HDFC Ergo Health Optima Super Plan
HDFC Ergo Optima Super is a top-up plan which aims to enhance the existing health cover at nominal rates. Unlike other top-up plans, this plan is an aggregate plan where the Sum Assured limit needs not ne crossed at every claim. The total aggregated claim in one policy year is summed up, compared with the deductible limit and then the top-up claim is triggered. It can be taken as an individual plan or as a family floater one depending on the policyholder’s choice
How it works –This plan is available for 1 or 2 years after which it has to be renewed. The cover allowed comes in three ranges of 500,000, 700,000 and 10,00,000. The Deductible Limit which means the limit up to which the policyholder will meet the claim himself is chosen by the policyholder and comes in the range of 1-7 lakhs and 10 lakhs.
This plan provides for in-patient Treatment, both pre and post hospitalization expenses, day care procedures, organ donor expenses and ambulance charges.
The plan is unique because, unlike other top-up plans, it does not call for the exhaustion of the deductible limit at every claim in a year. While computing the claim amount, the entire claims made in a year (if they are lower than the deductible limit) are summed up and co-related with the deductible amount. If it is higher than the deductible, the excess is paid by the company.
For instance, say, Mr. A has a 10 lakh plan with a 6 lakh deductible. He is hospitalized 2 times during a policy year for unrelated illnesses. The total bill runs up to 3 lakhs and 5 lakhs. In the first instance, there will be no claim since the deductible is 6 lakhs. In the second instance however, since the aggregate expense is 8 lakhs, the policyholder will get 2 lakhs from the insurer.
Another unique feature of the plan is the Waiver of Deductible benefit wherein, the plan becomes a normal Health Plan with zero deductible limits from the 6th continuous policy year or if the policyholder is between 55 and 60 years of age then they can exercise this option provided the policy was bought prior to turning 50 and has been continuously renewed. The waiver of Deductible Benefit also ensures reduction of waiting period subsequently.
Key Features of HDFC Ergo Health Optima Super Plan
What is covered in HDFC Ergo Health Optima Super Plan?
Regular Benefits
Hospitalization Benefit |
Covered |
Pre Hospitalization |
60 Days |
Post Hospitalization |
90 Days |
Day Care Procedures |
Covered |
Domiciliary Treatment |
Not Covered |
Maternity Benefits:
Waiting Period |
- |
Normal Delivery |
- |
Caesarean Delivery |
- |
New Born Babies |
- |
Vaccinations |
- |
Other Benefits
Ayurvedic,Unani,Sidha& Homeopathy |
- |
Hospital Cash |
- |
Ambulance Charges |
Up to Rs.2000 per hospitalization |
Sum Insured Restoration |
- |
Health Check Up |
- |
Organ Donor |
Covered |
Second Opinion |
- |
Child Education Fund |
- |
Health Programs |
- |
Cumulative Benefit |
- |
Exclusions - What is not covered in HDFC Ergo Health Optima Super Plan?
Eligibility and Restrictions of HDFC Ergo Health Optima Super Plan
|
Minimum |
Maximum |
Coverage Amount (in Rs.) |
5 Lacs |
10 Lacs |
Policy Term (in years) |
1 |
2 |
Entry Age of Principal Insured(in years) |
91 days |
65 |
Entry Age of Child(in years) |
91 days |
5 |
Maturity Age(in years) |
Lifelong |
Sample illustration of Premium of HDFC Ergo Health Optima Super Plan
The below illustration is for a healthy Male opting for Individual Plan and a Family Floater with 2 Adults and 2 children for a 1 year term plan
Sum Assured = 7 lakhs
Deductible = 5 lakhs
Age = 30, 40 and 50 years
Family Floater of Health Plan
2 Adults + 2 dependent children
Tax Benefits of Health Plan
Health Insurance premiums paid up to Rs. 15,000 and Rs 20,000 for senior citizen are allowed as a deduction from the taxable income each year under section 80D of the Income Tax Act.
Other Top-up Health plans from HDFC Ergo General Insurance
HDFC Ergo Optima Plus
Alternate Top-up HealthPlans from other Insurance Companies
HDFC Ergo Health Suraksha Top-up Plan
Bajaj Allianz Extra Care Health Insurance Plan
Star Super Surplus Health Insurance Plan