HDFC Ergo Optima Restore Health Insurance Plan - features, benefits, buy online and renew (2023)

Quick Summary: HDFC Ergo Optima Restore Health Plan

HDFC Ergo is a P&C insurer established in the year 2017. A collaboration between HDFC and ERGO International, Germany, HDFC Ergo occupies a prominent position in the Indian insurance industry as the third largest P&C insurer in the private sector.

Over the years, the company has maintained a very high record of claims settlement. HDFC Ergo has received the 'AAAA' rating from ICRA. He has a long list of awards and recognitions to his name.

HDFC Ergo offers various insurance products such as auto, travel, home and health. In this article, we are going to discuss HDFC Ergo Optima Restore Plan and all its features.

Best Features of HDFC Ergo Optima Restore Health Plan

The HDFC Ergo Optima Restore Plan is designed to meet your healthcare needs. The plane is aaffordable health planwhich provides coverage for the cost of treating injuries and illnesses. Let's take a quick look at the highlights of this plan:

1. The plan is available with coverage from INR 5 to 50 lakhs
2. Your hospitalization expenses due to illness or injury are covered
3. All your daycare procedures would be covered
4. Ambulance costs are covered up to INR 2000
5. The plan offers full coverage on the room rental.
6. The plan offers replacement of 100% of the insured capital, in case of exhaustion
7. If you don't complain, you can take advantage of renewal incentives that can increase your coverage by up to 100%.
8. Availability of preventive health checks up to INR 5,000
9. Expenses incurred 60 days before and 180 days after hospitalization would be covered
10. Get up to INR 1000 cash benefit per day and up to INR 6000 per hospitalization
11. With HDFC Ergo Optima Restore Plan you can save up to INR 75,000 as tax benefits
12. Procedures such as robotic surgeries, oral chemotherapy, and stem cell therapy are covered
13. You can enjoy premium discounts ranging up to 10%

HDFC Ergo Optima Restore Health Plan Benefits

1. In hospital benefits
   Optima Restore Health Plan covers your hospital stay that may be due to illness or injury.
2. restoration benefit
   After the first claim, you can claim 100% of the insured amount when your coverage is partially or totally exhausted. This benefit can be very useful if your medical expenses are depleted.
3. ambulance expenses
   Emergency ambulance charges up to INR 2,000 are covered in case a member needs to be rushed to a hospital.
4. profit multiplier
   You can enjoy a 2X multiplier benefit when you don't make a claim. You can get up to 100% coverage increase as a no-claims benefit.
5. Hospital Daily Cash
   When you are admitted to a hospital, there are numerous direct expenses that can affect your finances. You can get daily cash benefit up to INR 1000 per day and INR 6000 per hospital stay.
6. Pre and Post-hospitalization
   Monitoring and diagnostic costs before and after hospitalization are also covered by the Optima Restore Health Plan. Expenses for 60 days before and 180 days after admission are covered.
7. daycare procedures
   Treatments that require hospitalization for less than 24 hours are also covered by the HDFC Ergo Optima Restore Plan.
8. Organ Donation
   Medical and surgical expenses for organ donation are covered at the time of obtaining a larger organ.
9. lifetime renewal
   Your health coverage can protect you for life without the hassle of regular renewals. The Optima Restore Plan gives you eligibility for life.
10. room rental
    HDFC Ergo Optima Restore Plan does not put any sub-limits on the room rent, helping you have a comfortable stay in the hospital room.
11. health checks
    With the Optima Restore health plan, you can get up to INR 5,000 medical checkups to check your health and wellness.
12. modern treatments
    The Optima Restore plan also covers advanced treatments like robotic surgeries, oral chemotherapy, and stem cell therapy.
13. discounts
    • By adding 2 or more members to an Optima Restore policy, you can get up to a 10% discount on the premium amount.
    • By opting for the 2-year plan, you can get a 7.5% premium discount.
    • Get a Stay Active benefit and enjoy up to 8% off when you renew. You need to walk a daily average of steps that are counted in the Health Jinn mobile app.
14. Fiscal benefits
    Ohealth insurance premiumswho pay for the HDFC Ergo Optima Restore Plan are eligible for a tax exemption of up to INR 75,000.
15. recovery benefit
    With the HDFC Ergo Optima Restore Plan, if you are hospitalized for more than 10 consecutive days, you will be paid a fixed amount to help you recover from any financial loss you may have suffered due to your hospital stay.

