What Are The Eligibility Criteria of Optima Secure

Optima Secure Health Insurance eligibility focuses on simple entry rules designed for long-term coverage planning. The plan is suitable for individuals and families looking for comprehensive health protection with defined age limits at entry. Applicants must meet basic documentation and medical disclosure requirements at the time of proposal. Policy terms, renewability, and coverage continuation depend on compliance with insurer guidelines. Eligibility conditions may vary slightly based on plan variant and chosen sum insured.

Sum Insured Options - Optima Secure Health Insurance offers a wide range of sum insured options starting from ₹5 lakh up to ₹2 crore, allowing policyholders to choose coverage based on their healthcare needs. Premiums are calculated on a tier-based pricing model, differing for Tier 1 and Tier 2 cities. The policy is available with flexible tenure options of 1 year, 2 years, and 3 years.

Eligibility Criteria - The plan is open to adults from 18 years of age with no maximum entry age restriction. Dependent children aged between 91 days and 25 years can be covered under family floater policies. Optima Secure is available in both individual and family floater variants. Under the family floater option, the policy can include self, spouse, up to six dependent children, and parents or parents-in-law under a single policy with a shared sum insured.

Claim Settlement & Network Hospitals - Optima Secure is backed by a strong claim settlement ratio of 99.16%, ensuring dependable financial support during medical emergencies. Policyholders get access to over 15,000 network hospitals across India, enabling cashless treatment for both planned and emergency hospitalizations. The plan is designed to provide smooth and hassle-free claim support when it matters most.

Base Features of HDFC Ergo Optima Secure Plan

HDFC Ergo Optima Secure is a comprehensive health insurance plan designed to provide high-value coverage for individuals and families. It offers enhanced protection with features like automatic sum insured increase and coverage for large medical expenses. The plan supports cashless hospitalization across a wide network of hospitals in India, ensuring easy access to quality healthcare. With flexible policy options and lifelong renewability, Optima Secure focuses on long-term financial security against rising medical costs

1. In-Patient Hospitalization – When you are admitted to a hospital for more than 24 hours, Hdfc Ergo Optima Secure covers all medical expenses like tests, doctor fees, medicines, surgery, and room charges.

2. Pre Hospitalization – Medical expenses like tests, consultations, and medicines done before hospitalization are covered up to 60 Days in Hdfc Ergo Optima Secure.

3. Post Hospitalization – Medical expenses like follow-up visits, tests, or medicines done after you get discharged are covered up to 180 Days Hdfc Ergo Optima Secure.

4. Room Rent Expense – In case of emergency you can go for any room in Optima Secure Plan.

5. ICU Charges – The plan pays for all ICU expenses if you need intensive care during hospitalization.

6. Organ Donor – Covers surgery and medical expenses for the organ donor if you undergo for an organ transplant.

7. Domiciliary Hospitalization – If you need treatment at home because hospital beds are not available or you cannot be moved, the plan covers home hospitalization.

8. Home Care Treatment – Certain treatments that can be safely done at home without hospitalization are covered as long as they are medically advised.

9. AYUSH Treatment – Treatment taken in Ayurveda, Yoga, Unani, Siddha, or Homeopathy is covered.

10. Preventive Health Check-Up – You get free yearly health check-ups to monitor your health, even if you make claim.

11. E-Opinion – You can take a second medical opinion online from a specialist for a listed critical illness, without extra cost.

12. Road Ambulance – Covers ambulance charges fully when you need to be shifted to a hospital during an emergency.

13. Emergency Air Ambulance – Covers emergency air ambulance up to 5Lakh when immediate medical shifting is required.

Unique Benefits HDFC ERGO Optima Secure Plan

HDFC ERGO Optima Secure stands out by offering a built-in increase in sum insured over time, helping policyholders stay prepared for rising medical expenses without frequent upgrades. The plan also provides extended financial protection for high-cost treatments, ensuring better coverage even during critical or long term hospitalizations

1. Secure Benefit – Your sum insured gets doubled from Day 1 without paying extra. For Example: If you buy 10 lakh cover, it becomes 20 lakh automatically.

2. Super Secure Benefit – Gives triple coverage from day one, if your sum insured is 10 lakh & above and paid premium for 3years in one go.  For Example, If you buy 10 lakh cover & Paid premium for 3years in on go, it becomes 30 lakh automatically from day one onwards.

3. Plus Benefit – Every year your coverage increases by 50% of sum insured and maximum 100% without any extra cost, even if you make claims. This builds long-term higher coverage.

4. Restore Benefit – If your base sum insured gets used up, the plan automatically restores it for future claims in the same year for a different as well as same illness.

