HDFC ERGO OPTIMA RESTORE
Increase Sum-Insurred
The multiple benefit provide a increase in your SI amount after two clam free years.
Health check up
The plan cover health checkup expenses bases on the sum-insurred and plan type.
Automatic Restoration
This plan include automatic restoration equla to 100 percent of the SI amount you choose after every first clam.
Customize Health Insurance Plan For Yourself
The HDFC ERGO Optima Restore Benefit allows for a complete restoration of your coverage
immediately following the first claim.
The Multiplier benefit provides a 100% increase in your SI amount after two claim-free years. Renewal discounts, recovery benefits, organ donor coverage, and other major coverage benefits are also included in HDFC ERGO health optima restore. There are two things that make HDFC ERGO’s health insurance plan unique: Restore benefit and double the benefit.
SPECIFICATION
Sum Insured
3|5|10|15|20|25|50 Lakhs
Entry Age
Min. Adult 91 Days Child: 91 Days Max: Adult:65 years Child: 5years
Policy Term
1 | 2 Years
Renewability
Lifelong
Initial Waiting
Period 30 Days
Coverage Starts
31st Day On words
The HDFC ERGO Optima Restore plan is available with many fantastic benefits that are included at no extra cost.
Take a look at the plan’s specifications to better understand the HDFC ERGO Optima Restore and its eligibility.
In - Patient & Out - Patient Coverage
1. In - Patient & Out - Patient Coverage
The room rent cover is the highest amount of room expenses that can be claimed while admitted to a hospital.
- Private Single Air-Conditioned Room
- Twin Sharing
- General Ward
What is the status of your HDFC ERGO Optima Restore Plan coverage?
This policy covers your room rent expenses up to the SI amount you choose.
Amount paid for expenses raised before the policyholder was admitted to a hospital.
What is the status of this coverage under HDFC ERGO Optima Restore Plan?
This plan pays for medical expenses for up to 60 days before you are admitted to a hospital.
It is a special department in the hospitals where people who have very severe health problems are treated and cared for.
Under HDFC ERGO Optima Restore Plan, Is this covered?
This plan covers the costs of ICU care.
The Expenses that arises after the insured person has been discharged from the hospital. These expenses are- medical bills, follow-up tests & checkups, follow-up consultations etc.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
This plan pays for medical expenses for up to 180 days after you are discharged from the hospital.
Due to the lack of medical facilities in hospitals, or in case the person cannot be taken to the hospital, the insured person needs to be admitted to a home hospital.
To be covered financially, the treatment must last at least 72 hours.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
The domiciliary hospitalization for more than three days is covered by this policy up to the selected Sum Insured.
Medical Treatments that require a less than 24 hours of hospitalization, such as blood dialysis and cataract surgery, stiches, some minor surgeries etc. What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
This policy provides coverage for all day care procedures.
COVERED
OPD stands for Out Patient Department, where patients consult the Doctor for treatment of their ailments. So OPD charges are the cost of a doctor's consultation and any prescribed medical tests, that do not necessarily require hospitalization. What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
No OPD Charges are covered.
2. Coverage Terms
The Coverage for cost of treatment for COVID-19 upon a confirmed diagnosis from a government-approved center like ICMR.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
COVID-19 care is covered by this plan, after 30 days of inception.
Available As Booster Benefit
Insurance companies reward policyholders with an increase in the Sum Insured amount as a no-claim bonus on policy renewal for each claim-free year.
In the case of a claim, however, the bonus amount either expires or is reduced by a percentage that varies by plan. What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
After two claim-free years, this policy provides a 100% increase (50% of SI per year) in the sum insured. In the event of a claim, the bonus amount applied to your SI will be reduced by 50%.
Not Covered
Coverage for A common eye condition that caused when eye’s natural clear lens becomes cloudy, resulting to blurred vision.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
After a two-year waiting period, this plan covers cataract treatment.
COVERED
In the procedure of organ transplant, the cost incurred while removing the functioning organ(s) from the body of ORGAN DONOR and his wellbeing will be covered by your health insurance.
What is the status of this cover HDFC ERGO Optima Restore Plan coverage?
The plan covers organ donor expenses up to the Sum Insured amount opted.
COVERED UP TO 180 DAYS
A benefit in which the insurance company restores the total sum insured after it has been completely exhausted in treatment is known as automatic restoration.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
This plan includes automatic restoration equal to 100 percent of the SI amount you choose, after very first claim.
(NOTE: single claim in a policy year cannot exceed the basic SI)
Not Covered
It refers to the insurance coverage that includes expenses for both normal and c-section deliveries.
