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HDFC Ergo Health Optima Vital

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HDFC Ergo Health Optima Vital Plan

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.


Key Features of HDFC Optima Health Optima Vital Plan

  • 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



What is covered in HDFC Ergo Health Optima Vital Plan?

 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



Exclusions - What is not covered in HDFC Ergo Health Optima Vital Plan?

  • 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

Eligibility and Restrictions of HDFC Ergo Health Optima Vital Plan





Coverage Amount (in Rs.)

1 Lac

50 Lacs

Policy Term (in years)



Entry Age of Principal Insured(in years)



Entry Age of Child(in years)



Maturity Age(in years)



Sample illustration of Premium of HDFC Ergo Health Optima Vital Plan

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



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.

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