5. Protect Benefit – Non medical expenses like gloves, PPE kit, consumables are also covered, which normally hospitals charge separately but insurance does not pay. Protect Benefit ensures these costs are paid.

Optional Features of HDFC ERGO Optima Secure Plan

HDFC ERGO Optima Secure offers a range of optional features that allow policyholders to customize coverage based on their personal health and financial needs. These add-on benefits include options for critical illness protection, hospital cash support, and accident coverage, providing extra financial security beyond standard hospitalization. By choosing relevant riders, individuals can enhance protection for specific life stages, lifestyle risks, and long-term healthcare planning:

1. Aggregate Deductible Option - HDFC ERGO Optima Secure offers an aggregate deductible feature that allows policyholders to lower their premium by choosing how much they are willing to pay from their pocket in the first claim of each policy year. Deductible options range from ₹25,000 to ₹5 lakh, making the plan more affordable without reducing overall coverage. A higher deductible directly results in a lower premium, giving flexibility based on budget and risk preference.

2. Unlimited Restore Benefit - The Unlimited Restore Benefit ensures that the sum insured is automatically reinstated whenever it gets exhausted. This benefit can be used unlimited times within the same policy year, covering multiple hospitalizations for both related and unrelated illnesses. It provides continuous protection and eliminates worries about running out of coverage during medical emergencies.

3. Health Critical Illness Cover - This rider provides lump-sum financial support on the diagnosis of 51 major critical illnesses. The payout is made immediately, allowing policyholders to manage treatment costs, recovery expenses, long-term care, or personal financial needs. It is ideal for individuals looking for strong critical illness protection along with their health insurance plan.

4. Health Hospital Cash Benefit - Under this benefit, policyholders receive a fixed daily cash allowance during hospitalization. Options range from ₹500 to ₹2,000 per day, helping cover non-medical expenses such as travel, food, attendant charges, and other out-of-pocket costs. It adds extra financial comfort during hospital stays.

5. Individual Personal Accident Rider - The personal accident rider offers lump-sum compensation in case of accidental death or permanent total or partial disability. It ensures financial security for the insured and their family during unforeseen situations, strengthening overall protection beyond hospitalization coverage.

6. Optima Well Being - Optima Well Being is a wellness-focused rider designed to reduce everyday healthcare expenses. It includes unlimited in-clinic and tele-consultations, online fitness programs, wellness support, and free home sample collection. Policyholders also get discounts of up to 50% on lab tests and scans and up to 20% on medicines, promoting preventive healthcare and cost savings.

7. Parenthood Rider - The Parenthood Rider is tailored for young couples planning a family. It covers pre-natal care, delivery, post-natal expenses, IVF treatment, and embryo storage after a two-year waiting period. The rider also offers worldwide coverage for maternity and IVF-related treatments, supporting modern family planning needs.

8. ABCD Chronic Care - This rider provides coverage for four major lifestyle diseases Asthma, Blood Pressure, Cholesterol, and Diabetes. Coverage starts just 31 days after policy inception, unlike traditional plans with long waiting periods. It is suitable for individuals managing lifestyle-related conditions who need early and reliable health coverage.

9. Limitless Cover - Limitless Cover offers extremely high financial protection for major medical expenses. For sum insured between ₹10 lakh and ₹50 lakh, policyholders can make unlimited claims once in a lifetime. For sum insured above ₹50 lakh, unlimited claims are allowed twice in a lifetime, making it ideal for high-cost treatments, complex surgeries, and long term hospitalizations.

Waiting Period in HDFC ERGO Optima Secure

Waiting periods are an important factor in any health insurance plan. They define the time you must wait before coverage becomes active for certain illnesses or conditions. Understanding these waiting periods helps you make the right choice when buying medical insurance in India:

1. Accidental Coverage – All accidental hospitalization cases are covered from day one of the policy.

2. Initial Waiting Period – The initial waiting period is typically 30 days from the start of the policy. During this period, coverage for certain seasonal and uncertain illnesses becomes active. These conditions include, Dengue, Malaria, Fever, Heart Attack, Cancer

3. Specific Illness Waiting Period – Some slow-growing or planned illnesses require a 2-year waiting period before coverage starts. These specific illnesses include, Cataract, Kidney Stones, Gall Stones, Piles, Hernia

4. Pre-Existing Disease (PED) Waiting Period – A pre-existing disease (PED) is any medical condition you already have before buying a health insurance policy. Common pre-existing conditions include, Asthma, High Blood Pressure (Hypertension), Thyroid disorders, Cholesterol, Diabetes, these conditions are covered only after a 3-year waiting period, ensuring long-term financial protection for lifestyle-related or chronic illnesses.

5. Maternity Waiting Period – 2year waiting period is applicable for covering the expenses related to maternity.