HDFC ERGO Easy Health Optima Plus Individual Insurance

HDFC ERGO Health Optima Plus is a unique top-up plan that ensures optimum protection in case of a medical emergency. The policy comes with an exceptional feature which helps in converting the policy into a full-fledged indemnity insurance policy. When it operates as a top-up policy along with the regular health insurance a deductible is applied, but when it converts into an indemnity policy, all the deductibles are waived off. The policy is affordable with a nominal premium. With the option of converting, you can enjoy a policy with no waiting period to serve in your retirement age. Let’s know about the plan in details:

Basic Features of HDFC ERGO Health Optima Plus

HDFC ERGO Health Optima Plus comes with the following features:

  • Offers coverage for higher hospitalisation expenses
  • The plan can be availed at an affordable premium
  • Provides extensive in-patient care after deductible
  • Lifelong renewability
  • Tax benefit to be availed for the premiums paid towards the plan
  • This policy can be converted to a full-fledged plan with zero deductible
  • Cashless hospitalisation in more than 4500 hospitals across India
  • The policy is offered as an individual sum insured basis
  • You can include your spouse, children or dependent parents as well
  • The policy comes with no policy ceasing age option
  • Option to choose from 1 or 2 years of policy tenure
  • Deductible to be chosen from Rs. 1lakh to 5 lakh as per the insurance requirement

Benefits of HDFC ERGO Health Optima Plus

Here’s a quick run through of the various benefits offered under HDFC ERGO Health Optima Plus:



Maximum sum insured

Rs. 5 lakh

Option of deductibles

Either of the option Rs. 1 lakh to Rs. 5 lakh

In-patient Treatment

24 hours hospitalisation is compulsory to avail this


Expenses incurred in treatment  60 days prior to the hospitalisation


Expenses incurred in treatment  90 days post hospitalisation

Day Care Procedures

Covered for 140 listed day care procedures which don’t require 24 hours hospitalisation

Organ Donor

Medical expenses incurred in transplanting an organ to the insured person

Emergency Ambulance

Up to Rs. 2000 per hospitalisation

Domiciliary Treatment

Medical expenses while availing treatment at home which would have required proper hospitalisation

Exclusions of HDFC ERGO Health Optima Plus

The policy doesn’t cover the insured under below conditions:

  • 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 will be entertained for the expenses incurred in treating a specific illness such as hernia, joint replacement surgeries, cataract, surgery of hydrocele etc. without serving a waiting period of 2 years
  • Expenses towards 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
  • Expenses incurred in the items of personal comfort and convenience

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

HDFC ERGO Health Optima Plus Premium

Sum Insured












91 Days-35 Years






36-45 Years






46-60 Years






61-75 Years






Above 75 years







Waiting Period for HDFC ERGO Health Optima Restore Plan

  • From day 1: Only accidental claims will be accepted
  • Covered after 30 Days: Initial waiting period for paying off a regular claim, except those for a specific illness and pre-existing illness
  • Covered after 2 years: specific illnesses
  • Covered after 3 years: Pre-existing illnesses

(Refer the policy document for the complete list of illnesses covered)

Eligibility for Availing HDFC ERGO Health Optima Plus

Minimum Entry Age

5 years (if one of the parent is covered)

Maximum Entry Age

65 years

Entry age for dependent children

91 days

Policy Tenure

1 or 2 years

Discount Offered under HDFC ERGO Health Optima Restore Plan

  • 10% family discount if more than 2 members are covered
  • Avail 7.5% discount by opting for a multi-year policy with 2-years tenure

Additional Benefits Offered Under HDFC ERGO Health Optima Plus

  • Conversion to Nil Deductible Policy - The insurer offers the option to convert the plan to a full-fledged health insurance plan when you approach your retirement age. This is possible at renewal between 58-60 years of age. The only condition is you have to enrol with the insurer before the age of 50 years. Moreover, the policy needs to have renewed without a break to avail the benefit of the full-fledged
  • 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 without a hassle. If you are not satisfied with the existing insurance provider, you can check the plans of HDFC ERGO Health and transfer your existing policy without losing the policy benefits. With portability, you need not to 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 Plus Plan, you can save on tax under Section 80D of Income Tax Act. The premiums paid towards the policy are exempted from the tax

