The HDFC Ergo Optima Secure Global Health Insurance Plan

The Optima Secure Global Health Insurance Plan, covering all the essential benefits, add-ons, and unique features.

Core Plan Benefits

1. Secure Benefit
   • Instant Double Coverage: Doubles the base coverage amount from day one without additional cost. For example, if you choose a base cover of INR 1 crore, this instantly becomes INR 2 crore.
2. Plus Benefit
   • Automatic Coverage Increase: After one year, the base cover increases by 50%, and after two years, it increases by 100%, regardless of claims made. For instance, a base cover of INR 1 crore becomes INR 1.5 crore after one year and INR 2 crore after two years.
3. Restore Benefit
   • Full Coverage Restoration: If a claim is made (either partial or total), the plan automatically restores 100% of the base cover, available for any subsequent claims within the same policy year.
4. Protect Benefit
   • Coverage for Non-Medical Expenses: Covers the costs of non-medical consumables (e.g., gloves, masks, hygiene items) used during hospitalization, which are often excluded from standard plans.
5. Global Health Cover
   • Emergency Overseas Coverage: Pays for emergency hospitalization expenses incurred outside India. Each overseas claim is subject to an INR 10,000 deductible.
6. Pre- and Post-Hospitalization Coverage
   • Extended Coverage Period: Unlike standard plans, this policy provides coverage for 60 days prior to hospitalization and 180 days after discharge. This benefit includes expenses such as tests, medications, and consultations related to the hospitalization.

Additional Coverage and Features

1. Home Healthcare
   • Treatment at Home: Covers costs for treatments conducted at home (available in select cities) if they would typically require hospitalization. This includes doctor visits, nursing care, and related medical expenses on a cashless basis.
2. Daily Cash Allowance for Shared Room Accommodation
   • Daily Cash Payout: Provides INR 800 per day for a maximum of INR 4,800 if hospitalized for over 48 hours in a shared room. This amount can help cover peripheral costs such as travel, food, and lodging for caregivers.
3. Preventive Health Check-Up
   • Annual Health Check: Allows policyholders to undergo preventive health checks every year regardless of claim history, with a sub-limit of INR 8,000 for individual policies and INR 15,000 for floater policies.
4. AYUSH Treatment
   • Alternative Medicine: Covers inpatient treatment costs for Ayurveda, Yoga, Naturopathy, Unani, Siddha, and Homeopathy therapies.
5. Emergency Ambulance Coverage
   • Ambulance Costs: Covers emergency road and air ambulance expenses, with air ambulance coverage up to INR 5 lakhs.
6. E-Opinion for Critical Illness
   • Second Opinion: Provides coverage for online consultations for any of the 51 critical illnesses listed in the policy, available through the insurer’s network.
7. Domiciliary Hospitalization
   • Home-Based Hospitalization: Covers treatment costs when hospitalization is required but not feasible, such as if the patient is unable to be moved to a hospital.
8. Organ Donor Expenses
   • Donor Medical Costs: Covers medical expenses incurred for the organ donor’s in-patient treatment, specifically for organ harvesting.

Optional Add-Ons

1. Overseas Travel Secure
   • Accompanying Person Coverage: If hospitalized abroad for over five days, the plan covers travel and accommodation costs for one companion:
     • Travel: Two-way air ticket expenses for the accompanying person.
     • Accommodation: Overseas stay costs up to INR 15,000 per day for a maximum of 30 days in a policy year.
2. Critical Illness Cover
   • Additional Illness Coverage: Coverage for 51 critical illnesses, with sum insured options ranging from INR 1 lakh to INR 2 crores (in multiples of 1 lakh). This add-on can be useful for high-cost treatments such as cancer, major organ transplants, or cardiac surgeries.
3. Unlimited Restore Benefit
   • Unlimited Restorations: Enables unlimited coverage restorations up to 100% of the base sum insured within a policy year, applying each time a claim is made.
4. Individual Personal Accident Rider
   • Accident Insurance: Provides a lump-sum payout in cases of accidental death, permanent total disablement, or permanent partial disablement. The sum insured can be up to 5 times the base plan, with a maximum limit of INR 1 crore.
5. Hospital Cash Benefit
   • Daily Allowance During Hospitalization: Offers daily payouts ranging from INR 500 to INR 10,000 (with a 30-day maximum) to cover out-of-pocket expenses.
6. Optima Wellbeing
   • Outpatient Benefit: Covers costs for various outpatient benefits such as routine doctor visits, diagnostic tests, and medications.

Discount Options

1. Aggregate Deductible Discount
   • Up to 56% Premium Discount: Opt for a deductible (from INR 25,000 up to INR 5 lakh) to reduce the premium by 14% to 56%.
2. Family and Loyalty Discounts
   • Multi-Family Member Discount: Receive a 10% discount if covering two or more family members under the same individual policy.
   • Loyalty Discount: A 2.5% discount is available if you hold an active retail insurance policy with a premium above INR 2,000.
3. Long-Term Policy Discount
   • Multi-Year Policy Discounts: Discounts of 7.5% for two-year policies and 10% for three-year policies.

