HDFC ERGO Health Insurance Mediclaim insurance

HDFC ERGO Health Mediclaim insurance

• Key highlights of HDFC ERGO Health Insurance

  HDFC ERGO Health Insurance is a joint venture between The Apollo Hospitals Group and Munich Health, world leaders in health insurance, a company which is part of the Munich Re Group, one of the largest Property & Casualty Reinsurers in the world. The company, headquartered in Gurgaon, is one of the largest standalone health insurers in India and offers a comprehensive range of Health, Personal Accident and Travel insurance solutions across its 40 branches across major metros in the country. They also have a strong distribution network of 25,000 individual agents and Bancassurance relationships with some of the leading Private and Public sector banks in the country. HDFC ERGO Health is also extremely active in the Corporate Health insurance space.

• Optima Restore – Individual

  Energy is another unique product from the AMHI stable and is a plan tailormade for Diabetes patients. It is essentially a wellness management program for individuals with Type 1 Diabetes, Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and/or Hypertension. It offers Day 1 coverage for all hospitalisation arising out of Diabetes and Hypertension (with no waiting period). The plan is also a combined package providing coverage for Inpatient hospitalisation expenses along with an availability of wellness solutions & health rewards for monitoring your health and earning rewards accordingly. The plan covers:

  • Individuals from the age of 18 years to 65 years for individuals with Type 1 Diabetes, Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and/or Hypertension.
  • There are 8 sum insured options from ₹2 lacs upto ₹50 lacs
  • The plan has 2 variants – Gold (cost of wellness test included) & Silver (cost of wellness test excluded), both available with/ without the co-payment option of 20%.
  • The policy will be issued for 1 year.

  The plan coves Pre & Post Hospitalisation, 182 Day Care procedures, Organ Donor, Emergency Ambulance and Shared Accommodation benefit. There is also a Restore facility of 100% of the Sum insured, a Cumulative Bonus benefit for every claim free year

  Optima Restore – Individual
  Basic Sum insured per insured person per policy year (in ₹ INR)	3,00,000	5,00,000	10,00,000	15,00,000	20,00,000 / 25,00,000 / 50,00,000
  In-patient Treatment	Covered
  Pre-Hospitalization	Covered, upto 60 Days
  Post-Hospitalization	Covered, upto 180 Days
  Day Care Treatment	Covered
  Domiciliary Treatment/Home Treatment	Covered
  Treatment for Organ Donor	Covered
  Daily cash for Choosing shared accommodation	800 per day, Maximum 4,800				1,000 per day, Maximum 4,800
  Emergency Ambulance	Upto Rs.2,000 per Hospitalisation
  E-opinion in respect of critical illnesses	Covered
  Emergency Air Ambulance Cover	Not Covered		Covered upto 2,50,000 Lacs per hospitalization and maximum upto sum insured in an year
  2) Restore Benefit	Equal to 100% of basic sum insured
  3) Multiplier Benefit	Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%.In case of claim, bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy
  4)Health Checkup	Not covered	Upto 1,500	Upto 2,000	Upto 4,000	Upto 5,000
  5) Critical Advantage (Illness) Rider	Offered (where base Sum Insured is 10 lacs & above)

  Energy- Diabetes Plan

  Optima Restore Family Floater plan is designed specially to cover a family which can include your spouse, dependent children, parents and parents-in-law. The primary insured can choose from seven sum insured variants from ₹3 lacs, ₹5 lacs, ₹10 lacs, ₹15 lacs, ₹20 lacs, ₹25 lacs and ₹50 lacs. The plan also includes unique benefits such as Restore, Multiplier and Stay Active.
  
  With Restore benefit even if any family member uses the sum insured partially or fully, instantly an additional 100% of the sum insured will be added to the insured’s policy, and the restored sum insured would be available to everyone covered under the plan. It is applicable once during a policy year. Similarly the Multiplier benefit rewards the insured with a 100% increase in sum insured for every two claim free years. The Stay Active benefit rewards customers who lead an active lifestyle, the benefit allows a customer to enjoy premium discounts simply by exercising.
  
