HDFC ERGO Health Optima Restore Plan

HDFC ERGO Health Optima Restore Plan

HDFC ERGO Health Optima Restore Plan



Product Features

Optima Restore

Sum Insured

Rs 3 Lac, 5 Lac, 10 Lac, 15 Lac, 20 Lac, 25 Lac, 50 Lac

In-patient Treatment

Hospitalization charges more than 24 hours is covered


Medical expenses incurred in 60 days before the hospitalisation are covered


Medical expenses incurred in 180 days after the hospitalisation are covered

Day care Procedures

All day care procedures are covered

Domiciliary Hospitalization

Medical expenses incurred for availing medical treatment at home due to health conditions or unavailability of bed at the hospital, which would otherwise have required hospitalisation.

Ambulance Cover

Upto Rs. 2,000 per hospitalisation for utilizing ambulance service for transporting insured person to hospital in case of an emergency is covered

Organ Donor Expenses

Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient is covered

Restore Benefit

Instant addition of 100% Basic Sum Insured on complete or partial utilization of Your existing Policy Sum Insured and Multiplier Benefit (if applicable) during the Policy Year. The restore sum insured can be used to all claims including claims for same illness/disease for which a claim has already been paid.
However, single claim in a Policy Year cannot exceed the sum of Basic Sum Insured and Multiplier Benefit (if any)

Multiplier Benefit

50% increase in your basic sum insured for every claim free year, subject to a maximum of 100%. In case a claim is made during a policy year, the limit under this benefit would be reduced by 50% of the basic sum insured in the following year. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy

Preventive Health Check-up

Preventive Health Check-up available on all Sum Insured above 3 lac on renewals irrespective of claims

E-Opinion in respect of a Critical Illness

Second opinion by a Medical Practitioner from Our panel, for a Critical Illness suffered during the policy period.
“Critical Illness” includes Cancer of Specified Severity, Open Chest CABG, Myocardial Infarction (First Heart Attack of specific severity), Kidney Failure requiring regular dialysis, Major Organ/Bone Marrow Transplant, Multiple Sclerosis with Persisting Symptoms, Permanent Paralysis of Limbs and Stroke resulting in permanent symptoms

Emergency Air Ambulance

Expenses upto 2.5 lacs for ambulance transportation in an airplane or helicopter for emergency life threatening health conditions is covered. This cover is available for Sum Insured of 10 lac and above

Stay Active Benefit

We encourage you to stay healthy and fit, with Stay Active benefit, simply walk your way to good health and earn upto 8% discount on your renewal premium.

Critical Advantage Rider (optional)

You can opt to cover yourself worldwide at our network centers against treatment expenses for 8 major illnesses that include Cancer, Coronary Artery by-pass surgery, Heart Valve replacement / repair, Neurosurgery, Live Donor Organ Transplant, Bone Marrow Transplant, Pulmonary artery graft surgery and Aorta Graft Surgery. The rider offers you freedom to not only avail best healthcare services world over but also covers all travel costs for the insured and accompanying relative, accommodation expenses, second opinion & post hospitalization expenses. This rider will be offered where base policy Sum Insured is Rs.10 lacs & above. This rider can be issued to an individual and/or family only on individual Sum Insured basis.


  • Comprehensive range of Sum Insured from 3 Lac to 50 Lac
  • Coverage for hospitalization, pre and post hospitalization, day care expenses and more
  • Restore Benefit automatically adds 100% sum insured on complete or partial utilization of your Sum Insured
  • Multiplier benefit doubles your sum insured in 2 claim free years
  • Preventive Health check-up benefit offered at renewal irrespective of claim status
  • We encourage you to stay fit and with Stay Active benefit, simply walk your way to good health and earn upto 8% discount on your renewal premium.
  • No sub-limit on room rent: With Optima Restore you can get the room you like and the treatment you deserve without a hassle
  • Policy term option of 1 and 2 year, and is available for both individuals and family
  • Family Discount of 10% if 2 or more family members are covered under Optima Restore Individual Sum Insured Plan, and an additional 7.5% discount is offered on the premium if you choose a 2 year policy
  • Cashless treatment at network hospitals
  • Life-long renewability, subject to regular receipt of premiums by Us.
  • Tax benefits under 80D of Income Tax Act*

*Tax benefit are subject to changes in tax laws. Please consult your tax advisor for more details.


