HDFC ERGO Health Optima Vital Critical Illness Insurance Policy

Lifestyle diseases are at the rise. Thanks to a sedentary lifestyle, bad food habits and increasing stress, we’re more vulnerable to non-communicable diseases. And treating them is the real hurdle as they come at a cost. Adding to this, a critical illness plan like HDFC ERGO Health Optima Vital, helps you stay healthy without breaking the banks. Here’s how:

The policy comes with the following features:

  • Avail cashless access to over 4500+ network hospitals in over 800 cities
  • The plan comes with no policy ceasing age
  • Tax benefit for the premiums paid towards HDFC ERGO Health Optima Vital plan
  • The policy offers lifelong renewability benefit
  • Options to choose from sum insured between Rs 1 lakh to 5 lakh
  • The policy offers easy switch without a hassle
  • A maximum of 4 adults and a maximum of 5 children can be covered under single premium

Benefits of HDFC ERGO Health Optima Vital Plan

Category Coverage
Sum Insured 1,2,3,4,5,10,15,20,25,30,35,40,45,50 (lakhs)
Coverage for 37 Critical Illnesses Cancer of Specified Severity, major burns, kidney failure, end-stage liver disease, apallic syndrome and so on
E-opinion in respect of a Critical Illness Second opinion from a medical practitioner

Additional Benefits under HDFC ERGO Health Optima Vital Plan

  • E-opinion - The insurer arranges for the second opinion from a medical expert from their panel if the insured requests. This benefit can be availed once in a policy tenure
  • Portability Benefit: The insurer ensures a smooth portability option in case you are not satisfied with the existing health insurance provider and want to shift to HDFC ERGO Health . You can browse over the plan according to your comfort and switch without losing the accumulated policy benefits such as NCB bonus or waiting period.
  • 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.
  • Tax Benefits - With HDFC ERGO Health Optima Vital plan, you can save on tax under Section 80D of Income Tax Act. The premiums paid towards the policy are exempted from the tax deduction.
  • Sum Insured Enhancement - The basic policy sum insured can be enhanced at the time of renewal if insured feels the existing SI insufficient. It may be subjected to medical test or the waiting period will be applied afresh depending on the amount up to which the sum insured is enhanced.

Waiting Period for HDFC ERGO Health Optima Vital Plan

  • Covered after 90 Days: Initial waiting period for paying off a regular claim arising out of a health condition
  • Covered after 4 years: Pre-existing illnesses

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

HDFC ERGO Health Optima Vital Plan: Policy Exclusions

HDFC ERGO Health Optima Plan cannot be claimed under below conditions:

  • No claim will be entertained within the first 90 days of the policy period
  • Claim arising due to pre-existing condition will be covered after 48 months of the waiting period
  • Any critical illness in the presence of HIV /AIDS or other related illness
  • Congenital internal and external diseases, mental disorder
  • Use of alcoholic or intoxicating substances leading to an adverse health condition
  • Health condition arising due to war or act of war, use of a nuclear weapon, chemical weapon or radiation of any kind
  • Any expenses arising from pregnancy, miscarriage, maternity or birth are excluded
  • If the insured person is involved in any illegal activity, breach of law or injury arising due to suicide or attempts the suicide
  • Participation in navy, military or air force operations, adventurous activities leading to injury or serious health conditions are not covered

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

Eligibility Criteria of HDFC ERGO Health Optima Vital Plan

Feature Age
Minimum entry age 18 years-25 years 
Maximum entry age 65 years
Renewal age lifelong
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
Policy Tenure 1 & 2 years
Sum Insured 1,00,000-5,00,00020,00,000 for age above 55 years

Discount to be Availed Under HDFC ERGO Health Optima Vital Plan

  • A 7.5% discount in case the policyholder pays 2 years premium in advance as a single

Pre- Policy Check-up:

A pre-policy medical test will be required in case of sum insured Rs. 6 lakh or more or it is compulsory for the age group 46 years or above. However, the insurer will reimburse the expenses incurred due to the test on acceptance of the policy proposal. The health-check up reports are valid for a period of 30 days.

HDFC ERGO Health Optima Vital Plan Renewal Process

HDFC ERGO Health Optima Vital Plan can be renewed either online or offline. Online renewal offers the comfort of renewing your policy even sitting at the office or lying on the bed. To renew your policy online, the insured has to follow certain steps.

Below are the steps of renewing the HDFC ERGO Health health insurance online:

  • Visit the official website of HDFC ERGO Health and navigate through 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 the 10-digit policy number and proceed
  • Calculate the premiums online and pay it using a credit/debit card or net banking
  • You’ll receive an instant renewal message with an acknowledgement. The renewed policy will be sent to the registered email Id. You can download the policy instantly.

The premiums are subject to change as per the prior approval from IRDA. However, the insurance company is obliged to intimate the insured about any change 3 months prior to the renewal date.

HDFC ERGO Health Optima Vital Plan Claim Process

HDFC ERGO Health ensures hassle-free claim settlement. However, you can claim your policy in a smooth manner only if you approach the right way. In this regard, the insurer has set certain easy steps to claim HDFC ERGO Health Maxima policy. In order to claim you're critical illness policy with HDFC ERGO Health :

  • Intimate the insurance provider about any event or occurrence that may lead to a claim within 14 days of the diagnosis from the first occurrence of the illness. A claim can be registered by calling at the 24x7 helpline number of the HDFC ERGO Health or writing to their official email ID.
  • A duly filled claim form shall be submitted along with the supporting documents within 45 days of completion of the survival clause
  • Any additional information must be submitted with 15 days of the request
  • Upon receiving and verification of the documents, the insurer will approve the admissible amount and settles the claim within 30 working days, from the receiving of the documents.
  • The payment will be transferred to the savings account of the policyholder. In case of delay in payment beyond the period of 7 days, the insurer is liable to pay an interest at 2% existing bank rate.

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

Documents Rquierd for Claiming HDFC ERGO Health Optima Vital

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

  • Duly filled and signed claim form by the insured
  • Copy of identity proof of the insured
  • A medical certificate confirming the diagnosis of critical illness from an authorised doctor with a higher qualification
  • Investigation reports/ other related documents reflecting the critical illness diagnosis
  • Original discharge letter / day care summary if any
  • Keep a copy of all documents for your record as well

Points to Remember: 

  • Cashless services can be availed only at a network hospital
  • The settlement will be done in the name of policyholder only
  • Without a complete claim form, the documentation is incomplete
  • In order to avail the policy benefits, the person with critical illness has to survived for a period of 45 days, from the first diagnosis
  • Delay in intimation of claim may lead to rejection of 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.

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