HDFC Ergo Optima Secure In-depth Review

Whatever you expect a good health insurance plan to offer, HDFC Ergo Optima Secure has it all. It has no limitations or cappings for any treatment, covers almost all costs and offers 2 times cover from day 1 under the policy at no extra cost. All these features make it a great health insurance plan.  But what are the limitations of HDFC Ergo Optima Secure? And who should buy this plan?  We will look into all this in this in-depth review of HCFC Ergo Optima Secure.

Highlights of HDFC Ergo Optima Secure Plan

Secure Benefit – This feature doubles your health cover under the plan from day 1 at no extra cost. If you take a base cover of Rs. 10 Lakh, you get cover of Rs. 20 Lakh from day 1. This is an amazing feature and no other plan in the market offers this. Plus Benefit – This feature is similar to no claim bonus (NCB). Your base cover increases by 50% on 1st renewal and 100% by 2nd renewal irrespective of your claim status and does not reduce even if you make a claim later. If you start with a base cover of Rs. 10 Lakh, your cover grows to Rs. 15 Lakh after 1 year and Rs. 20 Lakh after 2 years. This coupled with the secure benefit makes your cover Rs. 30 Lakh after 2 years. 

Other Features

Room Rent and Hospitalisation Expenses – Room rent and hospitalisation expenses are covered at actuals up to sum insured. There are no cappings or limits which makes HDFC Ergo Optima Secure policy a great choice.

Protect Benefit – Protect benefit covers the cost of all consumable items at actuals. You don’t have to pay anything from your pocket to fully cover your hospital bill.

Pre and Post Hospitalisation Expenses – Pre and post hospitalisation expenses are covered for 60 and 180 days respectively at actuals.

Restore Benefit – One time restore benefit is available from 2nd claim onwards during a policy year. However, multiple restoration benefits come at an added cost.

Other Benefits – Day care treatments, alternative treatments, home health care and organ donor expenses are also covered at actuals. Emergency road ambulance benefit up to sum insured and air ambulance benefit up to Rs. 5 Lakh is also available.

No Copay – This plan comes with zone wise premiums. However, you can take treatment anywhere in India without any copayment, irrespective of where you bought the policy. This ensures that your policy never spills the bill.

Policy Conditions

You can choose from a wide range of cover amount from Rs. 5 Lakh to Rs. 2 Crore in HDFC Ergo Optima Secure Plan Minimum age at entry for a dependent child is 91 days and maximum age is 25 years. Minimum age at entry for an adult is 18 years and maximum is 65 years. However, once you have bought the policy, lifelong renewal is available for adults. You can buy the policy as a family floater or multi individual. A multi individual policy covers 2 or more individuals under one policy with each family member having separate coverage individually. You can add upto 4 adults and 6 children in a policy which is great. You can choose policy tenure from 1 to 3 years depending on your choice.

What’s NOT good in HDFC Ergo Optima Secure?

HDFC Ergo Optima Secure offers great features but it is quite an expensive health insurance plan.  Also premiums in this plan are charged age wise so expect your premium to increase every year with age. Whereas other health insurance plans mostly charge premiums age band wise. The plan also has a waiting period of 36 months for pre-existing diseases which is standard yet long. Some other health insurance plans offer a reduction in the waiting period with extra cost. HDFC Optima secure does not have that feature.

About HDFC Ergo General Insurance

HDFC Ergo Optima Secure is the most selling health offering by HDFC Ergo General Insurance. The company was promoted by erstwhile HDFC Limited and Ergo International AG in 2002. Post the amalgamation of HDFC Limited with HDFC Bank Limited, HDFC Ergo has become a subsidiary of HDFC Bank. HDFC Ergo General Insurance is a leading private general insurer in India with a track record of over 2 decades. HDFC Ergo General Insurance has one of the highest claim settlement ratios in the health insurance industry. For the financial year 2023-24, its claim settlement ratio by number of policies was 97.94% and by amount was 87.15%. However, its incurred claim ratio is also high with the last 3 years average being 83.89% [Source – NL- 37 & NL – 20 data of IRDAI] If we look at the combined ratio, it’s more than 1 which means the insurer is spending more on claim settlement and other expenses when compared to net premiums it is earning. Its last 3 years average combined ratio is 107.64%. This can be a cause of worry. Talking about volume of claim related complaints, the company performs really well. Last 3 years the average volume of claim complaints is around 7 which is impressive.  The insurer also has tied up with 13000+ hospitals throughout the country so you can easily avail cashless facility when required.

Should you buy HDFC Ergo Optima Secure?

HDFC Ergo Optima secure is a robust plan with great features. The plan has no sub-limits or copay so your hospital bill will never be spilled over to you. The insurer has performed well and looks good and quite efficient in its claim settlement process.  This plan is great for those who do not have any special health care requirements. So if you do not have any problem with its premium pricing, this plan is good for you.