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HDFC ERGO Optima Plus Health Insurance

526 reviews Rate This
HDFC ERGO Health Insurance
Optima Plus
Cashless Approval TATWithin 37 mins
Claim Settlement Ratio99.80%
Network Hospitals13,000+
PED Coverage Starting From3 year
Special Benefits2X Cover from Day 1
Starting Premium Rs. 1090/month

About HDFC ERGO Optima Plus Health Insurance

The Optima Plus Plan by HDFC Ergo Health Insurance (formerly known as Apollo Munich Health 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.

This HDFC ERGO Health Insurance 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.

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Optima Plus User Reviews

4.7
Rating based on
526 User reviews
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What users are saying
  • All
  • I like it.

    This health plan is liked by me due to its affordability and brilliant features in its bucket. This is a plan that has been used in the best possible manner after the retirement as it requires no waiting period and holds the option of converting it into a fully-fledged zero deductible health insurance plan. I adore this plan.

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    I
    By Ishita Khanna
    On: Feb 17, 2020
  • It’s got my back!

    Being a top-up plan this plan has been a great assistance. It gave me a good coverage amount and number of benefits. There are many good things I have utilized with this plan. After the plan exhaustion, there is no need for me to worry as this plan has always been there to get my back.  

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    V
    By Vijay Verma
    On: Feb 17, 2020
  • Gives me peace of mind.

    This health policy served me as a top-up policy. It ensured delivering an optimum protection to me during a medical contingency. When the plan is availed as a top-up plan as per the existing health insurance policy, a deductible is applied on it. This is a plan which gives me mental relief. 

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    S
    By Sukhdev Singh
    On: Feb 03, 2020
  • Special top-up plan!

    The plan is a rare top-up plan. It delivered me special benefits. It lessens the chances of situations where funds may go short by providing me with assistance during medical-related contingencies. This top-up policy owns a lot of benefits, which attracted me. It is always there on my bucket list. 

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    A
    By Andeep Rana
    On: Feb 03, 2020
  • Loving this plan.

    I love this plan. This is an affordable and easy to buy product and considered as a big insurance policy stuffed inside a small one. The Optima Plus plan gave me the coverage for higher medical-related costs at a nominal premium. I now have enough coverage including this plan that I need not to worry. 

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    S
    By Sumit Sharma
    On: Jan 21, 2020
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HDFC ERGO Optima Plus Expert Review

  • Expert Review

    Optima Plus, a top-up policy, is designed to offer additional help to the policyholders when their existing plans fall short to cover medical contingencies. It functions as a spare tool of the vehicle which never leads it to stop in the midway due to a breakdown. The top-up policy is affordable and easy to buy product. The plan is considered as a big insurance policy stuffed inside a small one. It offers the coverage for higher medical-related expenses at a nominal premium. This plan also provides a conversion benefit into a nil deductible insurance plan which is fully-fledged at the time of retirement.

    Optima Plus Plan is equipped with several benefits such as cashless service, portability, day care procedures, organ donor expenses, and so on. It comes with lifelong renewability option, which means there is no maximum cover ceasing age under this plan. Even if it is a top-up policy, customers may sometimes have several confusions from retaining it to reviewing it. Hence, a 15 day free look period and a 30 day grace period is provided with the plan. It certainly eases the customers for giving it a try.  

  • Major Attractions

    During a medical emergency, falling short of funds is the biggest nightmare for everyone. So, owning a top-up policy lessen the chances of such events and provide assistance during medical-related contingencies. The top-up policy, apart from its basic beneficial trait, owns a lot of benefits, which attracts the customers. Here are some attractive features of the plan:

    • In-patient hospitalisation option
    • Pre and post hospitalisation costs
    • Coverage for daycare treatments
    • Emergency ambulance expenses 
    • Conversion to Nil Deductible Policy
    • Domiciliary hospitalisation covered
    • Availability of organ donor expenses 
    • 7.5% discount on the purchase of a 2 year policy

  • What’s More?

    Besides these benefits, the policy is appreciated for a few more of its offerings. It acquires some more basic but important features that enhances the value of the plan by offering ease to utilise the plan. Here are further crucial elements of the plan:

    • 30 days of grace period is given
    • 15 days of free look period is offered
    • Easy portability option is provided
    • Policy period options of 1 or 2 years
    • Tax benefit is offered on the premium

  • Conclusion

    The plan is a great health insurance option to opt for. It never leaves you alone in difficult times and stands by your side with additional coverage. The Optima Plus plan is one of the rare top-up policy that comes with the feature of conversion into a nil deductible health insurance plan at the time of retirement. A deductible is applied when the plan functions as a top-up and when it converts into a full-fledged health insurance policy, all deductibles are waived. 
     
    If you need proper assistance and advice related to its purchase, choose insurancedekho.com. InsuranceDekho is a health insurance broker which provides assistance to analyse, compare and purchase the policy. The team of insurancedekho.com also offers after-sale services and help policyholders in claim settlement procedure as well.     

HDFC ERGO Optima Plus Brochure

  • 571.32 KB
  • PDF Document
  • Sep 05, 2019
Download PDF

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. 2000 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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