HDFC ERGO Health Optima Restore - Individual Plan

Medical emergencies can strike anytime, leaving you obstruct financially. A right type of health cover, hence, is essential to protect your savings. Given that, individual health insurance plans come in hand that cover the insured against various illness and accidental hospitalisation. Nevertheless, the challenge is to choose the right type of cover amongst the plethora of insurance products. In this regard, Optima Restore-an individual health insurance plan offered by HDFC ERGO Health is worth your investment. Let’s explore the plan in detail:

HDFC ERGO Health - Optima Restore Health Insurance Plan is an individual plan that comes with an auto-restoration benefit. In case of exhaustion of the sum insured, it reinstates automatically for no additional cost. Additionally, the policy comes with three incredible benefit- restore, multiplier and stay active.

Salient Features of HDFC ERGO Health Optima Restore Plan

 The policy comes with the following features:

  • 100 of auto-restoration of sum insured is possible if it is exhausted. This benefit can be utilised only once in the policy tenure and can’t be carried forward to the next year
  • 100% increase of sum insured after 2 claim-free year under Multiplier Benefit
  • Under Stay Active Benefit, avail additional discount up to 8% on the renewal premiums for leading a healthy life by walking. You can calculate the steps you walk using an app called ‘Health Jinn’.
  • Avail cashless access to over 4500+ network hospitals in over 800 cities.
  • The plan come with no co-payment
  • NCB bonus of 50 % on Sum Insured per year up to a maximum of 100% for every claim-free year
  • Pre-existing illness covered after 3 years of waiting period
  • Tax benefit for the premiums paid towards Optima Restore plan
  • The policy comes with lifelong renewability
  • Opt for a higher coverage with sum insured from 3 lakh to 50 lakh
  • The policy comes with portability benefit as well

Benefits of HDFC ERGO Health Optima Restore Plan


Inpatient Benefit

Sum Insured Option

3 lakh/5 lakh/10 lakh/15 lakh

20 lakh/25 lakh/50 lakh


Up to 60 days

Up to 60 days


Up to 180 days

Up to 180 days

Day Care procedures

All day care treatment included

All day care treatment included

Domiciliary treatment



Organ donor



Daily cash for Choosing shared accommodation

Rs.800 per day, Maximum Rs.4,800

Rs.1000 per day, Maximum Rs.4,800

Emergency Ambulance

up to Rs. 2000/per hospitalisation

up to Rs. 2000/per hospitalisation

E-opinion in respect of critical illness



Emergency Air Ambulance Cover

Not covered

Covered up to Rs.2.5 lakhs per hospitalization and maximum up to sum insured in a year


Restore Benefit

Equal basic sum insured (100%)

Equal basic sum insured (100%)

Multiplier Benefit

Avail NCB bonus of 50% of the basic Sum Insured (SI) for every claim free year. The NCB can be availed maximum up to 100%

Avail NCB bonus of 50% of the basic Sum Insured (SI) for every claim free year. The NCB can be availed maximum up to 100%

Health Check-up

Not covered by 3 lakhs plan

Up to Rs.1500 (5 lakhs SI)

Up to Rs 2000 (10 lakhs SI)

Up to Rs. 4000 (15 lakhs)

up to Rs. 5000

Critical Advantage Rider

Covered if the basic sum insured is Rs. 10 lakhs and above

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

Waiting Period for HDFC ERGO Health Optima Restore Plan

  • From day 1: Only accidental claims will be accepted
  • Covered after 30 Das: all illnesses, except the specific illnesses, pre-existing illness and other conditions that are in the list of exclusion
  • Covered after 2 years: specific illnesses
  • Covered after 3 years: Pre-existing illnesses

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

Exclusions for HDFC ERGO Health Optima Restore Plan

The policy will not entertain any claim arising out of the following situations:

  • Any claim for pre-existing illness before the policy completes 3 years
  • Expenses incurred for treating HIV or AIDS or related exclusion
  • The policy doesn’t cover mental disorder, congenital diseases, expenses for cosmetic surgery or weight control measures
  • Accident or injury occurred while driving under the influence of alcohol or other intoxicating drugs
  • Injury due to war or warlike situation, civil war, use of a nuclear weapon, terrorist attack
  • Expenses incurred towards dental treatment, pregnancy etc.
  • Treatment for specific illness before serving the waiting period of 2 years

(For the complete list of exclusion, please refer to the policy document)

Eligibility Criteria of HDFC ERGO Health -Optima Restore



Minimum entry age

Children- 91 days/5 years


Maximum entry age

65 years

Renewal age


Family Definition

Individual Plan - A maximum of 4 adults and a maximum of 5 children can be included

Calculation of premium

Basis of age and the sum insured chosen

Optima Restore Renewal Process

Optima Restore policy comes with lifelong renewal benefit where there is no policy ceasing age. The policy needs to be renewed every year, either online or offline. A grace period of 30 days is offered in case the renewal date is missed. The insured can renew it online in four easy steps:

  • Visit the official website of the insurer and navigate through the renewal option
  • Mention the policy details on the respective field. The first time user will have to mention the 10-digit policy number, while if you’ve renewed the policy earlier, mention the 12-digit policy number
  • Calculate the premiums online and pay through debit/credit cards or net banking
  • Get the instant acknowledgement on policy renewal and get the renewed policy downloaded from the registered mail Id.

You can renew the policy offline by visiting the insurer's office and pay the premiums by cheque or cash at the counter.

Remember, the premiums are subjected to change with prior approval from IRDA. Any change in this regard will be intimated by the insurer prior to the policy renewal due date, at least 3 months in advance.

HDFC ERGO Health -Optima Restore Plan: Claim Process

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.

1. Cashless Claim:

Cashless claim facility can be availed only at the network hospitals of the insurance provider.

Claim Intimation: To avail the policy benefits, you will have to intimate the insurer about the claim. In case of planned treatment, the insurer has to be informed at least 48 hours prior to the hospitalisation. In case of emergency hospitalisation, the insurer needs to be informed within 24 hours of admission. Register your claim by calling on the toll-free number or email them. You can visit the nearest branch as well to register a claim.

Claim Related Information: While registering your claim, the following information will be required:

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

After providing the related information, the claim executive will provide a claim reference number for future use.

Pre-authorisation Letter:  In both cashless claim service you will have to fill and submit a pre-authorisation form requesting for availing cashless benefit. The cashless services are only offered after the insurer provides its consent on this.

Claim Settlement: Avail the treatment free of cost, while the incurred expenses are directly settled with the hospital authority by the insurance company. You will have to pay the difference of total claim, which is not covered by the insurer.

2. Reimbursement Claim

If you avail the treatment from a non-network hospital, you can claim the Optima Restore policy under Reimbursement clause. The claim process can be initiated in the following ways:

  • Avail the treatment from a preferred hospital and pay the bills at the time of discharge
  • Collect the original bills with the receipts
  • Register a claim by filling and submitting the claim form along with the relevant documents
  • Post receiving the required documents, the insurer will process the claim within 30 days
  • If there is any discrepancy the same will be intimated within 7 days
  • In case of claim rejection, the insurer will be informed stating about the reason
  • The approved amount will be settled and transferred to the registered bank account number

Document Required

 The following documents are to be furnished to claim HDFC ERGO Health Optima Plan:

  • Duly filled claim form
  • Police FIR in case of accidental claim
  • Pre-authorisation letter for cashless claim
  • KYC document of the insured
  • 1st 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
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.

Latest Health Insurance Articles

If I Buy top-up Health Insurance, What Should be my Policy Cover?

If I Buy top-up Health Insurance, What Should be my Policy Cover?

Why do you carry a Stepney or a spare tire in your car? So that you can use this spare tire as a stand-by in case one of the tires gets punctured. Similarly, a top-up health insurance plan acts as a Stepney to your med...
Updated: 20th January 2021
Are Wellness Benefits In Health Insurance Useful?

Are Wellness Benefits In Health Insurance Useful?

The real cost to insurance companies is low. It is not surprising to know that the impact achieved is low too. Let’s talk about this in detail. Last week Rhea called her insurer to inquire about the complementary health check-up benef...
Updated: 15th January 2021
10 Reasons why buying a Health Insurance in your 20s a Good Idea

10 Reasons why buying a Health Insurance in your 20s a Good Idea

In India, for a young person in his early 20s, availing a health insurance policy is imperative due to increasing health risks from a sedentary lifestyle. After COVID outbreak, the popularity and need of a health cover h...
Updated: 15th January 2021
High or Low Deductible Health Insurance - Which one to Opt for?

High or Low Deductible Health Insurance - Which one to Opt for?

There are so many health insurance plan options available that it gets difficult to understand all of them and their features. When you are purchasing a health insurance policy you might actually want to do some planning ...
Updated: 4th January 2021
Exploring Manipal Cigna Health Insurance and Claim Settlement

Exploring Manipal Cigna Health Insurance and Claim Settlement

As residents of a developing nation, we are exposed to the risk of contracting various illnesses. Despite thorough maintaining an active lifestyle, we are prone to various illnesses. A lot of factors such as pollution and f...
Updated: 4th January 2021
Download the Policybazaar app
to manage all your insurance needs.