Other Features and Exclusions

• Cashless Network: Access to over 16,000 network hospitals in India for cashless treatment.
• Lifetime Renewability: Coverage can be renewed for life, irrespective of claims or changes in health status.
• No Co-Payment Based on Location: There’s no location-based co-payment for treatment in any Indian city.
• Tax Benefits: Premium payments are eligible for tax deductions under Section 80D of the Income Tax Act.

Exclusions and Waiting Periods: Standard exclusions apply, including specific waiting periods of 30 days for new policies, 24 months for certain treatments, and 36 months for pre-existing diseases.

This plan provides extensive global coverage, innovative benefits like automatic coverage restoration and inflation-adjusted sum increases, plus an array of optional add-ons that can help meet specific healthcare needs.

1. What is the Optima Secure Global Health Insurance Plan?

• Answer: It’s a comprehensive health insurance plan offering global coverage, automatic coverage restoration, and unique benefits like instant double coverage and increased sum insured over time.

2. What are the benefits of the Optima Secure Health Insurance Plan?

• Answer: The plan includes instant double coverage, automatic increases in coverage, full restoration of coverage, non-medical expense coverage, and emergency overseas hospitalization.

3. Does Optima Secure provide coverage for international medical expenses?

• Answer: Yes, it covers emergency hospitalization expenses incurred outside India, subject to an INR 10,000 deductible.

4. What is the ‘Secure Benefit’ in Optima Secure?

• Answer: The ‘Secure Benefit’ automatically doubles the base coverage amount from day one without any additional cost.

5. How does the ‘Plus Benefit’ work in Optima Secure?

• Answer: The ‘Plus Benefit’ increases your base coverage by 50% after one year and 100% after two years, regardless of whether you make a claim.

6. What is the ‘Restore Benefit’ in this plan?

• Answer: The ‘Restore Benefit’ restores 100% of your base coverage after a claim, available for subsequent claims within the same policy year.

7. Does Optima Secure cover non-medical expenses during hospitalization?

• Answer: Yes, it covers non-medical expenses such as gloves, masks, and hygiene items that are typically excluded from other plans.

8. What is ‘Home Healthcare’ in the Optima Secure plan?

• Answer: Home Healthcare covers the cost of treatment at home for conditions that would normally require hospitalization, including doctor visits and nursing care.

9. Does Optima Secure cover AYUSH treatments?

• Answer: Yes, it covers inpatient treatment for alternative therapies like Ayurveda, Yoga, Unani, Siddha, and Homeopathy.

10. Can I get a second opinion for critical illness under Optima Secure?

• Answer: Yes, the plan provides coverage for second opinions for 51 critical illnesses through online consultations.

11. What is the ‘Unlimited Restore Benefit’?

• Answer: This add-on feature restores coverage up to 100% of your base sum insured an unlimited number of times during the policy year after a claim.

12. What is the daily cash allowance benefit in Optima Secure?

• Answer: If you’re hospitalized in a shared room for more than 48 hours, you receive INR 800 per day (up to INR 4,800) to cover peripheral expenses like travel, food, and lodging for caregivers.

13. Does Optima Secure cover organ donor expenses?

• Answer: Yes, it covers medical expenses for organ donors, including treatment for organ harvesting.

14. How can I reduce the premium of my Optima Secure policy?

• Answer: You can reduce your premium by choosing a deductible, applying for multi-family member or long-term policy discounts, and opting for add-ons like the Aggregate Deductible Discount.

15. Can I get health insurance for my family under Optima Secure?

• Answer: Yes, the plan offers family floater options with discounts for covering multiple family members.

16. Is Optima Secure health insurance valid globally?

• Answer: Yes, it provides global coverage, including emergency medical expenses abroad, with a deductible for overseas claims.

17. How does the Optima Secure plan handle pre-existing conditions?

• Answer: Pre-existing conditions are covered after a waiting period of 36 months, subject to terms and conditions.

18. What are the tax benefits of Optima Secure health insurance?

• Answer: Premium payments are eligible for tax deductions under Section 80D of the Income Tax Act.

19. What are the exclusions in Optima Secure health insurance?

• Answer: Common exclusions include waiting periods for pre-existing conditions, treatment for certain illnesses in the first 30 days, and specific treatments that require a waiting period of up to 2 years.

20. Is there lifetime renewability for Optima Secure?

• Answer: Yes, the Optima Secure plan offers lifetime renewability, ensuring coverage even if you make claims or experience changes in health.

21. Does Optima Secure offer any discounts?

• Answer: Yes, discounts are available for choosing higher deductibles, insuring multiple family members, long-term policies, and loyalty benefits.

22. What is the hospital cash benefit?

• Answer: The hospital cash benefit provides daily payouts (INR 500 to INR 10,000) for out-of-pocket expenses during hospitalization.

23. Does Optima Secure cover emergency ambulance services?

• Answer: Yes, it covers emergency ambulance costs, including air ambulance services up to INR 5 lakh.

24. What is domiciliary hospitalization?

• Answer: Domiciliary hospitalization covers medical treatment at home when hospitalization is not feasible due to a patient’s condition.

25. Can I opt for an individual personal accident rider?

• Answer: Yes, the individual personal accident rider offers a lump-sum payout for accidental death, total disability, or partial disability, with coverage up to 5 times the base plan sum insured.

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