HDFC Ergo Optima Secure Plan: Get Unlimited Coverage For Your Family

What is HDFC Ergo Optima Secure Plan?

The HDFC ERGO Optima Secure Plan provides financial protection and reduces all medical expenses. It saves you from all future financial losses arising due to Disease & Accident. It offers a lot of benefits with huge coverage. This plan provides coverage starting from 5Lakh to 2 Crore sum insured. The Optima Secure Plan offers several benefits such as Lifelong renewal, In-patient treatment, Pre & Post Hospitalization, Restore benefit, Domiciliary treatment, Day care treatment, Road Ambulance, Air Ambulance, etc. rather than this Optima Secure Plan provides a lot of unique benefits which make the Plan different from others Plan such as Secure benefit (4X coverage), Super Secure benefit (5X coverage), Plus benefit, Home care treatment, Consumable benefit, Robotic surgery, Modern treatment, etc. The Optima Secure Plan focuses on the requirement of customers & their families. At present the company also covers COVID-19 after 15 days of policy purchase. You will get Tax benefit u/s 80D. There is a Free look period of 15 days to go through your policy and change your decision for a better understanding, let's take a closer look at this plan.

HDFC Ergo Optima Secure Plan Review

Network hospital – 13000+ network hospitals are covered under HDFC ergo Optima secure health plan.
Claim settlement ratio – HDFC Ergo health insurance has currently 100% claim settlement ratio.
Claim approval time – HDFC Ergo health insurance approves the claim within 20 Min of claim intimation.
Claim type – In HDFC Ergo health insurance it settles the claim directly, there is no TPA [Third Party Administrator] between the company and the customer.

Eligibility Criteria of HDFC Ergo Optima Secure Plan

There are some eligibility criteria in the HDFC Ergo optima secure plan. Check the details as mentioned below:

Entry age	91 days to 65 years
Family size	Covered up to 6 members
Plan type	Individual/Family floater
Plan variant	Optima secure, optima super secure plan
Tenure	1 Year, 2 Year & 3 Year
Cashless hospitalization	All over India
Base sum insured	5L, 10L, 15L, 20L, 25L, 50L, 1Cr & 2Cr

Details of HDFC Ergo Optima Secure Plan

Features	Optima Secure Plan
In-patient treatment	Covered up to sum insured
Room rent	Actual
ICU charges	Actual
Pre-hospitalization	60 days
Post-hospitalization	180 days
Day care treatment	All daycare treatments covered
Organ donor	Covered up to the sum insured
Domiciliary hospitalization	Covered up to the sum insured
Home care treatment	Covered up to the sum insured
Restoration	100% of the sum insured, multiple times
Plus benefit	50% of the sum insured maximum up to 100%, It will never reduce
Secure benefit	Covered up to 100%
Super secure benefit	Covered up to 200%
Consumable benefit	Covered up to the sum insured
Robotic surgery	Covered up to the sum insured
Modern treatment	Covered up to the sum insured
Road ambulance	Actual amount covered
Air ambulance	Covered up to 5lakh
Health check-up	Available
Share accommodation	Up to 15lakh sum insured - INR 800/Day up to INR 4800. Above 15lakh sum insured - INR 1000/Day up to INR 6000.
Ayush treatment	Covered up to the sum insured
Bariatric surgery	Covered up to the sum insured
Second e-opinion	Once in a policy year
Tax benefit u/s 80D	Up to INR 75000

HDFC Ergo Optima Secure Plan Premium Calculation

The health insurance premium is an amount you need to pay to the insurer to keep your health insurance active. In return, the insurer is liable to pay for hospital bills and healthcare expenses which are incurred by you in case of a medical emergency. The health insurance premium depends on factors like age, location & family size. Let’s look at some examples of health insurance premiums as mentioned below:

Family Size	Sum Insured	Premium*
Individual	500000	10384/-
Self, spouse	500000	15004/-
Self, spouse & 1 child	500000	18402/-
Self, spouse & 2 child	500000	21801/-
Senior citizens	500000	33382/-

Unique Features of Hdfc Ergo Optima Secure Plan

Consumable benefit – All non-payable items are covered up to the sum insured.
Home care treatment – Get treated at home.
Secure benefit – In Optima Secure Plan your base sum insured gets doubled immediately after purchasing the plan with no extra cost. For example - If you buy a policy for 10lakh the Company will give you 20lakh coverage from the same year onwards.
Super Secure benefit – In Super Secure benefit your base sum insured gets tripled immediately after buying Optima Secure Plan by paying a 3-year premium in one shot. For example - If you buy a policy for 10lakh by paying a 3-year premium the Company will give you 30lakh coverage from the same year onwards.
Plus benefit – Under plus benefit your sum insured will increase by 50% of the base sum insured maximum up to 100% whether you take a claim or not. It will never reduce whether you take a claim or not. It will be your fixed bonus.

