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HDFC Ergo Health Optima Plus Plan

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HDFC Ergo Health Optima Plus Top Up Insurance Plan


HDFC Ergo Health Optima Plus Top Up Insurance Plan offers to cover you for higher hospitalization expenditures at nominal premium. It is the only plan in India that offers an option to convert to a fully-fledged nil deductible health insurance plan on retirement.


How it works – The plan offers coverage from the age of 5 years onwards with maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parent is covered under this policy). You and/ or your family members namely spouse, dependent children, dependent parents are eligible for buying this cover (plan offers a family discount of 10% if 2or more family members are covered under the same policy).  The policy offers coverage on individual sum insured basis only. Maximum 6 members can be added in a single policy. In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy. Your premium at renewal may change due to a change in your age or changes in the applicable tax rate. The policy period options include period of 1 or 2 years(s). (It offers 7.5% discount if you opt for a 2 year policy)


Key Features of HDFC Ergo Health Optima Plus Top Up Insurance Plan

  •  In-Patient Hospitalisation -The medical expenses for coverage for hospitalization of more than 24 hrs with no room rent limits.
  • Pre-Hospitalisation - The medical expenses that you incur due to illness during 60 days immediately before you are hospitalized.
  • Post-Hospitalisation - The medical expenses you incur in the 90 days immediately after you are discharged from hospital.
  • Day-Care Procedures - The medical expenses for enlisted 140 day-care procedures, which do not require 24 hours hospitalization due to technological advancement, are covered.
  • Domiciliary Treatment - The treatment expenses involved in getting a treatment done at home which otherwise would need hospitalization.
  • Organ Donor - Treatment expenses for the organ donor at the time of organ transplant.
  • Emergency Ambulance - Expenses incurred if ambulance service is used on the way to hospital for hospitalization (up to Rs. 2000).


Additional Features of HDFC Ergo Health Optima Plus Top Up Insurance Plan

  • Conversion to Nil Deductible Policy - The option to convert the plan to a fully fledged Indemnity Health Insurance plan at retirement is available only at renewal between 58-60 years provided you have enrolled with Us under this policy before the age of 50 years and have renewed with us continuously without a break.
  • Cashless Service - You need to obtain a pre-authorization for all planned admissions atleast 48 hours prior to actual admission or regularize any ‘emergency’ admission within 24 hours post the admission. The details of the process and the documentation requirements are given in the guide-book sent along with the policy.
  • Portability - If you are insured with some other company’s health insurance and you want to shift to us on renewal, you can. Our portability policy is customer friendly and aims to achieve the transfer of most of the accrued benefits and makes due allowances for waiting periods etc.
  • Tax Benefits - With the Optima Plus Health Insurance Plan you can presently avail tax benefits for the premium amount under Section 80D of the Income Tax Act. (Tax benefits are subject to changes in Tax Laws)




Exclusions - What is not covered in HDFC Ergo Health Optima Plus Top Up Insurance Plan?

  • All treatments within the first 30 days of cover except any accidental injury.
  • Any pre-existing condition will be covered after a waiting period of 4 years.
  • 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele etc.
  • Expenses arising from HIV or AIDS and related diseases.
  • Congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments.
  • Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
  • Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
  • Pregnancy, dental treatment, external aids and appliances.
  • Items of personal comfort and convenience.
  • Experimental, investigative and unproven treatment devices and pharmacological regimens.
  • Please refer to the Policy Wording for the complete list of exclusions.
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