About HDFC ERGO Optima Restore Plan
HDFC ERGO Optima Restore provides enhanced medical coverage to safeguard the health of individuals and families with the help of the restore benefit. It pays for the emergency and planned medical expenditures incurred on hospitalization, ambulance services, day care procedures, domiciliary treatment, etc. It also has other attractive benefits like the multiplier benefit, daily cash for choosing shared accommodation, preventive health check-ups, etc.
HDFC ERGO Optima Restore Plan: Key Highlights
| Categories | Specifications |
|---|---|
| Coverage | ₹3 lakh to 1 crore |
| Pre-policy Medical Check-up | 3 years |
| Specific Diseases Waiting Period | 2 years |
| Discount | 10% family discount 7.5% multi-year discount 5% online discount 2.5% loyalty discount |
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Key Benefits of HDFC ERGO Optima Restore Plan
HDFC ERGO Optima Restore Plan Inclusions, Exclusions & Optional Cover
Inclusion of HDFC ERGO Optima Restore Plan may differ from one plan to another. Some of the inclusions that are common under all the policies are given below:
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In-patient TreatmentIt pays for the cost of hospitalization of at least 24 hours, including room rent, doctor’s fees, nursing fees, OT expenses, etc.
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Pre-hospitalization ExpensesIt covers medical expenses incurred for up to 60 days before being admitted to a hospital.
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Post-hospitalization ExpensesIt pays for the medical expenses incurred for up to 180 days after hospital discharge.
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Day Care ProceduresIt covers the cost of medical procedures and treatments requiring less than 24 hours of hospitalization.
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Domiciliary TreatmentIt pays for the medical expenses incurred on home hospitalization if being admitted to a hospital is not possible.
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Organ Donor ExpensesIt covers the cost of harvesting the organ donated for the transplant surgery of the insured.
Exclusion of HDFC ERGO Optima Restore Plan may differ from one plan to another. Some of the inclusions that are common under all the policies are given below:
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Dental treatments
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Maternity expenses
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Hospitalization due to abuse of intoxicants like drugs and alcohol
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External aids and appliances
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Hospitalization due to war or acts of war
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Non-allopathic treatments
Optional Cover of HDFC ERGO Optima Restore Plan may differ from one plan to another. Some of the inclusions that are common under all the policies are given below:
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Unlimited Restore BenefitIt restores the base sum insured of the policy by unlimited times in a policy year regardless of partial or complete exhaustion of the sum insured.
In case of emergency we are just a call away. Take care of your family, we will do the rest. Our claim specialists will reach your location & complete the formalties from filing the claim to documentation to coordinating with insurer, TPA & hospital. Available in New Delhi and 114+ cities View cities list ›Policybazaar Claim Process
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HDFC ERGO Optima Restore Plan: FAQs
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Q: Is cataract surgery covered in Optima Restore?
Ans: Yes. The HDFC ERGO Optima Restore policy covers the cost of cataract surgery but after a waiting period of 2 years.
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Q: Does Optima Restore cover accidents?
Ans: Yes. Hospitalizations arising from an accidental injury are covered by the HDFC ERGO Optima Restore policy from day 1.
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Q: How does Optima Restore work?
Ans: The HDFC ERGO Optima Restore policy comes with the restore benefit that reinstates the base sum insured by 100% in case of partial or complete utilization. This benefit is available once a year unless you opt for the unlimited restore benefit.
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Q. What is the advantage of selecting a policy with a duration of more than 1 year?
Ans: If one buys Aditya Birla Health Insurance for more than a year, one can save 7.5 % and 10% on the 2 and 3 years premium, respectively.
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Q. How is an Individual cover different from a Floater cover?
Ans: In an Individual cover, coverage is offered to each individual in the family separately. In a Family Floater health insurance plan, each family member is covered based on a floater sum insured.
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Q. How is an Individual cover different from a Floater cover?
Ans: In an Individual cover, coverage is offered to each individual in the family separately. In a Family Floater health insurance plan, each family member is covered based on a floater sum insured.
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Q. What is a waiver of a mandatory co-pay cover?
Ans: This benefit is covered on payment of an additional premium. Therefore, any mandatory co-payment that is applicable under the Aditya Birla Activ Health Essential Plan will be waived off.
HDFC ERGO offers two types of claim settlements – cashless and reimbursement. Follow the steps to raise a claim:
- Find the nearest network hospital of HDFC ERGO
- Get admitted to the hospital
- Notify the insurance company about the hospitalization
- In case of pre-planned hospitalization, intimate the insurer before hospital admission.
- Fill up the pre-authorization form and submit it to the hospital staff
- The pre-authorization form will be sent to HDFC ERGO for approval.
- Once approved, obtain medical treatment.
- At the time of discharge, sign all the medical documents.
- Pay for the items/services not covered under the HDFC ERGO policy
- The network hospital will send the hospital bill to HDFC ERGO.
- After review, the insurance company will pay the bill amount directly to the network hospital.
- Inform the insurance company about the hospitalization
- In case of planned hospitalization, notify the insurer before hospital admission.
- Receive medical treatment
- At the time of discharge, pay the entire hospital bill in full.
- Collect all the medical documents, bills and payment receipts
Our Claim specialists in below cities will reach your hospital or home in 30 minutes to support your health insurance claim
