HDFC Ergo Optima Secure
Overview
HFDC Ergo Optima Secure is a comprehensive health insurance plan offered by HDFC Ergo General Insurance. This is a robust health insurance plan that covers all base health insurance benefits without any restrictions. The plan also offers some amazing features. The much talked about Secure Benefit doubles your cover amount from day 1 without any need to activate or claim it. Plus Benefit increases your coverage by another 100% over the next 2 years if you simply renew your cover with the insurer. It literally takes your health cover to 3X in 2 years without any related increase in premium.
HDFC Ergo Optima Secure is a fairly expensive health insurance plan. If you do not mind paying a high premium for a robust health insurance plan from the house of HDFC, HDFC Ergo Optima Secure is a great choice.
Pros and Cons
- Secure benefit – Provides 2X coverage from day 1. It’s automatic and you don’t need to activate it.
- Plus benefit – Adds 50% of base coverage after 1st renewal and another 50% after 2nd renewal, regardless of claims made.
- No room restrictions – Covers all room categories. Choose any room available in the hospital and you are fully covered.
- All daycare procedures covered – Covers minor surgeries or procedures that require less than 24 hour hospitalisation.
- Protect benefit – Covers cost of consumables (non-medical items) such as syringes, gloves, oxygen masks, reducing out-of-pocket expenses.
- Premium payment – Monthly payment option is available.
- Higher premiums – The extensive benefits come with a higher premium, making the plan expensive.
- Age-wise premium – Premiums increase annually with age.
- Long waiting period of 36 months on pre-existing illnesses.
- No maternity coverage.
Plan Benefits
Never spills the bill on you
HDFC Ergo Optima Secure covers all inpatient hospitalisation expenses at actuals up to sum insured. There are no disease-wise or other sub-limits. The plan ensures you never pay a portion of hospitalisation expenses out-of-pocket.
No room restrictions
HDFC Ergo Optima Secure covers all room categories. Pick any room available in the hospital to suit your lifestyle.
Secure Benefit – 2X Coverage from Day 1
You get 2X coverage from day 1. A policy with Rs. 10 Lakh base sum insured provides Rs. 20 Lakh coverage from day 1. It’s automatic and you don’t need to activate it.
100% Plus Benefit in 2 Years
Plus benefit in HDFC Ergo Optima Secure increases your coverage by 50% each on the 1st year 2nd renewal, irrespective of your claim status. This coupled with Secure Benefit takes your coverage to 3X in 2 years.
Automatic Restoration Benefit available
If you claim fully or partially under the policy once during a policy year, the insurer restores your sum insured once for subsequent hospitalisations during the policy year. If you want multiple such restorations during a policy year, you can buy an add-on.
All daycare procedures covered
In case you need to undergo a surgery or minor which requires less than 24 hour hospitalisation, your plan covers these medical costs too.
Pre and Post-hospitalisation expenses covered
Covers pre-hospitalisation and post-hospitalisation expenses up to sum insured for 60 and 180 days respectively. This covers your diagnostic tests, followup consultations, medication and other related expenses.
Alternative Medicine covered
Want to take ayurvedic or homeopathic treatment for your illness? This plan covers the hospitalisation expenses fully up to sum insured.
Get Free Annual Health Checkup
Undergo preventive health checkup once every policy year, all at the cost of your insurer. Free annual health checkups are available from 2nd policy year onwards subject to some limits.
Coverage for Home Healthcare
Want to avail treatment from the comfort of your home? Your insurer covers the cost on a cashless basis .
Get coverage even if you are forced to be hospitalised at home
Get full coverage from your insurer even if you are forced to be hospitalised at home due to health conditions or hospitals running out of beds. In health insurance parlance, this is called domiciliary hospitalisation.
Covers ambulance charges
Need an ambulance in case of a medical emergency? Don’t worry. The plan covers road as well as air ambulance charges (up to specified limits) in case of an emergency.
Covers organ harvesting cost in case of an organ transplant
If you are an organ recipient, your insurer will cover the hospitalisation expenses of the organ donor for harvesting the donated organ.
Get daily cash benefit if you choose to stay in a shared accommodation
If you choose to stay in a shared accommodation during hospitalisation, your insurer rewards you with a fixed daily cash benefit. This has a separate limit over and above your base coverage.
E-Opinion for Critical Illness
The insurer covers the expenses towards E-Opinion taken for any major critical illness once in a policy year. However, this benefit can be availed only at network provider healthcare centres.
You can choose a deductible
Multiple deductible options are available under this plan. Choose one of them to make the plan more affordable. However, choose a deductible with caution as it might pinch you while making a claim.
Policy Conditions
| Sum Insured Range | Rs. 5 Lakh – Rs. 2 Crore |
| Entry Age | 91 Days – 25 Years for dependent children, 18 Years onwards for adults |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | Individual, Multi-Individual and Family Floater |
| Family Coverage | Up to 4 adults and 6 children under the family floater option and 6 adults and 6 children under the multi-individual option. |
| Premium Payment | Monthly, Quarterly, Half-yearly, Annual |
Exclusions
Waiting Periods
- Initial Waiting Period: 30 days (except accidents)
- Specific Illness Waiting Period: 24 months.
