HDFC ERGO Health Optima Vital

ALL YOU NEED TO KNOW

Features

Cover for 37 critical illnesses
Lumpsum payout irrespective of treatment cost
Coverage upto 50 lakhs
No cover ceasing age under the policy

Benefits

Provides financial security for you and your loved ones with Lumpsum payout in case of diagnosis with critical illness
Use payout to cover any miscellaneous expense incurred.
Save tax as per 80D

WHO IS ELIGIBLE TO BUY THIS POLICY?

This policy covers persons in the age group of 18 years onwards. A dependent child can be covered from 18 years to 25 years provided both parents are covered in a critical Illness policy of an Indian Insurer. The maximum age at entry is 65 years.
The policy will be valid for a period of 1 or 2 year(s) as opted. A 7.5% discount is offered on opting for a 2 year policy.
An individual and/or his family members namely spouse, dependent children, dependent parents are eligible for buying this policy.
The policy will be issued on individual sum insured basis only.
A maximum of 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. The 4 adults can be a combination of self, spouse and parents.

WHAT ALL CRITICAL ILLNESSES ARE COVERED?

Optima Vital insurance will pay the insured person the sum insured as a lumpsum amount for the identified critical illness, medical events or surgical procedures listed below.

(The Insured Person must survive 30 days from the date of confirmed diagnosis and defined severity)

Cancer of specified severity.
Kidney failure requiring regular dialysis.
Multiple sclerosis with persisting symptoms.
End Stage Liver Failure
Myocardinal Infraction (First heart attack of specific severity).
COMA of specified severity.
Third Degree Burns.
Goodpasture’s syndrome.
Apallic syndrome.
Aplastic anaemia.
Systemic lupus erythematosis.
Bacterial meningitis.
Multiple system atrophy.
Progressive scleroderma.

(Insured person must survive 30 days from the date of actual undergoing of the below procedures)

Open chest CABG.
Major organ/bone marrow transplant.
Aorta graft surgery.
Open heart replacement or repair of heart valve.
Pneumonectomy.
Pulmonary artery graft surgery.

(Insured Person must survive 90 days from the date of confirmed diagnosis of below defined events)

Primary Parkinson’s disease.
Alzheimer’s disease.
Motor neuron disease with permanent symptoms.
Stroke resulting in permanent symptoms.
Permanent paralysis of limbs.
Primary (idiopathic) pulmonary hypertension.
Benign brain tumor.
Cardiomyopathy.
End stage lung Failure.
Brain surgery.
Progressive supranuclear palsy.
Creutzfeldt-jakob disease. (CJD)
Major head trauma.
Encephalitis.

(Insured person must exhibit permanent impairment for 6 months from the occurrence of the event)

Blindness.
Deafness.
Loss of speech.

Note: Please refer to the policy wording to learn more details regarding the specific definitions and listed conditions required to be fulfilled while accepting a critical illness claim

WHAT OTHER BENEFITS ARE AVAILABLE?

E-opinion: On request of the insured person diagnosed with a critical illness, We will arrange for a second opinion from a medical practitioner selected by the insured person from Our panel. This benefit can be availed once in a policy year.
Tax Benefit: With the critical illness insurance plan you can currently avail tax benefits for the premium amount under Section 80D of the Income Tax Act. (Tax benefits are subject to changes in Tax Laws)

WHAT WILL NOT BE COVERED?

All illnesses & treatments within the first 90 days of the cover.
Any pre-existing condition will be covered after a waiting period of 48 months.
Any critical illness in presence of HIV infection and / or any AIDS.
Congenital internal and external diseases, defects or anomalies.
Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
War or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
Any treatment arising from pregnancy (including voluntary termination), miscarriage, maternity or birth (including caesarean section).

Note: Please refer to the Policy Wording for the complete list of exclusions

WHAT WOULD BE THE PROCEDURE FOR MAKING CLAIMS?

Critical Illness

Intimate HDFC ERGO Health within 14 days of diagnosis of first occurrence of critical illness.
Submit a duly filled claim form along with specified documents within 45 days of completion of survival period for the critical Illness against which the claim is made.
Any additional information requested must be submitted within 15 days of our request.

E-opinion

Please submit duly filled claim form along with the copy of all medical reports including investigation reports and discharge summary (if any) at any of HDFC ERGO Health’s branch office.
You need to select our panel doctor from whom you would prefer to take the second opinion.
(Please refer HDFC ERGO Health’s website or call at 24 X 7 toll free line to obtain the list of our panel doctors).
On receipt of the complete set of documents, we will forward the same to the concerned doctor.

FURTHER QUERIES?

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 care@hdfcergo.com

Commission on General Insurance