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HDFC ERGO Optima Plus Health Insurance

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Optima Plus
Claim Settlement Ratio86.52%
COVID-19 CoverYes
In-House Claim SettlementAvailable
Network Hospitals10,000+
Policies Sold10,66,395
Renewability Lifelong Renewability

About HDFC ERGO Optima Plus Health Insurance

The Optima Plus Plan by HDFC Ergo General Insurance is a distinguished health insurance plan that serves as a top-up policy. It ensures delivering optimum protection during a medical emergency. When the plan is utilised as a top-up plan along with the existing health insurance policy, a deductible is applied on it, however, when it converts into an indemnity plan, the deductibles get waived off. This policy is acknowledged by the customers for its affordability, as it’s available at a nominal premium. The policy can be used in the best manner post-retirement with no waiting period due to the option of converting it into a full-fledged nil deductible health insurance plan.

The policy provides coverage to people from the age of 5 years to 65 years. The dependent kids can find the coverage from the 91st day of his or her birth, provided any of their parents are covered. The policyholders can enter the plan with their family members which include spouse, dependent kids, and dependent parents. But, if anyone enters the policy with 2 or more family members, he or she will be eligible for a family discount of 10%. The duration of the policy period comprises of 1 or 2 years, where 7.5% discount is applicable for choosing a 2-year policy.

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Key Inclusions and Exclusions of the Plan

What's Included

  • Coverage for in-patient hospitalisation
  • Pre and post hospitalisation expenses
  • 140 daycare treatments are covered
  • Cost incurred on domiciliary treatment
  • Treatment expenses for the organ donor

What's Not Included

  • Treatments within the first 30 days of cover 
  • Cosmetic surgery and weight control procedures
  • Abuse of hallucinogenic substances or intoxicants
  • Cost incurred on HIV or AIDS and similar diseases
  • Pregnancy, dental treatment, external aids, etc.

1957 HDFC ERGO Cashless Network Hospitals in India

Choose HDFC ERGO Critical Illness Plan

HDFC ERGO Optima Plus Brochure

  • 126.58 KB
  • PDF Document
  • Nov 10, 2020

Claim Process at HDFC ERGO Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

FAQs on Optima Plus Health Insurance Plan

  • What is the minimum and maximum entry age of people under the Optima Plus Plan?

    The minimum entry age under this plan is 5 years, while the maximum entry age goes to the age of 65 years. The dependent kids are allowed to be covered from the 91st day, only if either of their parents is covered under this plan.

  • Who all members from the family are allowed to be covered under this plan?

    You and your family members including spouse, dependent kids, dependent parents are eligible to get covered under this plan.

  • How many members can be covered under the Optima Plus Top-up individual plan?

    When it comes to the individual plan of Optima Plus Top-up Policy, a maximum of 4 adults and a maximum of 5 kids can be incorporated in a single policy. 

  • Does Optima Plus Top-up Plan provide any discount to its customers?

    Yes, if anyone owns the plan with 2 or more family members, he or she is provided with a family discount of 10%. Also, on choosing this policy for 2 years, 7.5% discount is offered. 

  • What is the policy period for this plan?

    The policy can be issued for 1 year or 2 years period after which it needs renewal.

  • Does this plan own TPA for claim settlement procedure?

    No, all claims under the Optima Plus Plan will be processed and settled by in-house claim team only. 

  • Does the plan offer coverage for the emergency ambulance?

    Yes, emergency ambulance expenses are provided for up to Rs. 2,000 per hospitalisation.

  • Are daycare treatments covered under the Optima Plus Plan?

    Yes, coverage is offered for specified 140 daycare procedures that do not require hospitalisation for 24 hours.

  • Does this policy offer domiciliary hospitalisation cover for senior citizens?

    Yes, the plan gives the coverage for domiciliary hospitalisation to all the insured members including the senior citizens.

  • Can I earn tax benefit on the purchase of the Optima Plus Plan?

    Yes, you can attain tax benefits with this plan as per the section 80D of the IT Act.  

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