HDFC Ergo Optima Restore
Overview
Optima Restore is a popular health insurance plan offered by HDFC Ergo General Insurance Co. Limited. And rightly so. It is an all-inclusive health insurance plan that covers all the basic benefits and offers features that are useful. It does not impose harsh clauses such as a copay or any disease-specific limit.
It is a good pick for those looking for robust and comprehensive coverage.
Pros and Cons
- No room restriction – Pick any room to get the treatment you deserve.
- Pre and post-hospitalisation expenses are covered by the insurer.
- Restoration Benefit – 100% restoration of your base sum insured instantly after the first claim.
- 2X Multiplier – Get 50% cumulative bonus at renewal, max up to 100% of the base sum insured, irrespective of claims.
- Non-medical items coverage comes with an add-on.
- This plan is fairly expensive.
Plan Benefits
Never spills the bill
HDFC Ergo Optima Restore covers all hospitalisation and related expenses up to the sum insured. It does not include any copayment or disease-specific limit. A great feature that makes this plan robust and all-inclusive.
Pick any room you like
You don’t have to worry about your stay at the hospital anymore. The insurer covers your room rent with no restrictions so that you can get the treatment you deserve.
Covers pre and post-hospitalisation expenses
This plan also covers the cost of hospitalisation-related expenses up to 60 days before the admission and 180 days after the discharge. These include consultation fees, diagnostic tests, medication, physiotherapy sessions, and more.
Covers treatment expenses even if you are hospitalised for less than 24 hours
Many treatments or surgeries done under anaesthesia now require less than 24-hour hospitalisation. They are called day care treatments. The plan covers the cost of all such treatments fully.
Get coverage even if you are forced to be hospitalised at home
Are you forced to be hospitalised at home? Think of a situation when hospital beds are unavailable or the patient’s medical condition does not allow him to be moved to a nearby hospital. This is called domiciliary hospitalisation. The plan still covers the expenses related to hospitalisation if done under the supervision of a medical practitioner and exceeds 3 consecutive days.
Covers organ donor expenses
Organ transplant surgeries are expensive. Moreover, the donor also requires surgery to harvest the organ. But you don’t have to worry anymore. The insurer covers the cost of harvesting an organ from a donor in case you are the organ recipient.
Get coverage for road and air ambulance charges
The insurer also covers ambulance charges in case of an emergency. Road ambulance charges up to Rs. 2000 per hospitalisation and air ambulance charges up to Rs. 2.5 Lakh per hospitalisation is covered.
Get one-time restoration benefit
With the Restore Benefit feature, the insurer provides 100% restoration of your basic sum insured instantly after the first claim. The restoration triggers on complete or partial utilization of your base coverage and is available to all insured persons for subsequent claims under the inpatient benefit during the policy year.
2X Multiplier Benefit
This feature works exactly like a cumulative bonus. The insurer adds a sum equal to 50% of the base sum insured at each renewal, irrespective of any claims, subject to a maximum of 100% of the base sum insured. So your coverage doubles at the end of 2 policy years.
Get free preventive health check-up
The plan gives you access to free annual preventive health check-ups for all insured members from the 2nd policy year onwards, subject to limits.
Get daily cash benefit for choosing shared accommodation
You get a daily cash benefit of Rs. 800 or Rs. 1000, depending on your base sum insured, if you choose to stay in a shared accommodation during hospitalisation.
Stay active to get a discount on renewal premium
Maintain a healthy lifestyle by walking daily a set number of steps to earn reward points. Use these points to get up to an 8% discount on your next premium. Step counting is done via the insurer’s mobile app.
Add-ons
Unlimited Restore
With this add-on, you get unlimited restorations of the sum insured during a policy year upon full or partial exhaustion of the base cover. The restoration applies only to the subsequent claims (related or unrelated) in a policy year. This feature comes in handy in case of multiple hospitalisations during a policy year.
Protector – To cover Non-medical Items
This add-on offers double benefits. Your sum insured increases every year in line with inflation. Additionally, you get coverage for non-medical items, such as masks, syringes, gloves, etc. This is a must-have add-on.
Hospital Cash
With this add-on, you get a daily cash benefit of Rs. 1000 or Rs. 2000 for each day of hospitalisation to cover incidental expenses related to hospitalisation. The benefit is available for a maximum of 30 days per policy year.
Personal Accident Cover
This add-on pays a portion of the sum insured in case of death or permanent disablement resulting from an accident. This benefit has a separate sum insured equal to 5 times the base sum insured, subject to a maximum of Rs. 1 Crore.
Policy Conditions
| Sum Insured Range | Rs. 3 Lakh – Rs. 50 Lakh |
| Entry Age | 91 Days – 25 Years for dependent children, 18 Years – 65 Years for adults |
| Policy Tenure Options | 1, 2 Years |
| Coverage Types | Individual and Family Floater |
| Family Coverage | Up to 4 adults and 6 children under the family floater option; spouse, dependent children, parents, parents-in-law can be included |
| 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 treatments
- 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 the HDFC Ergo Optima Restore plan?
What is the Restore Benefit in Optima Restore, and how does it work?
Can I claim the Restore Benefit multiple times in a year?
What is the Multiplier Benefit under HDFC Ergo Optima Restore?
What hospitalisation expenses are covered under HDFC Ergo Optima Restore?
Is cashless hospitalisation available under HDFC Ergo Optima Secure?
Are there waiting periods under the plan?
- 30‑day initial waiting period (except accidents)
- 24‑month waiting for specific illnesses
- 36‑month waiting for pre‑existing conditions.
