HDFC Ergo Health Optima Super

 

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 6^th 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.

 

• It is an aggregate top –up plan where the claims in the entire year are aggregated and tallied with the deductible limit before meeting the claim.
• It can be taken as an Individual Plan or a Family Floater one
• In an Individual Plan, a maximum of 6 people can be added in a single policy being a maximum of 4 adults (self, spouse, dependent parents) and 5 children.
• In a Family Floater plan, a maximum of 2 adults (in any combination of self, spouse and dependent parents) and) 2 children can be added.
• This plan has a unique Waiver of Deductible benefit wherein the policy becomes a complete normal health plan without any deductible limits. This option can be exercised either by people in the age of 55-60 years if they bought the policy prior to turning 50 years or at the beginning of the 6^th policy year if the policy has been renewed continuously every year.
• Lifelong Renewability in this plan
• Option of an annual policy term or 2 years term
• Cashless claim facility available across 4000+ hospitals in India
• Family discount of 10% available for at least 2 or more members covered under Optima Super Individual Sum Assured Plan
• A discount of 7.5% for a 2 year policy with premium of 2 years paid together
• Free Healthline Service which provides for primary consultation, health counselling, individual referrals, nutrition and diet.
• Free Health Risk Assessment which helps to profile every member’s health status and provide recommendations on nutrition and diet and lifestyle

 

 

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	-

 

 

• All treatments except within first 30 days, exceptions – accidental case
• Pre-existing conditions for first 4 yrs
• HIV, AIDS and related diseases
• Mental disorder, insanity, cosmetic surgery & weight control treatments
• Abuse of drugs, alcohol, hallucinogens, intoxicant
• Hospitalization due to war
• Pregnancy, dental unless specific plan taken
• 2 years exclusion for specific diseases
• Experimental, investigational or unproven treatment, devices and pharmacological regimens

 

 

 

	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

 

 

 

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

 

 

2 Adults + 2 dependent children

 

 

 

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.

 

HDFC Ergo Optima Plus

 

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