In case of any further queries or to know more about the product you can contact our Customer Care 022-6234-6234 or write to us at


What are the eligibility criteria for the plan?
We offer coverage from the age of 91days onwards with maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).

  • You and/ or your family members namely spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on individual sum insured basis.
  • Maximum 6 members can be added in a single policy. In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy.
  • Your premium at renewal may change due to a change in your age or changes in the applicable tax rate.
  • In a family floater policy, a maximum of 2 adults and a maximum of 5 children can be included in a single policy. The 2 adults can be a combination of self, spouse, father and mother or father in law and mother in law

What are the waiting periods in the policy?
The following waiting period would apply for the policy
All treatments within the first 30 days of cover except any accidental injury Any pre-existing condition will be covered after a waiting period of 3 years A waiting period of 24 months from the first policy commencement date will be applicable to the medical and surgical treatment of illnesses / diagnoses or surgical procedures mentioned in the following table even if the underlying cause is accident.However this waiting period will not be applicable where the underlying cause is cancer(s).

Organ / Organ System

Illness / diagnoses (irrespective of treatments medical or surgical)

Surgeries / procedure (irrespective of any illness / diagnosis other than cancers)

Ear, Nose & Throat (ENT)








Surgery for Nasal septum deviation

Surgery for Turbinate hypertrophy

Nasal concha resection

Nasal polypectomy


Cysts, polyps including breast lumps

Polycystic ovarian diseases




Prolapsed Uterus



Non infective arthritis

Gout and Rheumatism


Ligament, Tendon and Meniscal tear

Prolapsed inter vertebral disk

Joint replacement surgeries





Fissure/fistula in anus, Haemorrhoids, Pilonidal sinus

Gastro Esophageal Reflux Disorder (GERD), Ulcer and erosion of stomach and duodenum

Cirrhosis (However Alcoholic cirrhosis is permanently excluded)

Perineal and Perianal Abscess

Rectal Prolapse


Surgery of hernia


Calculus diseases of Urogenital system including Kidney, ureter, bladder stones

Benign Hyperplasia of prostate


Surgery on prostate

Surgery for Hydrocele/ Rectocele



Retinal detachment





Surgery of varicose veins and varicose ulcers

(Applicable to all organ systems/organs whether or not described above)

Benign tumors of Non infectious cysts, nodules, polyps, lump, growth, etc


What is restore benefit?
We will instantly add 100% of basic sum insured on complete or partial utilization of your existing policy sum insured and multiplier benefit (if applicable) during the policy year. the total amount (basic sum insured, multiplier benefit and restore sum insured) will be available to all insured persons for all claims under in-patient benefit during the current policy year and subject to the condition that single claim in a policy year cannot exceed the sum of basic sum insured and the multiplier benefit (if applicable). 

Conditions for Restore benefit: 
a. The sum insured will be restored only once in a policy year. 
b. If the restored sum insured is not utilized in a policy year, it will expire.
In case of a family floater policy, restore sum insured will be available on floater basis for all insured persons in the policy

If the first claim itself is over and above the basic sum insured + multiplier benefit, then in that case will the restore sum insured triggered can be utilized for that same claim or only for the next future claims.

Restore will be triggered after the 1st claim, irrespective of the 1st claim amount and can be used for future claims.

What is the minimum and maximum entry age in Optima Restore product?
For Policy Holder: the Minimum entry age is 18 years and Maximum entry age is 65 years For Adult Dependent: Minimum entry age is 18 years and Maximum entry age is 65 years & for Child dependent: the Minimum entry age is 91days and Maximum entry age is 25 years. Children between 91 days and 5 years can be insured if either parent is covered under this policy.