There is nothing better than a health insurance plan you can gift your family. In today’s era where medical emergencies are at the rise and soaring healthcare expenses taking its toll on people’s savings, covering your family against those out of the blue situations. Here comes a health insurance plan like HDFC ERGO Health Optima Restore plan comes in handy in covering your family. This policy is beneficial for those who are explicitly looking for advanced features. This policy comes with 3 basic features- Restoration, Multiplier and Stay Health benefit. The other features such as lifelong renewability, no claim bonus up to 50%, critical illness cover with E-opinion option, no co-payment etc. have made it worth your money.
The basic features of HDFC ERGO Health Optima Restore plan are:
HDFC ERGO Health Optima Restore family plan offers the following benefits:
|In-patient Cover||In-patient cover including the cost of nursing, room rent, doctors’ consultation fee, ICU rent, OT rent, cost of medicines and drugs, oxygen, X-ray etc.|
|Pre-hospitalisation||covered up to 60 days|
|Post-hospitalisation||covered up to 180 days|
|Restore Benefit||automatic reinstatement of sum insured in case of exhaustion of sum insured in a policy tenure|
|Daily Cash Allowance|
|Day-care Facility||covers all day care procedures which would otherwise have required 24 hours of hospitalisation|
|Health Check-up||Covered by the policy with a sum insured 5 lakhs and more|
|E-opinion||E-opinion in case of critical illness is covered|
|Emergency Air Ambulance||Up to Rs. 2.5 lakhs (Sum Insured: 20/25/50 lakhs)|
|Multiplier Benefit||Bonus for not claiming the policy up to 50%. This can be availed wither increasing the sum insured or reducing the policy premium. In case of a claim, the bonus would be reduced by 50%|
|Critical Advantage Rider||Optional benefit|
|Emergency Ambulance||Rs. 2000 per hospitalisation|
|Organ Donor Cover||Expenses incurred in harvesting an organ during transplantation up to a certain limit|
|Domiciliary Treatment||Expenses for availing treatment at home which otherwise would have required hospitalisation|
|Daily cash allowance for opting for shared accommodation||Rs.800 per day- Rs.4,800 (Sum Insured: 3/5/10/15 lakhs)Rs.1000 per day-Rs.4,800 (Sum Insured: 20/25/25 lakhs)|
With sum insured Rs. 10 lakh or more, you can choose to cover yourself against the listed critical illnesses. The treatment can be availed at the network hospitals for major eight ailments, where a lump sum amount is offered at the time of detection of the illness. This benefit is only covered under sum insured Rs. 10 lakhs or more. You can avail the second opinion in case of critical illness
(Refer the policy document for the complete list of illnesses covered)
The policy will not entertain any claim arising out of the following situations:
(For the complete list of exclusion, please refer to the policy document)
|Minimum entry age||Children- 91 days/5 years|
|Maximum entry age||65 years|
|Family Definition||A maximum of 4 adults and a maximum of 5 children can be included|
|Premium calculation||Basis of age and the sum insured chosen|
In order to ensure a smooth claim with HDFC ERGO Health , make sure you have an approach in the right way. Optima Restore plan can be claimed in two ways-Cashless claim and reimbursement claim. The cashless claim further can be categorised into Planned Cashless and Emergency Cashless.
Cashless claim facility can be availed only at the network hospitals of the insurance provider. To ensure a smooth claim, the insurer urges you to follow the below claim steps:
Claim Intimation: When it comes to hospitalisation, the claim is categorised into planned and emergency hospitalisation, based on which the insurer further compensates the amount towards cashless and reimbursement claim process. Whether it is a cashless or reimbursement claim, the first thing is to inform the insurer. In case of planned hospitalisation, 48 hours of prior intimation is required while in case of emergency hospitalisation, the insurer has to informed within 24 hours of hospitalisation. You can register a claim by using the 24x7 helpline number of the insurer or sending a mail regarding a claim.
Claim Related Information: At the time of registering your claim, the following information will be required:
A claim reference number will be provided by the claim executive for future reference.
Pre-authorisation Letter: in case of a cashless claim, you’ll require a pre-authorisation letter duly approved by the insurer. to do so, approach the insurance help desk in the hospital or TPA, who will further coordinate with the insurer regarding the same.
Claim Settlement: The insurer will convey its decision to the hospital authority. Once the pre-authorisation request has been accepted, you can avail treatment free of cost. The hospital bills will be settled directly by the insurer.
When you avail treatment from a non-network hospital and register a claim to compensate the incurred amount, it is called reimbursement claim. To ensure a successful claim, the following steps have to be followed:
While claiming HDFC ERGO Health Optima Restore Floater plan, the following documents are required: