HDFC ERGO Optima Senior Health Insurance Plan
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 (formerly known as Apollo Munich) Optima Senior Plan which you can consider for your parents. Here’s why:
Key Features of HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Plan
Optima Senior Health Plan by HDFC ERGO Health (formerly known as Apollo Munich) 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:
- Auto restoration of sum insured in case of overuse
- Lifelong renewability with no policy ceasing age
- Cashless hospitalisation facility at more than 4650 hospitals across the country
- The sum insured can be availed as individual and family floater basis
- Tax benefit to be earned as per the Income Tax Act of India for premiums paid
- Discount on the premium for covering more than 2 family members and opting for a long-term policy
- No premium loading in case of a claim made
HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Citizen Plan
|Sum insured options (Rs. in lakhs)||2,00,000, 300,000,500,000|
|In-patient Treatment Expenses||Covered|
|Emergency Ambulance Service||Covered|
HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Citizen Plan-Scope of Cover
- In-Patient Hospitalisation Expenses- The insurer compensates the medical expenses incurred during hospitalisation including the expenses such as room rent, nursing cost, doctor’s consultation fee, medicine costs, ICU rent, OT rent, cost of oxygen, X-ray, laboratory etc.
- Pre-Hospitalisation - The expenses spent on availing treatment for 30 days prior to hospitalisation
- Post-Hospitalisation - The expenses incurred due to availing treatment immediately 60 days post hospitalisation
- Day-Care Procedures - Expenses of listed 140 day-care procedures are covered which don’t require 24 hours of hospitalisation and are treated using the advanced technology
- Domiciliary Treatment - The expenses involved availing treatment at home, which would otherwise have required hospitalisation
- Organ Donor - Expenses spent while transplanting an organ from a donor are covered
- Emergency Ambulance -Ambulance expenses while transporting the insured from the spot of the incident up to Rs. 2000 per hospitalisation
- E-Opinion in Case of Critical Illness(optional) - Arrangements are made for availing e-onion from a practitioner of HDFC ERGO Health (formerly known as Apollo Munich) panel and expenses are covered. You can avail one opinion every policy year
Note: Copayment is applicable on room rent type & specific illness or surgeries
HDFC ERGO Health (formerly known as Apollo Munich) Senior Citizen Plan Premium Table
|Age Group||Sum Insured Options|
|above 85 years||42,497||57,032||96,402|
Additional Benefits of HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Plan
- Cumulative Bonus - for not claiming your insurance, the insurers offers a cumulative bonus of 5%, which can be availed as a discount on premium or increase of sum insured.
- Cashless Service - you can avail treatment free of cost under the cashless clause at more than 4600 hospitals in India. A pre-authorisation letter needs to be filled and submitted to the insurance company seeking permission for the cashless benefit. Once the insurer approves it, you can avail treatment free of cost.
- Enhancement of Sum Insured - In case you feel your current sum insured insufficient, you can enhance it. Provided it is done at the time of renewal and no claim has been made. In case you increase the SI one grid up, no medical test will be required. If the increase is more than one grip up, you may require a test or the waiting period will apply afresh depending on the amount up to which the sum insured is increased.
- Portability - Porting your insurance policy to HDFC ERGO Health (formerly known as Apollo Munich) is a hassle-free process, where the existing policy benefits are unaffected. You can port the policy without losing the accrued NCB benefit or no waiting period to be served afresh.
- Health Line Services & Discounts: you can avail Health Line services and discounts at associated hospitals, where discounts are offered on consultations all you need to do is to call the customer care and mention the customer ID to avail this facility. Get proper assistance in health-related counselling, primary consultation, health information, individual referrals, nutrition and diet.
Discounts to be Availed
- A 5% discount will be offered to the insured and spouse for choosing this plan of HDFC ERGO Health (formerly known as Apollo Munich)
- An additional 7.5% discount is offered for selecting a long-term policy with 2 years tenure
- No Claim Bonus: 5% discount for every claim-free year
Exclusions of HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Citizen Plan
The following situations are not covered by HDFC ERGO Health (formerly known as Apollo Munich) senior citizen plan:
- No claim will be entertained by the insurer which is made within initial 30 days of the policy period, except accidental claim.
- Pre-existing illness will be covered only after serving a waiting period of 3 years
- A 2 years waiting period is compulsory to serve for claiming your insurance for specific illnesses such as hernia, cataract, joint replacement etc.
- Expenses incurred while treating HIV or AIDS or other related diseases
- Claim arising due to the consumption of alcohol or intoxicating substances
- Injury due to war or an act of war or use of nuclear, chemical or biological weapons or radiation of any kind are excluded permanently
- Pregnancy, childbirth, dental treatment, external aids and appliances unless they are covered by your plan
- Congenital diseases, mental disorder or insanity, weight control treatments, cosmetic surgery and AUSH treatment are not covered
- Items of personal comfort and convenience
*Please refer to the original policy document for the full list of exclusions
Eligibility Criteria for HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Citizen Plan
Minimum Entry Age
Maximum Entry Age
1 & 2 years
HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Citizen Plan Renewal Terms
- HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Citizen plan comes with lifelong renewability due to which there is no maximum policy ceasing age. You can opt for this plan anytime even after the age of 61 years. However, the policy needs to renew in a year or two depending on the types of policy you’ve opted in order to ensure continuous policy benefits.
- There will be a grace period of 30 days offered for renewing an expired policy, in case you miss the actual renewal date.
- The applicable waiting period gets reduced by 1 year on every constant renewal of this plan.
- The premiums tend to change however with prior approval of IRDA only. The insurer is bound to inform the insured at least 3 months prior to the renewal due date if there is any change in terms of premium.
HDFC ERGO Health (formerly known as Apollo Munich) Optima Senior Citizen Plan Claim Process
A claim with HDFC ERGO Health (formerly known as Apollo Munich) 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 (formerly known as Apollo Munich) with a claim form and required documents||Register your claim with HDFC ERGO Health (formerly known as Apollo Munich) 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|
Easy Tips to Buy this Plan
- Avail maximum information about the plan regarding inclusions, exclusions, claim process etc. from the agent. If buying online check the details on the insurer’s website.
- Fill the application by mentioning the required details. Make sure the information provided are true.
- Handover the completed application form along with a premium cheque. When buying online, you can calculate the premium online and pay it using credit or debit card or through net banking
- You may require to undergo a medical test basic on the coverage taken, age and plan opted. The insurer will reimburse 50% of the total cost incurred
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