HDFC Ergo Optima Restore Plan: Avail A Wide Coverage

Why Choose HDFC Ergo Optima Restore Plan

HDFC ERGO's Optima Restore Policy has been the company's best-selling plan since its launch. In addition to providing comprehensive health coverage, it offers two variants, The Optima Restore Individual Plan and The Optima Restore Family Plan. Restore benefit and 2X multiplier benefit are the two unique advantages of HDFC ERGO health insurance optima restore. After making your first claim, HDFC ERGO Optima Restore Benefit restores your coverage to 100%. With the multiplier benefit, your SI amount is increased by 100% after two years without a claim. In addition to renewal discounts, recovery benefits, organ donor coverage, etc., HDFC ERGO health optima restore includes other major coverage benefits.

Specifications of The HDFC Ergo Optima Restore Plan

There are no additional costs associated with HDFC ERGO Optima Restore. Take a look at the specifications of HDFC ERGO Optima Restore to get an idea of its eligibility.

Sum insured	3, 5, 10, 15, 20, 25 lakhs
Entry age	Min. 91 days Max. 65 years
Policy term	1 / 2 years
Renewability	Lifetime
Waiting period	30 days

Benefits of HDFC ERGO Health insurance

HDFC ERGO provides a wide variety of benefits altogether in different divisions as follows-:

1. Protection Benefits - The cervical collar, braces, belts, and other support devices are covered by us. The cost of disposables during hospitalization will be covered with cashless payments such as buds, gloves, nebulization kits, and other consumables. Delivery kit, ortho kit, and recovery kit costs are covered by us. Surgical tape, gauze, cotton, crepe bandage, and other materials are covered in the procedure charges.

2. Deductible benefits - Deductibles are amounts you must pay at the time of a claim once each Policy Year, after which our coverage begins.

By paying the first INR 25,000 (opted deductible) of the claim in a policy year, you can reduce your premium by up to 25%
Paying a little bit more every year can save you up to 50%
The Buy-Back feature of this policy enables you to waive your chosen deductible after five years.

3. Discount benefits - If you purchase a health insurance policy online, you will receive a 5% premium discount. Optima Restore offers a 10% family discount when two or more members are insured under the same policy on an individual sum-insured basis. Discount for long-term policies: If you pay your premiums in advance for two or three years, you receive a 7.5% and 10% discount, respectively. With an active retail insurance policy with us and a premium above rupees 2,000, you'll get a 2.5% discount on your base premium.

4. Basic benefits - You can choose from a wide range of base covers ranging from 5 lacs to 2 crores. Floater policies are available for individuals and families. Choose a tenure between 1, 2 and 3 years for the policy. The No-Cost Installment option (Applicable to one-year policies) is now available for Credit and Debit card holders.

Exclusions of HDFC ERGO Optima Restore Plan

Exclusions that are permanent. Health insurance policies generally do not cover certain treatments and medical conditions. The following are not covered by HDFC ERGO optima restore health insurance:

Surgery involving cosmetics or plastics
Suicide attempt injuries
Infertility treatment, birth control, vicarious pregnancy, circumcision
Alcohol and drug-related hospitalizations
War and radiation-related hospitalizations
Treatments that are not allopathic
Diseases of the external congenital system
Sexually transmitted diseases or venereal diseases treatment
Obesity treatment