HDFC ERGO Health Optima Plus Renewal Process

In order to enjoy health insurance policy benefits uninterruptedly, timely renewal is essential. HDFC ERGO Health Optima Plus policy can be renewed online or offline. To renew it online:

  • Visit the website of the insurer and go to the ‘Renew Your Policy’ option
  • Mention the policy number. If you have renewed the policy earlier, mention the 12-digit policy number. If you are renewing for the first time, mention 10-digit policy number and submit
  • Calculate the premiums online and pay it using a credit/debit card or net banking
  • An instant renewal confirmation message will be sent and the renewed policy will be forwarded to the registered email Id. You can download the policy instantly.

If you want to renew the policy offline, then visit the nearest branch or approach an authorised agent who will help you go through the process. You can pay the premiums by cheque or paying cash at the branch office.

HDFC ERGO Health Optima Plus Claim Process

Apart from ensuring comprehensive financial protection and quality healthcare, the insurer also provides hassle-free claim settlement. HDFC ERGO Health Optima Plus offers two types of claims- Cashless claim for planned or emergency hospitalisation and Reimbursement claim. A cashless claim can be availed only at a network hospital where services can be availed free of cost. On the other hand, in case of reimbursement claims the treatment is availed at a non-network hospital and a claim is registered to refund the incurred amount. In order to provide its customers with the easy claim settlement, the insurer has set a few simple steps of claiming health insurance:

At the time of registering a claim, you’ll require to provide the below information:

  • Your contact details
  • Name of the Insured
  • Policy number
  • Date and time of incident/illness
  • Nature of illness/injury
  • Location of incident/illness/injury

A claim can be registered by calling at the 24x7 helpline number of the HDFC ERGO Health or can write an email stating about the incident or nature of the claim @ customerservice[@] or call at 1800-102-0333

Step-wise Claim Process

In case of Planned/Emergency Cashless Hospitalisation

  • Select the hospital from the network hospital list.
  • Intimate the insurer within 48 hours prior to the hospitalisation, with the required claim information mentioned above, by calling on the toll-free number 1800-102-0333. If it is emergency hospitalisation then inform the insurer within 24 hours of hospitalisation. Approach the hospital help desk to complete the formalities
  • The cashless request form or Pre-authorisation form needs to be filled and submitted to HDFC ERGO Health . It should be signed by the attending doctor, accompanying with the required reports
  • The insurer will review the documents and convey the decision to the hospital authority. The insurer may ask for an additional document, if required. Upon its approval, the treatment can be availed free of cost and hospital bills will directly be settled by HDFC ERGO Health . If the insurer rejects the request, the bills are to be paid by the insured initially and the claim for reimbursement.

In case of Reimbursement Claim

Reimbursement claim is registered if the insurer rejects your request for the cashless claim and you pay the medical expenses on your own. In order to ensure a reimbursement claim:

  • The claim initiation has to be made within a stipulated time window. Sooner you intimate the insurer, the better the chances of your claim being settled. You can call on their helpline number or write of the official email address
  • The key information regarding the policy shall be provided, along with the policy number
  • The claim form can be downloaded from the official website or you can approach the customer care for the same.
  • The duly filled and signed claim form needs to be submitted along with the supporting documents
  • The original medical bills have to be attached
  • Upon receiving and verification of documents, the insurer will settle the claim and the amount will be transferred to the insured’s account.

Documents Required for Claiming HDFC ERGO Health Optima Plus

  • Duly completed claim form and signed by the insured
  • Pre-authorisation letter to avail cashless claim benefit
  • Original medical bills including the receipts, consultation bill, diagnostic bills etc.
  • Medical report signed by the doctor mentioning about the nature of illness, injury or surgery
  • Discharge letter
  • An accurate diagnosis of the treatment for which a claim is made
Written By: PolicyBazaar - Updated: 08 January 2021
Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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