  The plan also covers Pre & Post Hospitalisation, Domiciliary Expenses, Day Care Treatments, Organ Donor, Daily Cash, E-Opinion (which is a second opinion), Emergency Ambulance Expenses (including Air Ambulance), Health Check-up and Critical Advantage Rider. Other criteria include:

  • Coverage is offered from the age of 5 years till maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
  • The Primary Insured you’re their family members namely spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on floater sum insured basis.
  • The policy period options include period of 1 or 2 years(s).

  Optima Restore Family Floater
  Basic Sum insured per insured person per policy year( figs in ₹ INR))	3,00,000	5,00,000	10,00,000	15,00,000	20,00,000 / 25,00,000 / 50,00,000
  1) Inpatient treatment	Covered
  Pre-hospitalisation	Covered, upto 60 days
  Post hospitalisation	Covered upto 180 days
  Day Care procedures	All Day Care Treatment Covered
  Domiciliary treatment	Covered
  Organ donor	Covered
  Daily cash for Choosing shared accommodation	800 per day, Maximum 4,800				1,000 per day, Maximum 4,800
  Emergency Ambulance	upto 2,000 per hospitalisation
  E-opinion in respect of critical illnesses	Covered
  Emergency Air Ambulance Cover	Not Covered		Covered upto 2.5 Lacs per hospitalization and maximum upto sum insured in an year
  2) Restore Benefit	Equal to 100% of basic sum insured
  3) Multiplier Benefit	Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%.In case of claim, bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy
  4) Health Checkup	Not covered	Upto 2,500	Upto 5,000	Upto 8,000	Upto 10,000
  5) Critical Advantage Rider	Offered (where base Sum Insured is 10 lacs & above)

• Optima Restore – Family Floater

  Optima Restore Family Floater plan is designed specially to cover a family which can include your spouse, dependent children, parents and parents-in-law. The primary insured can choose from seven sum insured variants from ₹3 lacs, ₹5 lacs, ₹10 lacs, ₹15 lacs, ₹20 lacs, ₹25 lacs and ₹50 lacs. The plan also includes unique benefits such as Restore, Multiplier and Stay Active.

  With Restore benefit even if any family member uses the sum insured partially or fully, instantly an additional 100% of the sum insured will be added to the insured’s policy, and the restored sum insured would be available to everyone covered under the plan. It is applicable once during a policy year. Similarly the Multiplier benefit rewards the insured with a 100% increase in sum insured for every two claim free years. The Stay Active benefit rewards customers who lead an active lifestyle, the benefit allows a customer to enjoy premium discounts simply by exercising.

  The plan also covers Pre & Post Hospitalisation, Domiciliary Expenses, Day Care Treatments, Organ Donor, Daily Cash, E-Opinion (which is a second opinion), Emergency Ambulance Expenses (including Air Ambulance), Health Check-up and Critical Advantage Rider. Other criteria include:

  • Coverage is offered from the age of 5 years till maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
  • The Primary Insured you’re their family members namely spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on floater sum insured basis.
  • The policy period options include period of 1 or 2 years(s).

  Optima Restore Family Floater
  1) Inpatient treatment	Covered
  Pre-hospitalisation	Covered, upto 60 days
  Post hospitalisation	Covered upto 180 days
  Day Care procedures	All Day Care Treatment Covered
  Domiciliary treatment	Covered
  Organ donor	Covered
  Daily cash for Choosing shared accommodation	800 per day, Maximum 4,800				1,000 per day, Maximum 4,800
  Emergency Ambulance	upto 2,000 per hospitalisation
  E-opinion in respect of critical illnesses	Covered
  Emergency Air Ambulance Cover	Not Covered		Covered upto 2.5 Lacs per hospitalization and maximum upto sum insured in an year
  2) Restore Benefit	Equal to 100% of basic sum insured
  3) Multiplier Benefit	Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%.In case of claim, bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy
  4) Health Checkup	Not covered	Upto 2,500	Upto 5,000	Upto 8,000	Upto 10,000
  5) Critical Advantage Rider	Offered (where base Sum Insured is 10 lacs & above)