Because pregnancy is a planned condition, it is usually not covered by most health insurance plans.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
Maternity coverage is not included in this plan.
Not Covered
In the event of unforeseen circumstances, it covers the costs of the newborn baby's hospitalization.
The following are some of the most common treatments that are covered under the new-born coverage (this can vary from plan to plan):
- Congenital disease (conditions since birth)
- Acute medical condition
- chronic conditions
- pre-mature delivery of the baby
- Asphyxia since birth
- Day care treatments
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
This plan doesn't cover expenses for new babies.
Available As A Rider
It is a daily cash payment that you will receive for the period you are being hospitalized. Usually, this is provided after you are discharged from the hospital.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
This plan includes a daily hospital cash benefit, with the daily allowance amount determined by the sum insured selected.
3. Alternative Treatment
COVERED
This is the cost of medicines and procedures used in AYUSH treatment (Ayurveda, Yoga & Naturopathy, Unani, Siddha, and Homeopathy), the treatment alternate to allopathy.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
The costs of AYUSH treatment are not covered by this plan.
NOT COVERED
In Vitro Fertilization (IVF) is an assisted reproductive technology (ART) procedure.
The following are the most frequently incurred costs associated with IVF and infertility treatments:
- Complete infertility
- No fertility
- Infertility diagnosis and limited fertility treatment
- Prescribed medication (which may or may not include fertility drug prescriptions)
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
IVF treatments are not covered under the plan.
COVERED UP TO 1 L
Medical treatments that require the use of cutting-edge technology, such as robotic surgery and stem cell therapy, are included in this Feature.
What is the status of this coverage under HDFC ERGO Optima Restore Plan?
This plan includes a variety of modern treatments, including:
4. Emergency Coverage
COVERED UP TO 2K PER HOSPITALITION
The expenses Incurred while using Ambulances that are used to transport patients from their homes to the hospital, as well as to transport them to various medical facilities outside the hospital.
Does HDFC ERGO Optima Restore Coverage Exist for this feature?
For each hospitalization, this plan will pay up to 2K in ambulance charges.
COVERED
In the event of a medical emergency, some Patients need to be referred to special hospitals, using air Ambulance facility. Air ambulances are specially equipped planes/helicopters that transport the patient from one location(hospital) to another for rapid treatment.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
Air ambulance expenses are covered up to INR 2.5 lakhs per hospitalization under this plan, but only for Sum insured of 10lakhs or more.
NOT AVAILABLE
Refers to the travel expenses of a family member (referred as companion) of the insured person in the event that the policyholder is admitted to a hospital outside of his or her residential city.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
Compassionate travel expenses are not covered under this policy.
NOT AVAILABLE
Coverage for treatment of Any medical or health emergency that may arise while you are outside of India.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
This feature is not available.
5. Wellness Programs
AVALABLE ANNULLY
After fulfilling the requirements of the company's policies, the policyholder can take advantage of a free health check-up program. This health checkup Feature is usually made available after First Renewal, but may vary from company to company.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
The plan covers health checkup expenses based on the sum insured and plan type.
List of Health Checkup -
- Blood Pressure Test
- Blood Sugar Test
- Lipid Profile
- ECG Test (mostly recommended after 35 though)
- Liver Function Test
- Urine Analysis
- Tests for Vitamin Deficiencies (Vitamin D deficiency is very common in India)
- Pap smear (recommended for women, once a year)
- Kidney function test
- Lung function test
NOT AVAILABLE
If a policy includes E-consultation, the policyholders can connect with an expert doctor via video chat, audio call, or chatbot for doctors' opinion from remote location.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
For critical illnesses, this plan provides one consultation per policy year.
AVAILABLE
The policyholder, as an option, can also choose to obtain a second medical opinion, which allows them to consult with another expert doctor from the company's network of medical practitioners.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
Not available.
NOT COVERED
This is the coverage for the costs associated with vaccinations and other preventative measures, which is provided by the company.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
This coverage is not available.
6. Limitation
NOT APPLICABLE
In the co-payment clause, the policyholder pays a portion of the hospitalization costs and the insurer pays the rest.
What is the status of this coverage under the HDFC ERGO Optima Restore Plan?
In this case, NO CO-PAYMENT APPLICABLE.
APPLICABLE
What is the Sub limit?
Sub limit is a condition in which the insurer will have to pay the medical expense up to a certain percentage and the remaining amount will have to be paid by the policyholder.
Coverage status under HDFC ERGO Optima Restore Plan coverage?
Sub-limit under this plan is applicable on modern treatments such as oral chemotherapy, deep-brain stimulation, etc. up to Sum Insured with a sub-limit of IL.
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