HDFC ERGO Optima Restore Plan

HDFC ERGO Optima Restore provides enhanced medical coverage to safeguard the health of individuals and families with the help of the restore benefit. It pays for the emergency and planned medical expenditures incurred on hospitalization, ambulance services, day care procedures, domiciliary treatment, etc. It also has other attractive benefits like the multiplier benefit, daily cash for choosing shared accommodation, preventive health check-ups, etc.

Categories	Specifications
Sum Insured	Rs 3 lakh to Rs 1 crore
Policy Tenure	1 year, 2 years, 3 years
Network Hospitals	12000+
Incurred Claim Ratio (2021-22)	97.47%
Pre-existing Diseases Waiting Period	3 years
Specific Diseases Waiting Period	2 years
Initial Waiting Period	30 days
Discount	10% family discount 7.5% multi-year discount 5% online discount 2.5% loyalty discount

Benefits of HDFC ERGO Optima Restore Plan

Here are the benefits of buying an HDFC ERGO Optima Restore plan:

Restore Benefit

Policyholders can restore their base sum insured by 100% immediately after their first claim with the restore benefit. This benefit is available once a year and gets activated on both partial or complete utilization of the base sum insured.
Multiplier Benefit

This unique benefit doubles the coverage amount of an HDFC ERGO Optima Restore policy in 2 years by increasing the sum insured by 50% every time no claim is raised during a policy year.
No Room Rent Limit

Unlike most health plans, this HDFC ERGO health insurance plan comes with no restriction on room rent limit, allowing policyholders to stay in a hospital room of their choice.
Preventive Health Check-up

The insurance company pays for the preventive health check-up of the insured regardless of claims so that the onset of any disease or medical condition can be detected at the right time.
Stay Active Benefit

The HDFC ERGO General Insurance Company also promotes the overall well-being of the policyholders by offering a renewal discount of up to 8% on achieving the average step count target.
Tax Benefits

Policyholders can also earn tax benefits on the premium paid to buy the Optima Restore policy under Sec 80D of the Income Tax Act.

HDFC ERGO Optima Restore Plan Eligibility Criteria

Check out the eligibility criteria for buying an HDFC ERGO Optima Restore plan:

Parameters	Eligibility Criteria
Minimum Entry Age	Adult – 18 years Child – 91 days
Maximum Entry Age	Adult – 65 years Child - 25 years
Coverage Type	Individual/ Family floater
Types of Relationships Covered	Self, spouse, dependent children, dependent parents and dependent parents-in-law
Renewability	Lifelong

Inclusions of HDFC ERGO Optima Restore Plan

The following medical expenses are included under an HDFC ERGO Optima Restore plan:

In-patient Treatment – It pays for the cost of hospitalization of at least 24 hours, including room rent, doctor’s fees, nursing fees, OT expenses, etc.
Pre-hospitalization Expenses – It covers medical expenses incurred for up to 60 days before being admitted to a hospital.
Post-hospitalization Expenses – It pays for the medical expenses incurred for up to 180 days after hospital discharge.
Day Care Procedures – It covers the cost of medical procedures and treatments requiring less than 24 hours of hospitalization.
Domiciliary Treatment – It pays for the medical expenses incurred on home hospitalization if being admitted to a hospital is not possible.
Organ Donor Expenses – It covers the cost of harvesting the organ donated for the transplant surgery of the insured.
Ambulance Cover – It pays for the medical expenses incurred by availing the road ambulance services to transport the patient to the nearest hospital.
Daily Cash for Choosing Shared Accommodation – It pays a daily cash allowance to the insured for choosing a shared room at the hospital.
E-Opinion for Critical Illness – It allows the insured to avail e-opinion from a qualified doctor for a critical illness once a year.
Emergency Air Ambulance Cover – It covers the cost of availing air ambulance services to transport the insured to the nearest hospital during a medical emergency.
Modern Treatments – It pays for the medical expenses incurred on treatments using technologically advanced methods.

Optional Covers:

Unlimited Restore Benefit – It restores the base sum insured of the policy by unlimited times in a policy year regardless of partial or complete exhaustion of the sum insured.