HDFC Ergo Optima Restore Health Plan Details

• Waiting period
  1. Other than accidental hospitalization, no treatment is covered within the first 30 days after the policy is issued
  2. During the first 24 months of the policy, certain treatments such as hernia, cataract, hysterectomy, etc. are not covered.
  3. Established/pre-existing conditions are covered only after 3 years of continuous renewals
• Free preview period
  With the Optima Restore plan, you get a free period of 15 days from the date of purchase. During this time, you can review the terms and conditions of the policy. If you consider that the policy does not meet your needs, you can return it, as long as there have been no claims. The refund will be processed once the stamp duty and the corresponding risk premium have been deducted from the premium paid by you.

What is not covered by the HDFC Ergo Optima Restore health plan?

When you invest in a health insurance policy, there are certain exclusions. These exclusions are situations where you may not be able to file a claim while you are hospitalized. Some common exclusions are:

1. The policy does not cover accidents you may encounter while participating in adventure sports.
2. Surgeries self-inflicted by the insured are not covered
3. Intoxicating drug/alcohol abuse is not covered
4. Claims caused by war would not be accepted.
5. HIV/AIDS infection is not included in the HDFC Ergo Optima Restore health plan
6. Venereal or sexually transmitted diseases are not covered.
7. Cosmetic surgery or obesity treatment would not be covered.

HDFC Ergo Optima Restore Health Plan Renewal Process

Depending on the term you choose for yourself, 1 year or 2 years, you would have to renew the policy. For the renewal of your policy, you can follow any of the given options:

1. You can renew your policy online through the company's official website. Visitwww.hdfcergo.com, go to 'Online renewal' and renew the policy instantly
2. You can renew your policy online through an insurance aggregator website
3. Call 022-6234 6234 OR 0120-6234 6234 and speak to a customer service executive who will guide you through the renewal process
4. You can also send your renewal request by email tocare@hdfcergo.com
5. Envie um check ou saque para HDFC General Insurance, D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078

HDFC Ergo Optima Restore Health Plan - Claim Process

When you invest your hard-earned money in a health insurance policy, your main concern is that, in the moment of need, you will be able to file a claim. HDFC Ergo strives to assist all clients with a quick and easy settlement procedure; however, it is your responsibility as the insured to follow all guidelines carefully. Let's look at the different aspects of the claims process.

• cashless claim
  if you want to take advantagecashless health insurance treatment, remember that you would have to undergo treatment at a hospital in the network. A network hospital is a hospital that has a partnership with the hospital. The cost of your treatment, depending on the policy and the insured sum, will be paid directly by the insurer. Depending on the plan option you choose, you may have to pay your share for services that are not covered by the plan.
  Remember, when you go for treatment with no money planned, you must get a prior authorization at least 48 hours before the treatment. Once the pre-authorization is received, the treatment must be carried out within a certain period of days.
  However, if it is an emergency treatment, the company must be informed within 24 hours of admission or treatment for the pre-authorization of the treatment.
• Request for reimbursement
  Due to time constraints or the unavailability of a certain treatment, if you were unable to obtain care at a network hospital, you may still receive reimbursement for your medical expenses. At an out-of-network hospital, you can make advance payments for treatment provided, and once treatment is complete, you can claim reimbursement.
  Be sure to notify the insurance company within 48 hours of hospitalization. You will need to complete and submit the application form along with other requested documents. Generally, the documents listed below are required to file a claim.
• required documents
  1. Health card issued by the company together with KYC documents
  2. Claim form - duly completed and signed
  3. Nature of the disease and necessary treatment.
  4. Medical prescriptions - medications and/or diagnostic tests
  5. Details of individual medical services
  6. original payment receipts
  7. All diagnostic and pathology reports.
  8. original discharge summary
  9. Transplant invoice, if any.

HDFC Ergo Optima Restore health plan - Policy network hospitals

The HDFC Ergo Optima restoration plan helps you gain access to more than 10,000 hospitals where you can receive treatment without cash. With such a wide network, you can file cashless claims almost anywhere in the country. As the company has its own claims settlement cell, executives are available at the hospital and will assist you with claims processing. The claim would be resolved as soon as possible without letting you go through any trouble.

HDFC Ergo Optima Restore Health Plan Review

You can't always plan for your hospitalization expenses, and for such unforeseen circumstances, you need to have a health insurance policy that not only helps you avoid a financial setback, but also provides comprehensive coverage. The HDFC Ergo Optima Restore Health Plan provides you and your family with complete health care coverage. You can purchase the plan with minimal paperwork in just a few minutes.

When it comes to claims, the company has maintained an excellent claim settlement record over the last 16 years of its establishments. As HDFC Ergo has an internal claims settlement cell, the process is transparent and fast. If you're looking for an easy-to-understand health insurance plan that offers comprehensive coverage along with an affordable premium, the HDFC Ergo Optima Restore Health Plan is definitely a plan worth considering.