Features of HDFC ERGO Optima Secure Plan

Lifelong renewal - Renew your cover lifelong and stay covered forever.
No sub-limit on room rent - With this health plan you can get the room you like and the treatment you deserve without a hassle.
No geography-based sub-limits - No matter where you buy your policy you can get treated in any city or hospital you like in the country with no additional co-pays or sub-limits.
Hospitalization expenses - Cover medical expenses incurred at the time of hospitalization that include room rent, ICU expenses, nursing expenses, surgeon’s fees road ambulance charges, anesthesia fees, blood, oxygen etc.
Pre-hospitalization – Optima Secure Plan covers medical expenses for 60 days of pre-hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred before hospitalization.
Post-hospitalization - Optima Secure Plan covers medical expenses for 180 days post-hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred after discharge.
Day Care treatment - Daycare treatments are those surgery that take hospitalization less than 24 hours like Stone, Cataract, Dialysis, Chemotherapy, Radiotherapy etc.
Organ donor expenses – The Company will indemnify the Medical Expenses incurred for a living organ donor’s treatment as an Inpatient for the harvesting of the organ donated.
Domiciliary hospitalization - Secure all medical expenses during domiciliary hospitalization.
Home care treatment - Get treated at Home.
Restore benefit - With the Restore benefit of Optima Secure Plan if any claim, partial or totally is made during the policy period then the 100% sum insured will be restored automatically multiple times without any additional cost.
Robotic surgery - All robotic surgeries such as Cholecystectomy, Gastric Bypass, Mediastinal Tumor, Atrial Septal Defect Repair, Coronary artery bypass, etc. are covered up to the sum insured.
Modern treatment - All modern treatments such as Oral chemotherapy, Stem cell therapy, Bronchial Thermoplasty, Genetic diseases or disorders, Deep Brain stimulation, etc. are covered up to the sum insured.
Road Ambulance - Road Ambulance covered up to the sum insured.
Air Ambulance - Air Ambulance covered up to INR 5 lakh.
Health Check-up – Optima Secure Plan provide preventive health check-up every year.
Share Accommodation - If you choose to share accommodation Up to Rs. 15lakh sum insured you will get INR 800/Day up to INR 4800 and above 15 lakh sum insured you will get INR 1000/Day up to INR 6000.
Ayush treatment – Optima Secure Plan covers In-patient hospitalization expenses even for alternate treatments method. Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy.
Bariatric surgery - Bariatric surgery is covered up to the sum insured.
Second E-opinion – The Company will provide you with a second opinion from Network Provider or Medical Practitioner if an Insured Person is diagnosed with critical illnesses during the Policy Period.
Tax benefits - You can avail of tax benefits for the premium amount under Section 80 D of the Income Tax Act.
Free look period - Get a 15-day free look period to understand and change your decision.

HDFC Ergo Optima Secure Plan V/S Optima Restore Plan

In HDFC Ergo Optima secure & Optima restore plan both products are comparatively reasonable and both plans have individual and family floater plan variants along with the features and benefits. As both plans are designed by HDFC Ergo health insurance with some special features but almost all benefits are the same such as In-patient hospitalization, pre & post-hospitalization, day care treatment, organ donor, Restore benefits, and many more. But there are some features difference in between both plans which make optima secure better than from optima restore plan. Let's take a look at all the differences as mentioned below:

Features	Optima Secure Plan	Optima Restore Plan
Road ambulance	Cover up to the sum insured	Cover up to INR 2000/hospitalization
Air ambulance	Cover up to 5 lakh	Cover up to INR 2.5 lakh
Ayush treatment	Cover up to the sum insured	Not covered
Home care treatment	Cover up to the sum insured	Not covered
Consumable items	Cover up to the sum insured	Optional
Plus benefit	50% of the base sum insured every year maximum up to 100% and it never reduces, whether you take a claim or not.	50% of the base sum insured every year maximum up to 100% and it reduces when you take a claim
Secure benefit	100% extra coverage from day 1	Not covered
Super secure benefit	200% extra coverage from day 1 if you paid the premium for 3 years.	Not covered

Discounts Under HDFC Ergo Optima Secure Plan

Long-Term Discount – Pay for a 2 years policy term and get a 7.5% discount and a 10% discount on choosing 3 years policy term.
Family Discount - 10% on family discounts on 2 or more members who are covered under an individual policy.
Employee Discount – 5% discount on premium, if any Insured Person is a HDFC Group employee.
Loyalty Discount – 2.5% discount on premium, if any Insured Person has an active retail insurance Policy with a premium above INR 2,000 with the Company.
NRI Discount – Get a 40% discount on the premium, if an insured person residing overseas with a declaration that they are based abroad in entirety for the Policy Year.