Inclusions Under Optima Restore Plan

Hospitalization - Inpatient treatment is covered up to your sum assured under this policy.
Coverage by Ambulances - In case of an emergency, this plan covers ambulance expenses (Rs.2000 per hospitalization)
Hospitalization Before and After - The plan covers all medical expenses before and after hospitalization (up to 180 days).
Procedures For Daycare - Daycare treatment methods, such as cataract surgery, are covered by this plan
Coverage for Advanced Technology Treatments - It covers advanced treatment methods such as robotic surgery, deep brain stimulation, stem cell therapy, and oral chemotherapy.
Costs Associated With Organ Donation - As long as the sum insured is reached, this plan covers all medical expenses related to harvesting organs from donors for transplantation. You can receive a daily hospitalization allowance (up to Rs. 6,000) for a maximum of six days depending on the amount insured.
Providing Care At Home - Up to your sum assured amount is covered for domiciliary treatment under this plan. Applicants with any of the following conditions/illnesses or a history of them may be rejected:
a. Glucose intolerance or diabetes mellitus.
b. Heart Attack, Coronary Artery Disease (Angioplasty, Coronary Bypass).
c. Congestive heart failure/conduction abnormalities of the cardiac system/pacemaker implantation.
d. Stroke (cerebrovascular accident).The presence of malignancy or cancer (such as leukemia, sarcoma, etc.).
e. The autoimmune diseases are rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, etc.
f. Transplantation of the renal system/Congenital disorders of the renal system.
g. Alcoholic and nonalcoholic cirrhosis.

Optima Restore Premium from HDFC ERGO - With Optima restored by HDFC ERGO, you can choose the SI amount and the number of members you wish to cover. Therefore, its policy premiums vary according to the customized HDFC ERGO health optima restore plans available to policyholders.

HDFC ERGO Health Insurance Claim Procedures

In the event of a medical emergency, a health insurance plan serves as financial support. For this reason, it is crucial that you read the steps below to understand how Health Insurance claims are processed differently for cashless claims and reimbursement claims.

1. Cashless claims

Notification -For cashless approval, fill out the pre-auth form at the network hospital.
Rejection/Approval-As soon as the hospital informs us, we update you on the situation.
The hospitalization process-Pre-auth approval is required for hospitalization.
Settlement of claims-Our claims is settled directly with hospitals at the time of discharge.

2. Reimbursement claims

A hospitalization bill must be paid in full and the original invoices must be preserved
You will need to send us all your treatment documents and invoices after you have been discharged from the hospital.
Invoices and treatment documentation related to your claim are verified by us
The amount of the approved claim is transferred to your bank account as soon as it has been approved.

FAQ

Is dental treatment covered by Optima Restore HDFC ERGO?

Most health insurance plans do not cover dental treatments. The HDFC Optima Restore health insurance will cover dental treatment only if it is needed as a result of an accident and requires a minimum of 24 hours of hospitalization.

Under HDFC ERGO optima restore benefits, what is the 2x multiplier?

After two years of no claims, the multiplier benefit doubles your sum insured.

Does HDFC Ergo Optima Restore cover maternity?

As far as this plan is concerned, it does not cover expenses related to maternity leave.

What is the procedure for canceling my Optima Restore policy?

HDFC ERGO health insurance customers can cancel their policies by giving written notice to any of the company's branches or calling its Toll-free number.

Is daily cash for choosing a shared room available under this policy?

Yes, optima restore provides daily cash for choosing shared accommodation. The cash amount depends on the sum insured chosen.

Are day care procedures covered under the optima restore plan?

Yes, daycare procedures are covered by the optima restore plan.

What is the maximum coverage given by the optima restore plan?

The plan offers insurance cover up to Rs. 50 lakh.

How many times can the restore benefit be claimed in a policy year or lifetime?

It can be used once in every policy year for a lifetime, provided you keep renewing your policy.

Will the insured person have to pay any additional premium when the sum insured is restored?

One member from a family floater plans to make a claim and exhaust the cover. Upon cover restoration, if another member under the policy also has to claim for the same disease, will he/she be eligible for the claims? Yes, optima restore covers its policyholders in case of multiple claims against the same or similar medical emergencies. The restore benefit can be availed for future claims. So multiple members can make the claims at different time intervals. The first claim can be made up to the base sum insured, after which the restore benefit activates for the next one.

What medical expenses are covered under this policy?

Optima restore plan covers pre and post hospitalisation expenditure along with allied expenses like ambulance, room rent and day care procedure as well.

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