HDFC ERGO Easy Health Optima Cash Insurance

HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Overview

HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash plan offers comprehensive coverage in the hour of need. It offers a daily cash benefit during a hospitalisation. This amount can be utilised to pay off the non-medical expenses while hospitalised.

This policy pays a lump sum that can be used for either medical expenses or other related expenses incurred during hospitalisation such as attendant’s food, travel and accommodation and so on. Usually, these expenses are not covered by a health insurance policy but can be equally daunting. Therefore, by purchasing HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash plan, you can cover the additional expenses incurred during hospitalisation. In addition, the biggest USP of this plan is no pre-medical health test and less paperwork. You can earn tax benefit for the premiums paid towards this plan.

Salient Features of HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan

The policy comes with the following features:

• Buy this policy online and get up to 25% discount
• Coverage for additional expenses such as travelling, attendant’s food, accommodation
• Less paperwork
• No pre-policy check-up
• No medical bills required for claim
• Avail tax benefit under Section 80D of Income Tax Act for the premium paid towards the plan
• Avail cashless access to over 4500+ network hospitals in over 800 cities
• Tax benefit for the premiums paid towards HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash plan
• The policy comes with lifelong renewability
• Grace period of 30 days for renewing an expired policy
• Options of Rs 1,000; Rs 2,000 and Rs 3,000 as daily cash allowance for 90days/ 180 days per policy tenure to choose from

Benefits of HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan

Benefit	Coverage	Duration
Sickness Hospital Daily Cash	Daily hospital cash allowance in case of hospitalisation for the period of 24 hours or more due to any illness	Maximum up to 90 days. 180 days per policy tenure
Sickness ICU Cash	Double the Daily cash amount for a period of 24 hours of hospitalisation  where the policyholder is admitted in ICU due to a sickness	Maximum up to 15 days per policy year.
Accident Hospital Cash	Daily hospital cash allowance in case of hospitalisation for the period of 24 hours or more in case the policyholder is hospitalised due to an accident	Maximum up to 90 days. 180 days per policy tenure
Accident ICU Cash	Double the Daily cash amount for a period of 24 hours of accidental hospitalisation  where the policyholder is admitted in ICU	Maximum up to 15 days per policy tenure
Day Care Procedure Cash	50% of cash allowance is offered for 10-day care procedures where 24 hours of hospitalisation is not required	The benefit can be availed for a maximum 6 daycare procedures in a policy tenure
Joint Hospitalisation due to an Accident	If more than one insured person is hospitalised, double daily cash amount for each (24 hours hospitalisation is required)	Maximum up to 10 days per policy year
Convalescence Cash	Lump sum amount is paid as daily cash if the person is hospitalised for more than 7 continuous days	Payable once per policy year
Parent Accommodation	In case the insured child age is  12 or less than 12 year and is hospitalised for more than 72 hours, a cash amount supporting parent’s accommodation during hospitalisation is offered	Maximum up to 30 days per policy year
Child Birth	Lump sum amount equivalent to twice the Daily Cash amount for female insured in case of pregnancy or during childbirth	Can be availed twice in the policy tenure

Additional Benefits of HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan

The additional benefits offered under the HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan are:

• Sum Insured Enhancement - the insured can enhance the basic sum insured of the policy at the time of renewal, provided no claim has been lodged. No fresh medical test is required in case of an increase of one grip up. However, if the increase of sum insured is more than one grip up, it shall be subject to medical test. The waiting period may apply afresh in relation to the amount that is increased.
• Cashless Service - You can avail cashless services at more than 4500 network hospitals of the insurance provider. In order to avail so, a pre-authorisation letter and health card will be required. The process of applying for cashless services is mentioned in the policy document.
• Portability - The insurer offers portability benefit as well, where you can switch to HDFC ERGO Health (formerly known as Apollo Munich) without a hassle. If you are not satisfied with the existing insurance provider, you can check the plans of HDFC ERGO Health (formerly known as Apollo Munich) and transfer your existing policy without losing the policy benefits. With portability, you need not have to serve the waiting period again for covering pre-existing illness, as the insurer will consider the served waiting period as valid.
• Tax Benefits - With Optima Cash Plan, you can save on tax under Section 80D of Income Tax Act. The premiums paid towards the policy are exempted from the tax

Waiting Period of HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan

The applicable waiting period under which the policy can’t be claimed are:

• Initial waiting period: first 30 days from policy initiation date. Only accidental claims are accepted
• Pre-existing Illness Cover: After 4 years of continuous renewal
• Specific Period Cover: After 2 years of policy renewal