- Waiting Period on Pre-Existing Diseases: 36 months
Medical Exclusions
- Congenital external diseases
- Maternity / Sterility or Infertility
- Obesity Control
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Unproven Treatment
- Dental Treatment
- Refractive Error Correction for less than 7.5 diopters
Non-Medical Exclusions
- Investigation and Evaluation
- Self-injury or attempt to suicide
- Alcoholism, drug or substance abuse
- Expenses for treatment necessitated by committing breach of law with criminal intent
- Expenses for treatment taken by a medical practitioner outside his discipline.
- War, terrorism, nuclear events
- Injuries from hazardous sports
About the Insurer
HDFC Ergo General Insurance is a joint venture between HDFC Ltd., one of India’s leading housing finance institutions, and ERGO International AG, the primary insurance entity of the Munich Re Group in Germany. Established in 2002, the company offers a broad range of insurance products including health, motor, travel, home, and cyber insurance, along with tailored solutions for businesses and enterprises.
HDFC Ergo is known for its strong digital presence and efficient claims service and remains a trusted name in the Indian insurance space.
Performance Highlights (FY24)
Turnover – Rs. 18,802 Crore
Claim Settlement Ratio – 97.94%
Incurred Claim Ratio – 87.70%
Volume of Claim Complaints – 6.89 / 10,000 claims
Network Hospitals – 13,000+
Get In Touch
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Frequently Asked Questions
What is Secure Benefit in HDFC Ergo Optima Secure?
The Secure Benefit in HDFC Ergo Optima Secure doubles your coverage immediately upon purchase at no extra cost. For example, if you choose a base sum insured of Rs. 5 Lakh, your total coverage becomes Rs. 10 Lakh from day 1.
How does the Plus Benefit work in HDFC Ergo Optima Secure?
Plus Benefit in HDFC Ergo Optima Secure increases your coverage by 50% of base sum insured upon 1st renewal and by another 50% upon 2nd renewal. Rs. 10 Lakh base sum insured grows to Rs. 15 Lakh after one year and to Rs. 20 Lakh after two years. Plus Benefit along with Secure Benefit effectively takes your coverage to 3X in two years.
Does HDFC Ergo Optima Secure offer restoration benefits?
Yes, HDFC Ergo Optima Secure offers one-time automatic restoration during a policy year upon full or partial exhaustion of coverage. However, multiple restorations are available as an add-on.
Is there a waiting period on pre-existing diseases under HDFC Ergo Optima Secure?
Yes, pre-existing diseases have a waiting period of 36 months before they are covered under the policy
Can I choose any hospital room during hospitalisation?
Yes, you can choose any room which is available in the hospital. Your insurer will cover the expenses.
Does HDFC Ergo Optima Secure cover non-medical expenses like PPE kits and gloves?
Yes, Protect Benefit under HDFC Ergo Optima Secure ensures coverage for non-medical expenses commonly incurred during hospitalisation, such as PPE kits, gloves, and masks, at no additional premium.
What sum insured options are available under HDFC Ergo Optima Secure?
HDFC Ergo Optima Secure offers sum insured options ranging from Rs. 5 Lakh to Rs. 2 Crore.
Does HDFC Ergo Optima Secure provide global coverage?
Yes, HDFC Ergo Optima Secure Global Plan variant provides coverage for emergency and planned treatments overseas, offering protection anywhere in the world. But, this variant is more expensive than the regular HDFC Ergo Optima Secure Plan.
Can I avail cashless treatment under HDFC Ergo Optima Secure?
Yes, HDFC Ergo offers cashless treatment at a vast network of 16000+ network provider hospitals across India. You can get cashless treatment at a network hospital for any of the covered conditions or treatments.
What policy tenure options are available under HDFC Ergo Optima Secure?
Tenure options of 1, 2 and 3 years are available under HDFC Ergo Optima Secure. You get a long term discount of 7.5% and 10% if you choose tenure options of 2 and 3 years respectively.
How does the aggregate deductible option work in HDFC Ergo Optima Secure?
The aggregate deductible in this plan allows you to reduce your premium commitment if you agree to pay a specified amount of claim out-of-pocket before your policy coverage becomes active in a policy year.
For instance, if you choose a deductible of Rs. 50,000, it can reduce your base premium by 40% for a sum insured up to Rs. 20 Lakh. In case of a claim, you pay the first Rs. 50,000 upfront. If the claim amount exceeds Rs. 50,000, your insurer pays the rest up to the sum insured.
Are maternity and newborn expenses covered under HDFC Ergo Optima Secure?
No, this plan does not provide coverage for maternity and newborn expenses.
Are daycare procedures covered under HDFC Ergo Optima Secure?
Yes, HDFC Ergo Optima Secure covers daycare procedures up to the sum insured.
Is there a co-payment clause in HDFC Ergo Optima Secure?
No, the plan does not have a co-payment clause.
Does HDFC Ergo Optima Secure offer coverage for AYUSH treatments?
Yes, if you want to consider alternative medicine, you are covered. AYUSH (Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy) hospitalisation expenses are covered up to the sum insured under this plan.
Are health check-ups included in HDFC Ergo Optima Secure policy benefits?
Yes, HDFC Ergo Optima Secure provides health check-ups every year from 2nd policy year onwards subject to a maximum limit, over and above the base sum insured.
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