Exclusions of HDFC ERGO Optima Restore Plan

HDFC ERGO Optima Restore plan excludes the following:

Dental treatments
Maternity expenses
Hospitalization due to abuse of intoxicants like drugs and alcohol
External aids and appliances
Hospitalization due to war or acts of war
Non-allopathic treatments
Congenital external diseases
Cosmetic surgery
Intentional self-injury
Unproven or experimental treatments

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FAQs

Q1. Is cataract surgery covered in Optima Restore?

Ans: Yes. The HDFC ERGO Optima Restore policy covers the cost of cataract surgery but after a waiting period of 2 years.
Q2. Does Optima Restore cover accidents?

Ans: Yes. Hospitalizations arising from an accidental injury are covered by the HDFC ERGO Optima Restore policy from day 1.
Q3. How does Optima Restore work?

Ans: The HDFC ERGO Optima Restore policy comes with the restore benefit that reinstates the base sum insured by 100% in case of partial or complete utilization. This benefit is available once a year unless you opt for the unlimited restore benefit.
Q4. Where can I check the premium for the HDFC ERGO Optima Restore policy?

Ans: You can check the HDFC ERGO Optima Restore premium chart to know the premium you will have to pay upon buying the policy.
Q5. Does HDFC ERGO Optima Restore offer free health check-ups?

Ans: Yes. You can avail free preventive health check-up facilities under your Optima Restore policy.
Q6. Can I check the premium of HDFC ERGO Optima Restore before buying?

Ans: Yes. You can use an HDFC ERGO Optima Restore premium calculator to check the premium you will have to pay before buying.
Q7. Does HDFC ERGO Optima Restore offer a cumulative bonus?

Ans: The HDFC ERGO Optima Restore policy comes with a multiplier benefit that doubles your coverage amount in 2 years, just like a cumulative bonus. It increases your sum insured by 50% for a maximum of 100% for every claim-free year.
Q8. Does HDFC ERGO Optima Restore have waiting periods?
Ans: Yes. The HDFC ERGO Optima Restore plan comes with the following periods:
- Initial waiting period - 30 days
- Specific disease waiting period - 2 years
- Pre-existing disease waiting period - 3 years
Q9. Is AYUSH treatment covered by HDFC ERGO Optima Restore?

Ans: No. AYUSH treatments are not covered by the HDFC ERGO Optima Restore policy.
Q10. Is dental treatment covered by HDFC ERGO Optima Restore?

Ans: The HDFC Optima Restore policy does not pay for dental treatments unless resulting from an accidental injury or illness.
Q11. Does HDFC ERGO Optima Restore cover medical expenses abroad?

Ans: No. The HDFC ERGO Optima Restore plan does not cover medical expenses incurred outside India.
Q12. Are OPD treatments covered by HDFC ERGO Optima Restore?

Ans: No. OPD treatments are not covered by the HDFC ERGO Optima Restore policy.
Q13. How is the premium of HDFC ERGO Optima Restore calculated?

Ans: The premium of HDFC ERGO Optima Restore is calculated based on the insured’s age, medical history, lifestyle habits, geographical location and sum insured.
Q14. How can I file an HDFC ERGO Optima Restore claim?

Ans: You can file an HDFC ERGO Optima Restore claim by informing the insurance company about your hospitalization as soon as possible. In case of a cashless claim, get pre-authorization from the insurer, avail the treatment at the network hospital, and the insurer will pay the medical bills on your behalf. In case of a reimbursement claim, pay all the bills during hospital discharge and submit the claim documents to the insurer to receive the claim amount.
Q15. Which documents are required to file an HDFC ERGO Optima Restore claim?
Ans: You need to submit the following documents to raise an HDFC ERGO Optima Restore claim:
- HDFC ERGO health insurance claim form
- Original hospital bills and payment receipts
- Original hospital discharge card
- Original chemist bills and payment receipts
- Doctor’s referral letter advising hospitalization
- Doctor’s prescription advising medicines and diagnostic tests
- Original diagnostic test reports

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