Overview
HDFC ERGO's Optima Secure stands out in the health insurance landscape by offering 4X coverage of your original sum insured (2X from day 1 and 3X after two consecutive years). ensuring peace of mind for individuals and families alike. Add to this a vast, cashless hospital network of over 13,000 facilities, wellness benefits, and high flexibility in sum insured (from ₹5 lakh up to ₹2 crore,), and you have a plan that is both extensive and future-ready.
Experts Review
Written by Nikhil Nair
Senior Writer
Optima Secure by HDFC ERGO combines innovation, transparency, and genuine usability. The plan's most striking proposition is its 4X coverage mechanism. Unlike typical no-claim bonuses that slowly stack up and reset upon a claim, Optima Secure guarantees your sum insured will be doubled immediately (Secure Benefit) and then topped up to 4X levels in subsequent years (Plus Benefit and Restore Benefit), regardless of claims.
What’s truly impressive is its built-in Protect Benefit, which covers the often overlooked non-medical expenses like gloves, masks, and consumables. Most health plans tend to exclude these, but with Optima Secure, it’s all part of the package. On the flexibility front, it offers various add-ons, from, hospital cash, unlimited restore, accident and OPD coverage with the Optima Wellbeing add-on.
On the downside, those who prefer “plain vanilla” plans with the lowest premium may find this offering on the higher side, especially in Tier 1 cities, although the extra coverage and benefits do justify the difference. Waiting periods and certain exclusions are in line with market norms, and the customer experience promises (quick cashless claims, multilingual service) reflect HDFC ERGO’s scale.
Pros
Offers a wide range of features.
Premiums are relatively well priced.
Insurer has a solid track record with great claim and service metrics.
Offers 2x Secure Benefit, which makes this policy stand out.
Cons
Maternity benefits not offered, which is a notable gap. Need to opt add-on for maternity cover.
Doctor consultations are not covered, which could be a drawback for some. Need to opt add-on for doctor consultations.
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
2x Secure Benefit
STANDOUT
You get 2x the cover you pay for: When you buy a policy with a cover of 10 lakhs for instance, you are automatically entitled to a cover of 20 Lakhs starting from day 1.
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.
Customisable
For any illness: Pre existing disease waiting period is modified/reduced from 3 years to 1 and 2 years.
Customisable
For Asthma, Hypertension, Cholesterol, Diabetes: Pre existing disease waiting period is reduced from 3 years to 30 days.
Add-ons
Unlimited Restoration
Recommended
Restores the cover unlimited times up to 100% of the sum insured for any illness.
ABCD Chronic Care
Recommended
For Asthma, Hypertension, Cholesterol, Diabetes: Pre existing disease waiting period is reduced from 3 years to 30 days.
Optima Well-being
Recommended
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.
Aggregate Deductible
Choose deductible between ₹25,000 and ₹5,00,000 and get a discount on premiums.
Parenthood
Maternity expenses covered between ₹50,000 and ₹2,00,000 after a waiting period of 2 years.
Reduction in PED
For any illness: Pre existing disease waiting period is modified/reduced from 3 years to 1 and 2 years.
Hospital Cash
Hospital cash benefit paid out if hospitalization is at least 1 day, with a maximum payout of ₹1000 to 2000 for up to 30 days.
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 ₹10,000,000, applicable only for the proposer.
Limitless
Unlimited coverage (without any upper cap) for a specified number of claims during the Policy lifetime.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
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.
Services for terminally ill individuals addressing non-medical needs are 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.
Internal congenital diseases
Non-infective arthritis
Pilonidal sinus
Diseases of the gallbladder, including cholecystitis
Calculus diseases of the urogenital system (e.g., kidney stones, urinary bladder stones)
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting periodCustomisable
Ditto's Take
◦ Excellent ◦
Waiting periods on this policy are excellent. This policy also further allows to reduce the PED waiting period to 1 and 2 years for all diseases and to 30 days for certain diseases.
What's missing in the policy
Maternity benefits not offered. Need to opt add-on for maternity cover.
Doctor consultations are not covered. Need to opt add-on for doctor consultations.
Compare Policies
Still confused?
Talk to our expert
advisor for
instant clarity
Frequently Asked Questions
Does Optima Secure 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 Secure have room rent restrictions?
Does Optima Secure offer a restoration benefit?
TALK TO OUR ADVISORS
Get real help from advisors who listen, guide and go the extra mile for you.