Key Benefits

• Secure Benefit

2X Coverage from Day 1

Secure Benefit instantly doubles the base sum insured you choose, giving you 2X coverage right from day one. This enhancement is automatic and built into the plan, with no additional premium and no activation required. From the very start of your policy, your coverage works harder for you.

• Plus Benefit

100% Increase in Coverage After 2 Years

With the Plus Benefit, your base sum insured grows automatically over time. It increases by 50% after the first year and doubles after two years, regardless of whether you make a claim. There is no dependency on earning a no-claim bonus, ensuring uninterrupted growth in your coverage.

• Restore Benefit

100% Restoration of Base Cover

If you make a claim during the policy year, the Restore Benefit automatically reinstates 100% of your base sum insured. Whether the claim is partial or full, your coverage is restored without any extra cost, so you remain financially protected for subsequent medical needs within the same year.

• Protect Benefit

No Deduction for Non-Medical Expenses

The Protect Benefit covers listed non-medical expenses, including consumables such as gloves, masks, and nebuliser kits, during hospitalisation. These costs are often excluded under standard health plans. With Optima Secure, they are covered automatically, without additional charges.

Together, these in-built benefits combine to provide up to 4X the coverage of your chosen base sum insured, delivering enhanced protection without increasing your premium.

• Organ Donor Expenses

Get reimbursements for medical expenses incurred for organ donor’s in-patient treatment for harvesting of the organ donated.

• Preventive Health Check-Up

Note:

• For an Individual policy, the limit applies per insured member.

• For a Floater policy, the limit applies once per policy year for the entire family.

How Optima Secure Works

Let’s understand how Optima Secure works

Suppose you choose an Optima Secure Policy with a base cover of ₹10 lakh. Here’s how your coverage grows and strengthens over time:

1. Secure Benefit

Instant 2X Coverage

From day one, your ₹10 lakh base cover is automatically doubled to ₹20 lakh. This enhancement is built into the plan and comes at no additional cost.

2. Plus Benefit

Coverage Increases Over Time

When you renew your policy:

• After 1 year: Your base cover increases by 50% (₹10 lakh becomes ₹15 lakh)

• After 2 years: Your base cover doubles (₹10 lakh becomes ₹20 lakh)

When combined with the Secure Benefit, your total available coverage becomes ₹30 lakh.

3. Restore Benefit

100% Restoration of Base Cover

If you make a partial or full claim of your ₹10 lakh base cover during the policy year, 100% of that base cover is automatically restored.

For example, if ₹10 lakh is claimed:

• Existing available coverage: ₹30 lakh

• Restored base cover: ₹10 lakh

• Total available coverage: ₹40 lakh

This ensures you remain financially protected even after a claim.

4. Protect Benefit

Coverage for Non-Medical Expenses

During hospitalisation, non-medical expenses such as consumables (gloves, masks, syringes, etc.) — which can add 10–20% to the total bill — are also covered under the Protect Benefit, without any additional premium.

5. 4X Coverage After 2 Years

With Optima Secure, a ₹10 lakh base cover can eventually grow to ₹40 lakh in total available coverage after 2 years — thanks to the combined impact of the Secure, Plus, and Restore Benefits.

This means your effective coverage can become 4X your chosen base sum insured, offering significantly enhanced financial protection over time.

6. Optional Deductible Benefit

By choosing to pay the first ₹25,000 of a claim in a policy year (voluntary deductible option), you can receive a 25% discount on your premium.

For example, a premium of ₹26,700 can reduce to ₹20,025.

• Extended Pre and Post Hospitalisation Coverage

Covers medical expenses incurred 60 days before and 180 days after hospitalisation, instead of the usual 30 and 90 days. This includes diagnostic tests, medicines, and other related medical costs within the specified period.

• Home Healthcare Coverage

Covers medical treatment taken at home that would otherwise require hospitalisation.
Includes expenses such as doctor consultations, nursing charges, and prescribed medical services — available on a cashless basis where applicable.

• Daily Cash for Shared Accommodation

Provides ₹800 per day (up to ₹4,800 per hospitalisation) if you opt for a shared room in a network hospital and the stay exceeds 48 hours.
This benefit helps offset out-of-pocket expenses such as travel, food, and caregiver costs.

• E-Opinion for Critical Illnesses

Provides access to e-opinion consultations for 51 critical illnesses through network providers in India. Covers teleconsultation or online consultation expenses for listed conditions.

• Hospitalisation Expenses

Covers inpatient hospitalisation costs including:

• Room rent (as per eligibility)

• ICU charges

• Nursing expenses

• Surgeon’s fees

• Road ambulance charges

• Day care treatments requiring hospitalisation for less than 24 hours

• AYUSH Treatment Coverage

Covers in-patient treatment expenses for alternative systems of medicine such as:

• Ayurveda

• Yoga and Naturopathy

• Unani

• Siddha

• Homeopathy

• Domiciliary Hospitalisation

Covers medical expenses incurred for treatment taken at home when hospitalisation is medically required but not feasible.

• Emergency Air Ambulance

Covers air ambulance transportation charges during medical emergencies, subject to policy terms.

• Extensive Hospital Network

You also gain access to 16,000+ network hospitals and healthcare service providers, enabling cashless treatment across India.

• Optional Add-On: Aggregate Deductible (Value Buy Option)

You can opt for a voluntary deductible — an amount you agree to pay per policy year at the time of claim. Post this deductible, the policy coverage applies.

Choosing a higher deductible can help you avail significant premium discounts (up to 65%), depending on the Sum Insured selected.

Standard Exclusions

The policy does not cover expenses arising from the following (as per policy terms and conditions):

• Investigation and evaluation for diagnostic purposes only

• Obesity control and related treatments

• Cosmetic or aesthetic surgery (unless medically necessary)

• Participation in hazardous or adventure sports

• Treatment arising from breach of law

• Alcoholism, drug or substance abuse

• Unproven or experimental treatments

• Sterility and infertility treatments

• Maternity expenses

Please refer to the detailed policy wording for the complete list of exclusions.

Waiting Periods

The following waiting periods apply from the policy inception date:

• 30 days initial waiting period (except for accidental injuries)

• 24 months waiting period for specified illnesses and surgical procedures

• 36 months waiting period for pre-existing diseases

Continuity benefits may apply for policies renewed without a break, subject to terms and conditions.

Important Regulatory Disclosure

Section 41 of the Insurance Act, 1938 (Prohibition of Rebates)

1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to take out or renew or continue an insurance policy in respect of any kind of risk relating to lives or property in India, any rebate of the whole or part of the commission payable or any rebate of premium shown on the policy. No person shall accept any rebate except as allowed in accordance with the published prospectus or tables of the insurer.

2. Any person making default in complying with the provisions of this section shall be liable for a penalty as prescribed under the Act.

• Life-long Renewal

The policy offers life-long renewal, irrespective of your health condition or claims made under the policy. Renewal may be denied only on grounds of fraud, misrepresentation, or non-disclosure by the insured.

• Waiting Period Reduction

With every continuous renewal of the policy, the applicable waiting periods mentioned in the policy wording are reduced by one year, subject to terms and conditions.

• Renewal Premium

Premiums are subject to change with prior approval from the Insurance Regulatory and Development Authority of India (IRDAI).

Any change in premium or benefits (other than due to change in age) will be made only with regulatory approval and will be communicated at least 3 months in advance.

• Withdrawal of Policy

In the event of withdrawal of this policy in the future, the insured will be informed at least 3 months prior to the expiry of the policy.

The insured will have the option to migrate to a similar indemnity health insurance policy available at the time of renewal, with accrued continuity benefits and waiver of waiting periods, provided the policy has been maintained without a break, in accordance with IRDAI portability and migration guidelines.

• Migration

An insured person has the option to migrate to a similar indemnity health insurance policy available at the time of renewal, subject to underwriting guidelines.

All accrued continuity benefits and waiting period waivers will be carried forward, provided the policy has been renewed without interruption and as per IRDAI portability/migration norms.

• Portability

The plan allows portability from another insurer. If you are insured under another health insurance policy, you may transfer to HDFC ERGO General Insurance Company Limited at the time of renewal.

Your accrued benefits, including waiting period credits, will be carried forward subject to underwriting guidelines and applicable IRDAI regulations.