Retirement age is a very sensitive phase of our life. When there is no regular flow of income, the probable health issues can pose a serious threat by taking a toll on one’s lifetime savings. Moreover, to meet the growing medical expenses of those regular doctors’ visits, a senior citizen plan is required.
Health insurance industry in India has witnessed many notable changes over a period. Gone are the days when you struggle for availing a health cover for your elderly parents. Earlier either the insurer denies to offer a plan or you end up paying a huge premium. But it is not the case now when buying health cover is easy even for super senior citizens as well. One such plan is HDFC ERGO Health Optima Senior Plan which you can consider for your parents. Here’s why:
Optima Senior Health Plan by HDFC ERGO Health Health Insurance offers comprehensive coverage with unique features like the Restore benefit under which the sum insured restores automatically in case you consume it during the policy tenure. It also provides you with a multiplier benefit where sum insured doubles your basic sum insured in 2 claim free years! Let’s delve into the basic policy features:
Category | Coverage |
Sum insured options (Rs. in lakhs) | 2,00,000, 300,000,500,000 |
In-patient Treatment Expenses | Covered |
Day-care Procedure | Covered |
Pre-Hospitalisation Expenses | Covered |
Post-hospitalisation Expenses | Covered |
Domiciliary Treatment | Covered |
Organ Donor | Covered |
Emergency Ambulance Service | Covered |
E-opinion | Covered |
Note: Copayment is applicable on room rent type & specific illness or surgeries
Age Group | Sum Insured Options | ||
20,00,000 | 3,00,000 | 5,00,000 | |
61-65 years | 11,932 | 14,615 | 22,553 |
60-70 years | 15,137 | 19,201 | 30,719 |
71-75 years | 18,367 | 23,986 | 39,428 |
76-80 years | 24,219 | 31,629 | 52,125 |
81-85 years | 32,051 | 42,433 | 70,849 |
above 85 years | 42,497 | 57,032 | 96,402 |
The following situations are not covered by HDFC ERGO Health senior citizen plan:
*Please refer to the original policy document for the full list of exclusions
Minimum Entry Age Maximum Entry Age Policy Tenure |
61 years No bar 1 & 2 years |
A claim with HDFC ERGO Health can be availed smoothly if the process is followed in the right way. In case of an in-patient hospitalisation, you can either go to any hospital of your preference in the insurer’s network list or outside the list. The only difference is if you go for the network hospital, you can avail cashless services, while in case of a non-network hospital you’ll have to pay the medical bills on you and claim for reimbursement later. Here is the claim process:
Network Hospital | Non-Network Hospital | ||
Planned Hospitalisation | Emergency Hospitalisation | Planned Hospitalisation | Emergency Hospitalisation |
Inform the insurer 7 days before hospitalisation | Get admitted to the hospital and inform the insurer as soon as possible | Inform the insurer 7 days before hospitalisation | Get admitted |
If authorisation is received, handover it along with an ID proof | Seek for pre-authorisation for cashless service and avail treatment free of cost, once it is approved. | Get admitted | Immediately inform the insurer |
At the time of discharge pay for the items that are excluded by the insurer | At the time of discharge pay for the items that are excluded by the insurer | Pay the medical bills at the time of discharge | Pay the medical bills at the time of discharge |
Verify the bills. Leave the original discharge letter and other related documents with the hospital authority | Verify the bills and sign on all the bills and the authorisation letter. Verify the bills. Leave the original discharge letter and other related documents along with a signed claim form with the hospital authority | Get the original bills and receipts, reports | Get the original bills and receipts, reports |
The insurer will settle the bill directly with the hospital | The insurer will settle the bill directly with the hospital | Register your claim with HDFC ERGO Health with a claim form and required documents | Register your claim with HDFC ERGO Health with a claim form and required documents |
In case insurer denies cashless service, then pay the bills on own and claim for reimbursement later | In case insurer denies cashless service, then pay the bills on own and claim for reimbursement later | Get the reimbursement up to an admissible amount | Get the reimbursement up to an admissible amount |
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