HDFC Health Optima Restore is a unique plan with restore benefit available as individual and family floater plan. One can buy the plan for wide range of health cover varies from 3 lac to 50 lac. The best part of the plan is restore benefit.
Table of Contents
HDFC Health Optima Restore Features & Eligibility
| Feature | HDFC Ergo Optima Restore |
| Minimum Age at Entry | 91 Days- Children above 91 days can be insured with Parents |
| Maximum Age at entry | 65 years |
| Sum Assured | Rs 3 Lac, 5 Lac, 10 Lac, 15 Lac, 20 Lac, 25 Lac, 50 Lac |
| Room Rent | Actual |
| Sub limit | No sub-limit on room rent |
| Renewability | Life-long renewability |
| Pre hospirtalization | 60 days prior to the hospitalization |
| Post Hospitalization | 180 days after hospitalization |
| waiting period for pre existing disease | 3 year |
| Day care procedures | Up to sum assured |
| Domiciliary treatment* | Medical expenses incurred for availing medical treatment at home due to health conditions or unavailability of bed at the hospital, which would otherwise have required hospitalisation. |
| Ambulence | upto 2000 |
| Air ambulence | up to 2.5 lac ( applicable for basic sum assure ABOVE 5 lac)) |
| Organ donor | Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient is covered |
| Restore Benefit | 100% of basic SA ( for any illness or any insured sum assure) Instant addition of Basic Sum Insured on complete or partial utilization of existing Policy Sum Insured. The restore sum insured can be used to all claims including claims for same illness/disease for which a claim has already been paid. However, single claim in a Policy Year cannot exceed the sum of Basic Sum Insured and Multiplier Benefit (if any) |
| Unlimted Restre benefit | Optional |
| Multiplier benefit/ Bonus | Bonus of 50% of basic SA for every claim free pol,icy year, maximum up to 100% of SA. In case of a claim, accumulated bonus will bbe reduced by 50% |
| E Opinion in respect of a critical illness | Second opinion by a Medical Practitioner from HDFC panel, for a Critical Illness suffered during the policy period. “Critical Illness” includes Cancer of Specified Severity, Open Chest CABG, Myocardial Infarction (First Heart Attack of specific severity), Kidney Failure requiring regular dialysis, Major Organ/Bone Marrow Transplant, Multiple Sclerosis with Persisting Symptoms, Permanent Paralysis of Limbs and Stroke resulting in permanent symptoms |
| Daily cash for choosing shared accommodation | 800/day ( max 4800) – For SA up to 15 lakh {1000/day ( max 6000) – For SA above 15 lakh |
| Stay active Benefit | with Stay Active benefit, simply walk your way to good health and earn upto 8% discount on your renewal premium, if you achieve step count target on the HDFC Moile application |
| Tax benefits under 80D | Tax benefits under 80D of Income Tax Act |
| Health check limit | Different for different SA |
| renewal | Lifelong renewal |
| Preventive health check up | At renewal ( available once at the end of block of every 2 policy years on basic sum assure of 5 lac and at the end of every year on SA 10 lakh and above |
| Premium Individual – | 18-35 year age |
| 5 lac | Rs.9753 |
| 10 lac | Rs.12261 |
| Family Floater | |
| Age of family members | 42/39/10/8 |
| Sum Assured-5 lac | Rs. 23681 + GST |
| Sum Assured-10 lac | No cover provided |
| Alternate treatment | No cover provided |
*Domiciliary hospitalisation or home-based treatment is a situation in which a person suffering from a disease, illness or injury receives hospital-like treatment at home.
What is Restore Benefit – HDFC Health Optima Restore
Under Restore benefit -100% restore of Sum Assured is available from second/next/subsequent hospitalization.
Same person or any other family member can use restore benefit for same or different disease hospitalization.
Restore benefit triggers on complete or partial utilization of basic sum insured (and multiplier benefit( as applicable)) during a policy year. This will be available to ALL Insured persons for subsequent claim under hospitalization.
For instance, Mr. Sharma bought HDFC Ergo Optima Restore – 10 lac sum insured.
Condition 1-Suppose he got hospitalized due to a illness.
Sum Assured – 10 lac
Bill – 9.80 lac/10 lac or lesser amount
In this case the entire amount of bill will be paid by the company.
Condition 2-In a different condition, If his bill amount is 12 lac than he has to pay 2 lac from his pocket.
Condition 3- Now suppose he or any other family member is hospitalized again in same policy year ( after the first hospitalization) than his cover amount of 10 lac is restored for entire family.
In such case he or his family can use restored amount of 10 lac again.
This restore benefit is available for any number of hospitalization.
What is not covered in HDFC Ergo Optima Restore
Few aspects are not covered under the policy such as:
- Treatment availed outside India
- Self-Inflicted Injuries
- War
- AIDS/HIV
- Venereal Or Sexually Transmitted Diseases
- Treatment Of Obesity Or Cosmetic Surgery
HDFC Ergo Optima Restore Waiting Period
First 30 Days From Policy Inception
Only accidental hospitalisations are covered for first 30 days from the date of policy issuance.
First 24 Months From Policy Inception
Few illnesses & treatments are covered after two years of policy issuance.
First 36 Months From Policy Inception -pre-existing conditions
Declared or accepted pre-existing diseases are covered after 36 months of continuous coverage.
Additional Reading
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