Hdfc Ergo Optima Restore Individual Health Insurance Plan
Overview
ERGO Health Insurance Limited (formally known as Apollo Munich Health Insurance Company Limited) is a Joint Venture between HDFC Ltd and Munich Health. HDFC Ltd is India's leading housing finance company of India based at Mumbai. Munich health is the primary health business division of leading reinsurer Munich Re based in Germany. Company has successfully secured the health of millions of families with its uncomplicated insurance services. The company is one of the most promising standalone health insurance provider with 10,000+ network Hospitals spread across 650+ cities. Rs.5000+ Cr worth of Claims have been settled by company since inspection. A network of 85000+ advisors have ensured a vast reach of company.The company has bagged the most coveted awards in the industry – Indian Insurance Awards for 'Product Innovation', Asia Insurance Industry Award for 'Innovation of the Year','Innovation Award' by Finnoviti for an unbelievable product in the Insurance industry, to name a few. HDFC ERGO Health offers benefits like lifelong renewal, no sub-limits, maternity, portability, restore and multiplier benefits, first over the counter Dengue Care product for just Rs. 444, etc.
Highlights For
Hdfc Optima
Restore
Restore Benefit
Modern Treatment
Features
Sub-limits
Health Check up
Free annual health check-up for all insured members according to the list of tests specfied in the policy document.
Ambulance
Transportation of the patient to the hospital and back home
Pre-Hospitalisation : 60 days
The amount of expenses incurred during this period prior to hospitalisation such as diagnostic tests, doctor fees, medicines, etc. for investigiation purpose are also payable by the insurer
Post Hospitalisation : 180 days
The amount of expenses incurred during this period after discharge from hospitalisation for the purpose of recovery such as follow-up tests, doctor fees, medicines, etc. are also payable by the insurer
Pre existing Disease cover : Treatments for Pre-existing diseases are covered after 36 months of continuous renewal.
Coverage for all Pre-Existing Diseases covered after a certain specified waiting period with continuous renewal.
Waiting Period- Initial : 30 days
No claims are accepted within this period except due to accidents/ injury.
Waiting Period- Specific : 2 years
Listed specific illness
Waiting Period- PED : 24 months
No pre-existing ailment related claims are accepted within this period.
Room Rent : upto sum insured
Room rent for in-patient hospitalisation
ICU Charges : upto sum insured
Charges for ICU hospitalisation
Co pay : No
% of the claim that the policyholder needs to pay out-of-pocket
Restore Benefit/ Recharge/ Refill : Equal to 100% of basic sum insured
If the sum insured is exhausted due to hospitalisation expenses of one or more members, there is an automatic restoration of the sum insured for related or unrelated ailments.
Health Check up : 5 lakh Upto - Rs 1500\n10 lakh - Rs 2000\n15 lakh - Rs 4000\n20-50 Lakhs - Rs 5000
Free annual health check-up for all insured members according to the list of tests specfied in the policy document.
No Claim Bonus : Bonus of 50% of the Basic Sum Insured for every claim free year,\nmaximum upto 100%.In case of claim, bonus will be reduced by 50%\nof the basic sum insured.
% of the sum insured that rises every claim free year.
Video/telephone consultation : No
E-consultation with expert doctors empanelled with the insurer for a second opinion.
Domiciliary hospitalization : Covered upto the sum insured
Home care treatment where there are no beds in the hospital or paitient is not in a condition to be moved to the hospital, This treatment is provided under the supervision of a registered medical practitioner.
Ambulance : Upto 2000 Hospitalisation
Transportation of the patient to the hospital and back home
Convalescence benefit : NO
A specific fixed amount of money paid as a recovery benefit for extended hospitalisation.
Organ Donor : Covered upto the sum insured
The costs for a surgical procedure of removal or damaged organ from the patient's body which could otherwise be fatal.
Bariatric cover : NO
Expenses related to obesity-related conditions such as high BP, sleep apnea, arthiritis asthma, etc.
Daycare : All day care treatments are covered
Covers in-patient hospitalisation expenses where the stay is <24 hours under a specified list of treatments
AYUSH : NO
Alternative treatment coverage such as ayurvedic, unani, sidha and homeopathy which leads to hospitalisation.
Congenital Coverage : NO
Covers medical expenses related to diagnosis and treatment of heriditary and internal congenital ailments/ conditions/ traits that exist from birth.
Modern Treatments : Yes
All advanced treatment with upgrade in technology.
Health Management/ Wellness : We will offer a discount at each renewal if the insured member achieves the average step count target on the mobile application
Benefits provided for staying fit and managing health
Maternity Benefit : NO
All expenses related to childbirth or legal medical termination of pregnancy, usually upto a specified limit.