HDFC Ergo
Optima Lite
HDFC Ergo’s new policy, Optima Lite, is a new variant of Optima Secure Family and is supposed to be an affordable alternative for Optima Secure. Now, while the policy does have some pros in the form of unlimited restoration features, no disease-wise sub-limits, and other basic features, the plan has quite a few caveats, too. Whether you are talking about room rent restrictions, limited access to the plan (not available in Tier 1 cities), low in-built bonus (only 10% up to 100%), or inadequate coverage (5 lakhs or 7.5 lakhs) - the Optima Lite plan has it all. In a nutshell, the plan’s affordability comes at the cost of its lack of comprehensiveness. You might want to figure out if this is a trade-off you want to side with.
What's good here?
You’ll never have to split the bill
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
You always have full cover irrespective of the disease
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Unlimited Restoration Benefit
Even after you claim part of the cover on one occasion, you will be allowed to claim the full cover any number of times repeatedly if you are hospitalized in the future. All in the same year by the way!!!
Free Health Checkups
If you’re planning on getting a full body checkup every year just to make sure you’re in fine working condition, the insurer will cover the costs.
Covers Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will cover you fully, up to the sum insured.
Pre & Post hospitalization expenses covered
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Day Care treatments covered
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs too. Think dialysis, chemotherapy or minor surgeries.
Full coverage even if you are forced to hospitalize at home
The insurer will bear the costs even if you are hospitalized at home due to a condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.
What's bad here?
Restrictions on the rooms you can pick and much more
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more - Read more here
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more - Read more here
What's okay here?
Reasonable waiting period for pre-existing diseases
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Special Bonus for being healthy
Your sum insured increases by 10% each year, even if you've claimed in the previous year. But before you get too ahead of yourself, do note that they’ll stop offering you the bonus when your sum insured increases by 100%. But hey, it's still a bonus.
Add-ons
Hospital Daily Cash
The insurer pays a lumpsum by adding a fixed sum (daily cash) every day until the day of discharge so you can deal with any potential loss in income during this time. The money will be reimbursed to you after you submit the required documents post-discharge, and while this looks like a neat benefit to have, we don’t recommend it since the benefit doesn’t compensate for the extra premium you pay.
Aggregate Deductible
If you ever have to make a claim, then you’ll be expected to pay a sum before insurance company settles the claim. This amount is called the deductible. So if you want to buy a policy at a better price, you can opt to pay a higher deductible i.e. you can pay lower premiums by offering to pay a sum (a deductible) when a claim comes up.
Optima Well-being
With this add-on, each insured member can avail of unlimited tele and in-clinic consultations with General Physicians from network-partnered facilities. Additionally, one can avail of free home sample collection and discounts on tests taken from partnered facilities. They can also take unlimited online fitness classes, counselling sessions for mental health, diet and nutrition from partnered facilities.
Protect Benefit
With this add-on, you also get extended coverage for generally excluded items like syringes, gloves, PPE kits etc.
Critical Illness
You’ll be entitled to receive the full cover once you’re diagnosed with any of the 51 critical diseases listed in the policy brochure. However, since the premiums here keep changing as you grow older, it may make more financial sense to buy a critical illness cover with term plans at better rates.
Individual Personal Accident
The add-on pays a portion of the cover amount to customers in the event the policy holder had to deal with deaths, injuries, and partial or total disability resulting from an accident.
Reduction in PED
This optional cover reduces the applicable pre-existing waiting period from 36 months to either 24 months or 12 months. If you are currently diagnosed with any condition and want to reduce the waiting period, it makes sense to opt for this add-on.
Plus Benefit
Every time you renew your policy, the insurance provider will grant you additional bonus cover totaling 50% of your sum insured. And they will continue doing this until the total cover adds up to 100% of the base sum insured.
Frequently Asked Questions
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