Add On Covers of Optima Secure Plan

Hospital Daily Cash Benefit – Company will pay an Insured, an additional fixed amount for each day’s hospitalization for a maximum of up to 30 days. One day is considered 24 continuous hours of hospitalization.
Personal Accident – In the event of the unfortunate demise of the insured within the policy period from the date of the Accident, the company will pay the Sum Insured. The Personal accident benefit will terminate after the Accidental Death benefit is paid for.
Deductible option – By choosing a Deductible option like INR 25000, INR 50000 & INR 1lakh you can reduce your premium.
Unlimited restore rider – You can claim 100% of the sum insured multiple times in the same time period.

Renewal Process of Optima Secure Plan

Life-long Renewal - Get a life-long renewal, regardless of your health status or previous claims made under your policy.
Sum Insured Enhancement - To protect yourself from rising medical expenses, you can enhance your sum insured or add more members of your family to your existing policy at the time of renewal.
Portability and Migration - You can port or migrate your policy at the time of renewal. Please reach out to us for any queries regarding migration and portability.

How to File a Claim Under Optima Secure Plan

You can file a claim in the HDFC ERGO Optima Secure plan in two ways as mentioned below:

1. Cashless Claim

Intimation – Fill up the pre-authorization form at the network hospital for cashless approval.
Approval/ rejection – once the hospital intimates the company, the company sends you the status update.
Hospitalization – hospitalization can be done on the basis of pre-authorization approval.
Claim settlement – at the time of Discharge Company will settle the claim directly with the hospital.

2. Reimbursement

Hospitalization – you need to pay the bills initially and preserve the original invoices.
Register your claim – Post-hospital discharge send to the company all your invoices and documents.
Verification – The company verifies your claim-related invoices and treatment documents.
Claim settlement – The company sends the approved amount to your bank account.

Exclusions of HDFC ERGO Optima Secure Plan

Conflict & Disaster - Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war-like situations, or rebellion.
Breach of law – The company does not cover expenses for treatment directly arising from or consequent upon any insured person committing or attempting a breach of law with criminal intent.
Treatment for alcoholism & drug abuse – Treatment for alcoholism, drug or substance abuse or any addictive condition and consequence thereof remain uncovered.
Congenital external disease, defects, or anomalies – The company does not cover medical expenses incurred for congenital external disease defects or anomalies.
Maternity Expenses - Pregnancy, dental treatment, external aids, and appliances.
Investigation & Evaluation - Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
Unproven Treatments - Expenses related to any unproven treatment, services, and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures, or supplies that lack significant medical documentation to support their electiveness.
Unrecognized Physician or Hospital - Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Indian Medicine or by Central Council of Homeopathy.
Costs that are not Reasonable and customary and treatments that are not medically Necessary.

FAQ

Does the No Cost Instalment feature in optima secure apply to all policy terms?

One-year policy holders are eligible for the feature. Cardholders with debit or credit cards can also take advantage of it.

Are AC Single rooms available in hospitals if I am hospitalized?

With the Optima Secure plan, you can choose an AC single room. For treatment/surgery at any hospital, you can choose an AC single room. When you are hospitalized at a network hospital, you can use this facility cashless. Additionally, there is no disease capping. Your sum insured can be used for the treatment of any disease. We want you to undergo quality treatment without worrying about room rent during hospitalization.

For the past three years, I have been insured with HDFC ERGO. Can I get a discount?

It's natural to expect a reward after 3 years of association. Optima Secure won't disappoint you; as a loyal customer, you are entitled to a loyalty discount. You will receive a discount of 2.5% if you have an active retail insurance policy with a premium over rupees 2,000 with us. A 2.5% loyalty discount on Optima Secure premiums is available to existing HDFC ERGO retail policyholders (2 Wheeler, motor, travel, home, health, cyber security insurance). This benefit won't be affected by your claim history.

How does my:Optima Secure protect me?

The use of ortho kits, gloves, masks, et hospitalization is very common during these pandemic times. In a hospitalization bill, these items are considered to be non-medical expenses. However, disposable items are not covered by most health insurance policies. The Optima Secure plan lets you pay for 68 non-medical items commonly used during a hospital stay at no additional cost.

In what ways does automatic restore benefit you?

For subsequent claims, for any illness, or for any insured person, the Optima Secure Health Insurance plan restores up to 100% of your base sum insured. The base sum insured is the amount you chose when purchasing the policy. You will benefit from this if you exhaust your existing sum insured for any claim or number of claims. In the first year after purchasing an Optima Secure Health Insurance plan with health cover of 5, 000, 000, and, you file a claim for 8, 000, 000. Your base sum insured will cover five lacs of hospital bills, while your secure benefit will cover the remaining three lacs. After a subsequent claim in the same policy year, you will be entitled to automatically restore benefits up to your base sum insured. After the 1st year, after you expend the Base Sum Insured, Plus Benefits (after the 1st year), and Secure Benefits (in this order), the automatic restore benefit kicks in. There is no carryover of unused automatic restore benefits to the next policy year.

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