HDFC Ergo Health Optima Restore

HDFC Ergo Health Optima Restore Insurance Plan is a Comprehensive Online Health Insurance Plan that provides comprehensive cover for the entire family.

Hospitalization

Tax benefit

Discount

Compare this plan with other Health Plans

Key Features

Hospitalization

Cashless Hospitalization
Quick turnaround time with 90% of pre-authorization is done within 2 hours of intimation or hospitalization
No caps/limits on doctor/surgery fees, operation theatre, room rent and intensive care unit

Tax benefit

Tax benefit on premiums paid under Section 80D of the Income Tax Act, 1961

No Claim Based

There is No claim based loading in this plan

Discount

Policy Term options of 1 or 2 years with a 7.5% Discount on 2 year policy terms

7.5% Discount on 2 year policy terms and more

Easy upgrade

This health plan also comes with an easy upgrade option on policy renewal

Quick turnaround time with 90% of pre-authorization is done within 2 hours of intimation or hospitalization

Free look period of 15 days from the receipt of policy documents

How it works

This policy can be taken for self, spouse, dependent children and dependent parents. This policy covers all basic hospitalization expenses with the benefit of restoring the initial Basic Sum Assured if it is utilized for claim and upto 100% of Basic Sum Assured as No Claim Bonus is payable in this plan. The plan can be taken for an Individual or as a Family Floater. In a Family Floater policy, a maximum of 2 adults and a maximum of 5 children can be included in a single policy. You can opt for 1 Adult and 3 children also. The plan offer lifelong renewability. There is no claim-based loading. Also you can upgrade to the next higher slab of cover on renewal. Maternity related expenses are excluded in this plan as is the case with most plans.

There are 2 Unique Benefits in this plan:

Restore Benefit: The Uniqueness in this plan is that in this plan, the Sum Assured is restored if it is exhausted that can be utilized for a future claim for a different illness is made during the same policy year. Thus, if the Initial Sum Assured gets exhausted, the entire amount is restored back into the plan at no extra cost!

Let us explain this with an example. If you have a Sum Assured of Rs 5 lakhs and Claim for Rs 6 lakhs in the first hospitalization, then the entire limit is exhausted and only Rs 5 lakhs would be payable. However, if another claim happens within the same year for a different illness or for a different family member, then the entire Sum Assured of Rs 5 lakhs is available for claim even though the initial Sum Assured has been exhausted.

Apollo Munich Optima Restore Working

However, the restore benefit works only if:

The entire Basic Sum Assured is exhausted
The claim is for a completely unrelated illness

Multiplier Benefit: Another Unique Benefit of this plan is that for a claim free year, there is a 50% increase of the Basic Sum Assured as No Claim Bonus and if the consecutive year is also Claim Free then the total No Claim Bonus increases by 100% with a net effect of Double the Basic Sum Assured.

Let us explain this with an example. If you have a 5 lakh policy and don’t claim in the first year, the cover increases to Rs 7.5 lakhs in the second year which rises to Rs 10 lakhs in the third year for another consecutive claim free year while the premium is calculated only for a premium for Rs 5 lakhs of initial Basic Sum Assured.

Apollo Munich Optima Restore Multiplier Benefit Working

In case of claim, the No Claim Bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy.

This plan provides for regular features like pre-hospitalization, hospitalization and post hospitalization expenses without any cap on charges like doctor’s fees, OT charges, etc. as well as Day Care Treatment, Domiciliary Treatment, Organ Donor costs, etc.

Restoration of the entire Sum Insured if used in the middle of the year at no additional cost
No claim bonus increases the insurance cover by 50% for one claim free year and then 100% for the consecutive claim free year
Lifelong renewal to stay insured forever
No sub-limits on hospital room rent or co-pay required
No loading on renewal premiums if a claim is made
Cashless treatment across 4000 hospitals in more than 800 cities
Wide cover for treatment against illnesses and accident
Tax benefits

Tax Benefit

There is Tax Benefits under section 80D of the Income Tax under the existing tax laws of the Income Tax, 1961:

Of Rs 15000 on the premium amount paid for Health Insurance Coverage of self, spouse and children
An additional amount of Rs 15,000 for premium amount paid towards Health Insurance Coverage of parents
Another additional Rs 5000 of deduction if either or both of the parents are Senior Citizen

Total Amount available for deduction under section 80D of the Income Tax Act, 1961 is Rs 20000 for Senior Citizen parents and Rs 15000 for self, spouse and children.