Exclusions of HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan

The common exclusions of HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan are:

• No claim will be entertained within the first 30 days of the policy period, except accidental claims
• Complications arising out of a pre-existing illness will not be covered before 4 years of waiting period
• No claim can be registered for treating a specific illness such as hernia, joint replacement surgeries, cataract, surgery of hydrocele etc. without serving a waiting period of 2 years
• Expenses incurred in treating HIV/AID or other related diseases that are permanently excluded
• Expenses towards mental disorder, cosmetic surgery, congenital illness, weight loss treatment etc. are not covered
• Any accident leading to hospitalisation while driving under the influence of alcohol or intoxicating substances.
• Injury due to war, warlike situation, due to the use of nuclear weapon and radiation, riot, strike or malicious act
• Expenses towards dental treatment, pregnancy, external aids, unless it is additionally covered by the plan
• Items of personal comfort and convenience

For the complete list of exclusions, please refer to the Policy Fine Print

Eligibility Criteria to avail HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan

Minimum Entry Age	5 years
Dependent Children	91 days
Maximum Entry Age	65 years
Policy Ceasing Age	No bar
Policy Tenure	1 or 2 years

Discount to be Availed under HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash

• 10% discount can be availed on the policy price if 2 or more family members are covered

HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Renewal Process

HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash offers lifelong renewability where is no policy ceasing age. The insured needs to renew the policy once in a year to get the policy benefits. One can either do it online or offline. Online renewal of Optima Cash policy requires the insured to visit the official website and follow the renewal instructions:

• Log in to the official website of the insurer
• Go to the ‘Online Renewal’ option
• Mention the policy details such as policy number
• The first time user will have to provide 10-digit policy number, while the others who have renewed the policy earlier will have to mention 12-digit policy number
• The premiums will be suggested accordingly. One can calculate it using the HDFC ERGO Health (formerly known as Apollo Munich) premium calculator
• Next is to pay the premiums using a debit/credit card or net banking
• An instant acknowledgement will be sent to the registered email Id and policy will be renewed

The insurer offers a grace period of 30 days in case the insured forgets the renewal due date. He/she has to renew the policy without a fail to avoid policy lapse.

The policy premiums are subjected to change with approval from IRDA only. Although policy terms regarding the premiums remain the same throughout the tenure, in case of any change with due permission from IRDA, the same has to be intimated to the customers as well. The insurer informs the policyholder regarding any change in the premiums 3 months prior to the policy renewal due date.

HDFC ERGO Health (formerly known as Apollo Munich)-Optima Restore Plan: Claim Process

HDFC ERGO Health (formerly known as Apollo Munich) ensures smooth and fast claim settlement in a hassle-free manner. You can register your claim online by approaching the online claim option. Or you can approach the customer care executive who guides you through the claim process.

1. In terms of cashless claim:

• Claim Intimation:

The foremost thing is to inform the insurer without a delay. If it is a planned hospitalisation, inform them 48 hours prior to the hospitalisation, while in case of emergency hospitalisation, it has to be informed within 24 hours of hospitalisation. A pre-authorisation letter has to be filled and submit by requesting for the approval from the insurer. the cashless services can be availed once the insurer approves the request.

• Claim Related Information

While registering your claim, the following information will be required. You can inform the insurer by calling on the too-free number and register along with the below details:

• Policy number
• Contact details
• Name of the insured
• Detail of the incident
• Date and time of the occurrence
• Nature of illness or injury

• Claim Settlement

Under cashless service, you can avail the treatment free of cost, while the insured expenses are settled directly with the hospital authority.

2. Reimbursement Claim

When healthcare services are taken from a non-network hospital, you can claim your policy under the reimbursement clause. Here the medical expenses are borne by you initially and can be reimbursed by filing a claim after getting discharged from the hospital. The original hospital bills are to be attached with the claim form, along with the other supporting documents. The claim is settled upon verification of documents and the approved amount is transferred to the insured’s savings account.

Document Required

 The following documents are to be furnished to claim HDFC ERGO Health (formerly known as Apollo Munich) Optima Cash Plan:

• Duly filled claim form
• Police FIR in case of accidental claim
• Pre-authorisation letter for cashless claim
• KYC document of the insured
• 1^st Investigation report
• Duly signed doctors report on the nature of the illness
• Original medical bills and receipts (reimbursement claim)
• Discharge report
• The insurer may ask for other documents supporting the claim