HDFC Ergo Health Optima Vital

HDFC Ergo Optima Vital Plan is a Critical Illness health insurance plan which is designed to cover 37 Critical Illnesses and the related expenses till Rs 50 Lacs. It helps to supplement the existing health plan in case of any critical illness which involves huge expenses for treatment.

How it works – The plan can be taken for one year or 2 years and premium needs to be paid regularly in case of a single year term or at once in case of a 2 year term and can be renewed lifelong. The plan covers 37 Critical Illnesses and the lump sum Sum Assured is paid on diagnosis of the covered Critical Illness with defined severity or on the date of undergoing surgery for the covered Critical Illness, irrespective of the amount spent on treatment. In fact this plan can be taken over and above a Reimbursement Health Insurance Plan.
The plan is available as an Individual Sum Insured basis only upto coverage of Rs 50 lakhs. There is a unique provision for an e-opinion under which, expert medical advice is provided by the insurer’s doctor relating to any of the mentioned Critical Illnesses.

• The plan is designed to provide a lump sum amount in case the policyholder is diagnosed with any Critical Illness covered under the scope of the policy or when a surgery is undertaken in  respect of the covered Critical Illness
• There are 37 Illnesses covered under the plan
• Lifelong Renewability in this plan
• Option of an annual policy term or 2 years term
• E-opinion is available where the company’s paneled doctor provides expert advice relating to any Critical Illness
• The benefit is paid in addition to claims received by other health insurance policies held by the policyholder
• A discount of 7.5% is granted for opting for a 2 year policy
• A maximum of 6 people can be added in an Individual Policy with a maximum of 4 adults (self, spouse and dependent parents) and 5 children
• 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

 The plan covers 37 Critical Illnesses and the lump sum amount is paid on diagnosis of the Illness with defined severity or at the time of undergoing surgery for the covered Illness. The list of illnesses covered is as follows:

1. Cancer of specified severity
2. Kidney Failure requiring regular Dialysis
3. Multiple Sclerosis with persisting symptoms
4. End stage Liver Disease with specified severity
5. First Heart Attack of specified severity
6. COMA of specified severity
7. Major burns
8. Goodpasture’s Syndrome
9. Apallic Syndrome
10. Aplastic Anaemia
11. Systemic Lupus Erythematosis
12. Bacterial Meningitis
13. Multiple System Atrophy
14. Progressive Scleroderma
15. Open Chest CABG
16. Major organ or Bone Marrow Transplant
17. Aorta Graft Surgery
18. Open Heart Replacement or repair of heart valve
19. Pneumonectomy
20. Pulmonary Artery Graft Surgery
21. Primary Parkinson’s Disease
22. Alzheimer’s Disease
23. Motor neuron disease with permanent symptoms
24. Stroke resulting in permanent symptoms
25. Permanent Paralysis of limbs
26. Primary Pulmonary Arterial Hypertension
27. Benign Brain Tumour resulting in permanent neurological symptoms
28. Cardiomyopathy
29. End stage Lung Disease
30. Brain Surgery
31. Progressive Supranuclear Palsy
32. Creutzfeldt-Jakob Disease (CJD)
33. Major Head Trauma
34. Encephalitis
35. Blindness’
36. Deafness
37. Total loss of speech

• All treatments except within first 90 days
• Pre-existing conditions for first 4 yrs
• Any Critical Illness in presence of HIV or AIDS
• Congenital internal and external disease, defects or anomalies
• Abuse of drugs, alcohol, hallucinogens, intoxicant
• Hospitalization due to war
• Maternity or pregnancy related treatment

The below illustration is for a healthy Male opting for a 1 year policy with

Sum Assured = 10 lakhs

Age = 35, 45 and 55 years

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.