Overview
The HDFC ERGO Optima Restore is a comprehensive health insurance plan, with sum insured options ranging from ₹5 lakhs to ₹50 lakhs. It includes features such as pre- and post-hospitalization coverage of 60 to 180 days, respectively, daycare procedures, organ donor expenses, AYUSH treatments, and domiciliary hospitalization (all up to the base cover amount). Key highlights include the 100% Restore Benefit, Multiplier Benefit, preventive health check-ups, and no room rent restrictions. These features make it a versatile option for managing healthcare costs effectively.
Experts Review
Written by Nikhil Nair
Senior Writer
The HDFC ERGO Optima Restore plan stands out for its innovative benefits that enhance financial security during medical emergencies. The Restore Benefit is particularly noteworthy as it reinstates the base sum insured immediately after partial or complete utilization, making it ideal for multiple claims within a year. The Multiplier Benefit further adds value by increasing the sum insured by 50% annually, up to 100%, irrespective of claims made.
In addition, the absence of room rent restrictions, disease-wise sub-limits & co-payment allows policyholders to choose accommodations and get treatments without additional costs. Preventive health check-ups are covered annually regardless of claims, promoting early detection of medical conditions. Above all, HDFC ERGO’s strong claim settlement ratio of 98% and extensive network of over 13,000 hospitals ensure reliable and hassle-free access to healthcare services.
The plan is on the expensive side of the spectrum, which might be a drawback for individuals with limited budgets.
Pros
Feature set is satisfactory.
Premiums are relatively well priced.
Insurer has a solid track record with great claim and service metrics.
Cons
Maternity benefits not offered, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some.
HDFC Ergo
Key Insights
Founded
2002
HDFC Ergo was established 23 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
98% claims settled in 30 Days
HDFC Ergo settles 98% of all claims it receives demonstrating strong credibility.
Network Hospitals
13,000+
HDFC Ergo has a strong network with over 13,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
7 complaints per 10,000 claims registered
HDFC Ergo maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
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.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
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.
Pre existing diseases waiting
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.
Pre/Post hospitalization
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 - 60 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Add-ons
Protector
Recommended
Cover increases in line with inflation every year, and non-medical expenses are covered.
Unlimited Restore
Recommended
Restores the cover unlimited times up to 100% of the sum insured for any illness.
Individual Personal Accident
Paid out as a lump sum of 500% of sum insured for Accidental Death, Total Permanent Disability, Permanent Partial Disability up to a limit of ₹10000000, applicable only for the proposer.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 1 day, with a maximum payout of ₹1000 to 3000 for up to 30 days.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Admission for administration of Intra-articular or Intra-lesional injections, Supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc) or IV immunoglobulin infusion.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Sinusitis
Rhinitis
Tonsillitis
Cysts
Polyps
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
L
Lavanya R.
Restore Benefit reinstating base SI immediately after use is amazing. Great for multiple claims.
N
Naina T.
No room rent restrictions! This is a huge relief, can choose any room.
Q
Qadir W.
Covers AYUSH treatments and domiciliary hospitalization, which offers flexibility.
T
Tanvi Z.
It's an expensive plan. The premium is quite high compared to others.
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Frequently Asked Questions
Does Optima Restore have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Optima Restore have room rent restrictions?
Does Optima Restore offer a restoration benefit?
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