look PeriodStarts 15 days from the date of policy inception
Tax BenefitsAvailable under Section 80D of the Income Tax Act, 1961
DiscountsNo Claim Discount of 5% at renewal

5% discount on the first policy year if you and your spouse are covered under the plan

7.5% discount if you opt for a 2-year policy period

Coverage Under HDFC ERGO OptimaSENIOR Health Insurance Plan

The insurance company is liable for the following medical expenses during the policy period.

  1. In-patient Treatment
  2. Pre-hospitalization up to 30 days
  3. Post-hospitalization up to 60 days
  4. 140 Daycare Procedures
  5. Domiciliary Treatment
  6. Organ Donor
  7. Emergency Ambulance up to INR 2,000 per hospitalization
  8. One E-opinion per policy year

Unique Benefit from HDFC ERGO OptimaSENIOR Health Insurance Plan

Besides its coverage, HDFC ERGO OptimaSENIOR Health Insurance Plan comes with the following benefits:-

  1. Lifelong Renewal – Once you purchase the HDFC ERGO OptimaSENIOR Health Insurance Plan, you can renew it forever.
  2. No Claim Based Loading/Underwriting – HDFC ERGO will never load the insured renewal premium or deny its coverage in case the insured claims or falls sick after taking HDFC ERGO OptimaSENIOR Health Insurance Plan.
  3. E-opinion – The insurance company will arrange a second opinion for the insured (on request), from the HDFC ERGO medical panel for listed ‘Critical Illness’.
  4. No Maximum Entry Age – As you know from above that HDFC ERGO hasn’t put a maximum entry age limit for the insured person, which means you can enter the plan anytime after the age of 61 years.
  5. Up to Five Lakh Coverage – You have the option to select a higher insurance cover up to INR 5 lakhs under the HDFC ERGO OptimaSENIOR Health Insurance Plan.
  6. Cashless Transactions – This Health Insurance plan enables you to get cashless treatment across 4000 network hospitals located at 800 cities in India.
  7. No Claim Discount – On your HDFC ERGO OptimaSENIOR Health Insurance Plan, get a 5% non-cumulative discount on renewal premium after every claim-free year, provided that the policy is renewed without a break.
  8. Portability – If you are interested in HDFC ERGO OptimaSENIOR Health Insurance Plan but can’t buy this because you are insured with some other company’s health insurance, don’t worry because you can shift any senior health insurance plan to HDFC ERGO. With the Portability Policy, a customer can easily transfer his/her health insurance plan.
  9. Waiting Period – The waiting periods mentioned in the policy schedule will reduce by 1 year on every continuous renewal of OptimaSENIOR policy.

Premium Chart for HDFC ERGO OptimaSENIOR Health Insurance Plan

Let’s have a look at the HDFC ERGO OptimaSENIOR Health Insurance Plan starting premium rates in the table below:-

Age at EntryFor Sum Insured of INR 2 LakhFor Sum Insured of INR 3 LakhFor Sum Insured of INR 5 Lakh
61-65 Years11,93214,61522,553
66-70 Years15,13719,201
71-75 Years18,36723,98639,428
76-80 Years24,21931,62952,125
81-85 Years32,05142,43370,849
> 85 Years42,49757,03296,402

Note – The premium will remain the same for the policy period. But your renewal premium may change due to a change in your age or the applicable tax rate.

Copayment Clause of HDFC ERGO OptimaSENIOR Health Insurance Plan

Now, let’s know about the HDFC ERGO OptimaSENIOR Health Insurance Plan copayment below.

SituationCo-payment In Percentage
Hospitalization in case of shared accommodation in a twin sharing room or any lower room type.15%
Hospitalization in case of shared accommodation in a single room or any higher room type.30%
Specified illness/surgeries30%
Day Care Procedures15%

A copay is the percentage of the claim amount that is borne by you, under the HDFC ERGO OptimaSENIOR Health Insurance Plan. The rest of the claim amount will be paid by the insurer.

Illustration 

Mr. Ramprasad has bought an HDFC ERGO OptimaSENIOR Health Insurance Plan with a Sum Insured of INR 3 lakh. During the policy period, Mr. Ramprasad is hospitalized in a twin sharing room for which he filed a claim of INR 1.5 lakh. In this case, Mr. Ramprasad needs to copay 15% of 1.5 lakh i.e. INR 22,500 and the rest of the 85% will be paid by the insurer.

Exclusion from HDFC ERGO OptimaSENIOR Health Insurance Plan

The insurance company shall not be liable for the following medical expense:-

  1. Treatments incurred within the first 30 days from the start of cover, except for the accidental injury
  2. Any pre-existing condition until the expiry of a 3-year waiting period
  3. Expenses arising from HIV or AIDS and its related diseases
  4. Non-allopathic treatments
  5. Cosmetic surgery
  6. Weight control treatments.
  7. Drugs and Alcohol abuse
  8. War, any act of war
  9. Nuclear, chemical or biological weapon and radiation of any kind
  10. Pregnancy
  11. Dental treatment
  12. External aids and appliances.
  13. Cataract, hernia, hysterectomy, joint replacement, hydrocele, etc. until the expiry of 2 years waiting period
  14. Items of personal comfort and convenience
  15. Experimental, investigative, and unproven treatments

Procedure for HDFC ERGO OptimaSENIOR Health Insurance Plan

When you are purchasing the HDFC ERGO OptimaSENIOR Health Insurance Plan, you need to go through the following process.

Step 1: Fill in the application form by mentioning your personal and health details. And ensure that the mentioned information is complete and accurate

Step 2: Submit the duly filled application form and the premium amount cheque along with necessary documents to your advisor.

Step 3: After that, you will be called for a medical check-up based on your age at entry, health declaration and opted cover. The check-up includes a medical examination by a doctor, blood tests for cardiac status, cholesterol levels, blood sugar levels, urine analysis and cardiac tests to assess your heart and kidneys.

On acceptance of the policy, HDFC ERGO will reimburse 50% of the total medical check-up costs incurred by you. As per your provided information and the medical examination report, the insurance company will accept or revise its offer to give you an optimal fit for your profile. However, this can be done only with the consent of the insured person. In case your policy is not accepted by the insurance company, you will be informed about it with a proper reason. Whereas in the case of acceptance, the final policy document and kit will be sent to you.

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