Eligibility

	Minimum	Maximum
Sum Assured (in Rs)	3,00,000	50,00,000
Policy Term (in years)	1	2
Entry Age of Life Insured (in years)	91 days	65 years
Renewable till Age (in years)	-	Lifelong
2 Years Standard Exclusion	For specific diseases like cataract, hernia, hysterectomy, joint replacement etc.
Waiting Period	30 Days
Waiting Period for Pre-existing Illness	After continuous renewal of 3 years
Grace Period	30 days from the date of expiry to renew the policy

Exclusions

Any treatment within first 30 days of cover except any accidental injury
Any Pre-existing diseases/conditions will be covered after a waiting period of 3 years
2 years of exclusion for specific diseases like cataract, hernia, hysterectomy, joint replacement etc.
Expenses arising from HIV or AIDS and related diseases
Abuse of intoxicant or hallucinogenic substance like drugs and alcohol
Pregnancy, dental treatment, external aids and appliances
Hospitalization due to war or an act of war or due to nuclear, chemical or biological weapon and radiation of any kind
Non-allopathic treatment, congenital diseases, mental disorder, cosmetic surgery or weight control treatments

FAQs

What does HDFC Ergo Health Optima Restore Insurance plan cover?

In-patient care: Hospitalization expenses such as room rent, nursing expenses, ICU charges, surgeon’s fees, doctor’s fees, anaesthesia, blood, oxygen, operation theater charges, etc. with no sub-limits

Day care treatment: Medical expenses incurred if hospitalization is less than 24 hours for listed 140 procedures

Pre and Post hospitalization: Medical expenses incurred 60 days immediately before hospitalization will be covered. Expenses incurred up to 180 days after being discharged from the hospital such as follow-up visits to medical practitioner, medication, etc will be covered.

Ambulance charges: Charges of Ambulance provided by the hospital or any service provider will be reimbursed upto Rs 2000 for each hospitalization

Organ Donor Cover: Medical expenses incurred by an organ donor while undergoing the organ transplant surgery if the organ is for the use of the insured person.

Domiciliary Hospitalization: Medical expenses incurred by the insurer for treatment at home will be reimbursed. The medical treatment should be for a period exceeding 3 consecutive days and should merit hospitalization.

Restore of Sum Assured: If the Sum Assured in the policy is exhausted due to claims made, then the company restores the entire sum assured once in the policy year. This restores Sum Assured amount can be used for future claims, not related to the illness / injury for which the claim has already been made during the same year.

Multiplier Benefit: For a Claim Free year, there is a No Claim Bonus of 50% and another 50% of No Claim Bonus for the second consecutive Claim Free year of total 100% of Basic Sum Assured

Treatment anywhere in the country: For select diseases / ailments / treatments, the Company will reimburse the cost of medical expenses, whether the insured gets these treatments anywhere in India.

What is the difference between a family floater and critical illness or hospital cash insurance?

The individual or family floater health insurance works on the principle of indemnity. This means that these insurance policies will pay you only what you have spent for medical treatment in hospital. On the other hand, the critical illness or the hospital cash insurance pays you the amount insured, irrespective of the amount spent for medical treatment. These are a benefit based policies.

Do I need to undergo a medical check-up while buying a health insurance policy?

You may be required to undergo a medical check-up after you buy, in case any member to be insured is above 45 age or for sum insured 7 Lakhs or above.

What is beneficial for me - floater insurance or an individual insurance?

Buying an individual cover or a floater cover is an individual’s perception. However, as a general rule, at younger ages floater cover is advisable. As you grow older, you should go for an individual cover.

What are the documents required for portability?

You can apply for Apollo Munich Optima Restore Plan under portability with following documents: