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Optima Secure is HDFC ERGO's hospital plan for someone who wants the sum insured on the proposal to be backed by extra cover, not only by a bonus that depends on a claim-free year. You choose a base sum insured from ₹5 lakh to ₹2 crore. On this variant, an equal amount is available in the same policy year as the Secure Benefit. The insurer uses the base first. Whatever is left of that extra amount does not carry into the next year. The policy can cover one person or a family floater. A floater can include a spouse, dependent children, parents, and parents-in-law, within the family-size limits printed on the policy. A two-year or three-year term is still accounted for one policy year at a time. Renewal is not refused because a claim was paid, and cover does not have to stop at a maximum age.
The base sum insured is paired with an equal Secure Benefit in the same policy year. Illness waiting periods still apply.
Finzony treats Optima Secure as a hospital plan for a family that can pay a full retail premium and wants a large admission to be able to go past the base sum insured. The useful detail is the order of payment, not a slogan. The base is used first, then any Plus Benefit that has already built up, then the Secure Benefit. A later admission in the same year can draw on a one-time restore of the base. A single admission cannot spend that restored amount. The waiting periods are the ordinary retail-health clocks, and they are long if a condition already exists. A new illness waits 30 days, a named list of procedures waits 24 months, and a declared pre-existing disease waits 36 months. Buying this plan does not cancel those clocks. Hospitalisation caused by an accident is the exception to the first two waits. Two limits are easy to miss. Restoration on the base plan happens once in the policy year. Unlimited restoration is a separate add-on. Plus Benefit, which grows even after a claim, reaches an extra amount equal to the base only after two continuous renewals. Maternity, routine outpatient visits, and treatment outside India are not standard benefits of this variant.
In the Optima Secure variant, the policy year includes an extra amount equal to the base sum insured. It can be used for more than one admissible claim, but only after the base sum insured is exhausted. It is applied once in the year. Any unused portion is dropped at renewal rather than carried forward. On a floater, the family shares it.
Optima Super Secure and the global variants set a different extra amount. This page is only the Optima Secure column.
On each continuous renewal, HDFC ERGO adds 50% of the expiring base sum insured, whether or not a claim was paid. The added amount stops growing once it equals 100% of the base, which takes two renewals. It is shared on a floater and is available for the base hospital covers and for Protect Benefit when that cover is in force.
A break in renewal stops the accumulation. A new member added later starts their own Plus Benefit clock.
An admissible inpatient stay of at least 24 hours can include room, boarding, and nursing as charged by the hospital, ICU, surgeon and specialist fees, medicines, operation-theatre charges, and an implant placed during surgery. Day care does not need the 24-hour stay. Road ambulance to or between hospitals in the same city is included when it follows an emergency or a covered admission.
A separate add-on that lifts the once-a-year cap on restoration. The base Optima Secure plan does not include it.
Buy it only if a second and third large admission in the same year is the risk you are paying to cover.
HDFC ERGO's hospital-cash add-on pays a daily cash amount for a covered stay. You choose the daily benefit when you buy the add-on. It is not part of the base premium.
The daily amount and the maximum stay are on the add-on schedule, not on this page.
A separate critical-illness add-on can pay a lump sum if a listed major illness is diagnosed. It has its own sum insured and its own conditions. It is not the same thing as the hospital indemnity cover.
An accident rider can be attached, sized from the base plan and capped by the rider's own maximum. It pays for accidental death or disability under the rider wording, not for illness hospitalisation.
You can choose an annual deductible so that HDFC ERGO starts paying admissible claims only after that amount has been borne in the policy year. On a floater, the family shares one deductible. It is a way to reduce premium, not a way to add cover.
The deductible can be reduced or waived later only on the narrow terms in the policy, including age and a minimum number of continuous years. Do not assume that option will be open.
The conditions and procedures below sit behind the 24-month specified-illness wait, even when they begin after the policy starts. If one of them is also a pre-existing disease, the longer 36-month wait applies. Accident claims are not held to this list. This is a reading list of the names that matter most, not a substitute for the schedule.
A new illness is not covered in the first 30 days. Hospitalisation caused by an accident is not held to this wait. The wait also drops away once the person has already had continuous cover for more than twelve months.
The named conditions and surgeries wait two years of continuous cover. An accident claim is not held to this list. If a listed condition is also a pre-existing disease, the longer wait applies.
A condition present before the policy, and its direct complications, waits 36 months. Cover after that depends on the condition having been declared and accepted. The increased portion of a later sum-insured hike starts this wait again.
These clocks start from the first Optima Secure start date with HDFC ERGO. Time already served on another Indian health policy can be credited if you port, under IRDAI portability rules. Raising the sum insured later starts the waits again on the increased portion only. The renewal grace period keeps continuity if the premium is paid inside it, but a treatment during the unpaid gap is not covered.
Insurer
HDFC ERGO Health Insurance plans and claim process
No. Optima Secure is the hospital plan whose Secure Benefit equals the base sum insured. Optima Lite is a separate, smaller HDFC ERGO plan. Optima Super Secure and the global variants are separate rows as well, with different extra-cover amounts.
On this variant, an amount equal to the base sum insured is available in the first policy year as Secure Benefit. The insurer spends the base first, and only then that extra amount. It is not a second policy, and it does not skip the illness waiting periods.
Disclaimer: Premium amounts are indicative and may vary based on age, health, and plan selected. Claim settlement ratios are from IRDAI Annual Reports. Finzony is not an insurance broker or agent. Verify all details on the official HDFC ERGO Health Insurance website before purchasing.
The base hospital section does not write a room-rent percentage. Read the schedule anyway, because a sub-limit printed there would override a general description.
Medical costs that belong to an admissible admission are covered for up to 60 days before the admission and up to 180 days after discharge. Organ-donor hospitalisation can be covered when the insured person is the recipient and the donor claim meets the transplant rules. The donor's own pre- and post-hospitalisation costs, and the cost of moving or storing the organ, are not part of that cover.
If the base sum insured is partly or fully used by a claim in the policy year, HDFC ERGO puts an amount up to that base back for later claims. This happens once in the year. It does not increase what a single admission can be paid. Unused restored cover does not carry into the next year. On a floater, the family shares the restored amount.
A single claim in the year cannot exceed the base, any Plus Benefit already earned, and Secure Benefit. The restored sum insured is for a subsequent claim.
When Protect Benefit is in force, listed non-medical items on an admissible hospital bill, such as gloves and masks, can be paid instead of being deducted. The product filing lists this with the optional covers and then builds it into some plan variants.
Confirm that the schedule shows Protect Benefit as in force before you rely on consumables being paid.
Home health care can stand in for an inpatient stay when a doctor prescribes it and HDFC ERGO approves it first. It is not available as a reimbursement you file afterwards. Domiciliary treatment applies when the person cannot be moved to a hospital, or when no room is available. Inpatient AYUSH treatment in an AYUSH hospital is covered up to the schedule sub-limit.
On each continuous renewal, the insurer pays for a preventive health check-up for a person who was covered in the previous year, up to the amount on the schedule. The unused amount does not roll forward, and the benefit is not paid if the policy is not renewed. It does not reduce the sum insured.
The rupee limit depends on the base sum insured and on whether the policy is individual or floater. Check the schedule rather than a blog figure.
Unused Secure Benefit is not carried into the next year. Plus Benefit is the part that builds on renewal: 50% of the base after one continuous year, and 100% of the base after two, even if you have claimed.
The base hospital cover pays room, boarding, nursing, and ICU as part of the hospital bill, and that section does not set a room-rent percentage. Your schedule is still the document that matters. If a sub-limit is printed there, that figure applies.
Yes. A floater can include a spouse, dependent children, parents, and parents-in-law, up to the family-size limits on the policy. Everyone on that policy shares one sum insured. A child ages out of the floater at 25.
HDFC ERGO does not refuse renewal because you claimed, and it does not load the renewal premium from your own claim history. Plus Benefit is also added on renewal even when a claim was paid, as long as you renew without a break.
No. Childbirth, caesarean delivery, miscarriage, and fertility treatment are exclusions. The policy describes ectopic pregnancy as the exception. There is no maternity add-on described on this plan page because it is not a standard Optima Secure benefit.
The premium depends on age, the people covered, the sum insured, the term, and any deductible or add-on. A single rupee figure would be wrong for most buyers. Quote it on HDFC ERGO's site for the actual ages and cover.