How does the waiting period affect my coverage?

The HDFC ERGO Optima Restore plan imposes a 30-day initial waiting period for all illnesses, excluding accidents. Specific treatments and pre-existing conditions have waiting periods of 24 and 36 months, respectively.

What happens if I don’t use my health insurance benefits for the entire year?

With no claims in a policy year, the Optima Restore plan offers a Multiplier Benefit, increasing your sum insured by 50% for the first claim-free year and up to 100% after two consecutive claim-free years.

Will my health insurance cover treatment abroad?

The HDFC ERGO Optima Restore plan does not provide coverage for treatments received outside India.

What is the sum insured restoration feature in the Optima Restore Plan?

The Optima Restore Plan offers an instant 100% restoration of your basic sum insured (and any earned multiplier) after your first claim—whether partial or full—and allows one such restoration per policy year (or unlimited if you opt for the “Unlimited Restore” add-on), available for future claims only, and expires if unused

OneAssure

Health Insurance

HDFC ERGO

Optima Restore

HDFC ERGO Optima Restore

Experience India's most trusted health insurance with HDFC ERGO Health Insurance. Get instant cashless treatment at 15000 network hospitals with sum insured up to ₹50 lakhs.

95

Claim Settlement Ratio

15000

Network Hospitals

9.4

Customer Rating

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95

Claim Settlement Ratio

15000

Network Hospitals

9.4

Customer Rating

Our Verdict

Expert Review: HDFC ERGO Health Insurance

Final Verdict

The HDFC ERGO Health Optima Restore Plan offers comprehensive coverage with unique Restore and Multiplier Benefits. Ideal for families and individuals seeking robust financial protection and rewarding no-claim incentives.

About

About HDFC ERGO Health Insurance

The HDFC ERGO Health Optima Restore Plan offers ₹3 lakh to ₹50 lakh in coverage, including hospitalization, pre-hospitalization (60 days), post-hospitalization (180 days), and daycare procedures. Its Restore Benefit reinstates 100% of the sum insured, while the Multiplier Benefit increases coverage by 50% per claim-free year, doubling in two years. It also provides preventive health check-ups at renewal. This plan ensures comprehensive coverage, financial security, and proactive health management, making it ideal for individuals and families.

The HDFC ERGO Health Optima Restore Plan offers ₹3 lakh to ₹50 lakh in coverage, including hospitalization, pre-hospitalization (60 days), post-hospitalization (180 days), and daycare procedures. Its Restore Benefit reinstates 100% of the sum insured, while the Multiplier Benefit increases coverage by 50% per claim-free year, doubling in two years. It also provides preventive health check-ups at renewal. This plan ensures comprehensive coverage, financial security, and proactive health management, making it ideal for individuals and...

Inclusions and Exclusions

Inclusions and Exclusions of HDFC ERGO Insurance Company Limited

Room Rent

Normal: Single A/c Private room
ICU: No Limit

Co-payment

All person(s) named in the schedule to this policy above the age of 80 years (age last birthday) shall bear a co-pay of 10% for each and every claim.

Waiting Period

Initial Waiting Period: 30 days from the policy's inception, applicable to all illnesses except those resulting from accidents.
Specific Diseases and Treatments: 24 months for certain listed illnesses and surgical procedures.
Pre-existing Diseases: 36 months before coverage begins for any pre-existing conditions declared at the time of policy purchase.

Cashless Healthcare Providers

16000+ network hospitals

Daycare Treatment

All day care treatments available. Expenses of Hospitalization for a minimum period of 24 consecutive hours only shall be admissible.

AYUSH Treatment

AYUSH is Covered up to Sum Insured.

Room Rent

Normal: Single A/c Private room
ICU: No Limit

Co-payment

All person(s) named in the schedule to this policy above the age of 80 years (age last birthday) shall bear a co-pay of 10% for each and every claim.

Waiting Period

Initial Waiting Period: 30 days from the policy's inception, applicable to all illnesses except those resulting from accidents.
Specific Diseases and Treatments: 24 months for certain listed illnesses and surgical procedures.
Pre-existing Diseases: 36 months before coverage begins for any pre-existing conditions declared at the time of policy purchase.

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Exclusions

No coverage for any illness, except accidental injuries, occurring within the first 30 days of policy commencement.
Conditions existing before policy inception are covered only after a continuous waiting period of 36 months.
Certain ailments and procedures, such as cataract, hernia, and joint replacement, have a 24-month waiting period before coverage begins.
Medical expenses arising from self-harm, including suicide attempts, are not covered under this policy.
Treatment costs related to alcohol or drug misuse and associated complications are excluded from coverage.
Expenses for cosmetic or plastic surgeries aimed at enhancing appearance are not covered unless medically necessary due to injury.
Medical expenses for fertility treatments, assisted conception, or related procedures are excluded from the policy.
Routine dental care, including dentures and oral surgeries, is not covered unless required due to an accident.

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About the company

HDFC Ltd., India’s top financial services company, and ERGO International, part of Munich Re Group of Germany. The company offers a wide range of insurance products, including health, motor, travel, home, and commercial insurance. In health insurance, HDFC ERGO is known for flexible plans, large coverage options, and easy claim processes. It has a wide hospital network across the country for cashless treatments. The company also provides modern services like wellness programs, online claim filing, and round-the-clock support. HDFC ERGO is trusted by millions of customers for its reliable service and transparent policies. With strong financial backing and global expertise, it combines local understanding with international standards. The company focuses on customer satisfaction and aims to provide affordable protection for families, individuals, and businesses across...

HDFC Ltd., India’s top financial services company, and ERGO International, part of Munich Re Group of Germany. The company offers a wide range of insurance products, including health, motor, travel, home, and commercial insurance. In health insurance, HDFC ERGO is known for flexible plans, large coverage options, and easy claim processes. It has a wide hospital network across the country for cashless treatments. The company also provides modern services like wellness programs, online claim filing,...