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) |
Benefits | Easy Health Standard | Easy Health Exclusive | Easy Health Exclusive | ||||
---|---|---|---|---|---|---|---|
Sum Insured per Insured Person per Policy Year (in lakhs) | 1,00,000 / 1,50,000 / 2,00,000 / 2,50,000 /3,00,000 / 4,00,000 / 5,00,000 / 7,50,000 / 10,00,000 / 15,00,000 | 3,00,000 / 4,00,000 / 5,00,000 | 7,50,000 / 10,00,000 | 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000 | 4,00,000 / 5,00,000 | 7,50,000 / 10,00,000 | 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000 |
In-patient Treatment | Covered | ||||||
Pre-hospitalisation | Covered | ||||||
Post-hospitalisation | Covered | ||||||
Day Care Procedures | Covered | ||||||
Domiciliary Treatment | Covered | ||||||
Organ Donor | Covered | ||||||
Emergency Ambulance | Upto Rs. 2,000 per hospitalization | ||||||
Ayush Benefit | Upto Rs. 20,000 | Upto Rs. 25,000 | Upto Rs. 50,000 | Upto Rs. 25,000 | Upto Rs. 50,000 | ||
Daily Cash for choosing Shared Accommodation | Rs. 500 per day, Maximum Rs. 3,000 | Rs. 500 per day, Maximum Rs. 3,000 | Rs. 800 per day, Maximum Rs. 4,800 | Rs. 1000 per day, Maximum Rs. 6,000 | Rs. 500 per day, Maximum Rs. 3,000 | Rs. 800 per day, Maximum Rs. 4,800 | Rs. 1000 per day, Maximum Rs. 6,000 |
Daily Cash for accompanying an insured child | Not Covered | Rs. 300 per day, Maximum Rs. 9,000 | Rs. 500 per day, Maximum Rs. 15,000 | Rs. 800 per day, Maximum Rs. 24,000 | Rs. 300 per day, Maximum Rs. 9,000 | Rs. 500 per day, Maximum Rs. 15,000 | Rs. 800 per day, Maximum Rs. 24,000 |
Newborn baby | Not Covered | Addtional benefit on payment of additional premium | |||||
Recovery Benefit | Not Covered | Rs. 10,000(>10 days of hospitalisation) | Not Covered | Rs. 10,000(>10 days of hospitalisation) | |||
Maternity Expenses | Not Covered | Normal Delivery Rs. 15,000* Caesarean Delivery Rs. 25,000* (* Including Pre/Post Natal limit of Rs.1,500 and New Born limit of Rs. 2,000) [waiting period 4 years] |
Normal Delivery Rs. 25,000* Caesarean Delivery Rs. 40,000* (* Including Pre/Post Natal limit of Rs.2,500 and New Born limit of Rs. 3,500) [waiting period 4 years] |
Normal Delivery Rs. 30,000* Caesarean Delivery Rs. 50,000* (* Including Pre/Post Natal limit of Rs.5,000 and New Born limit of Rs. 5,000) [waiting period 3 years] |
Normal Delivery Rs. 15,000* Caesarean Delivery Rs. 25,000* (* Including Pre/Post Natal limit of Rs.1,500 and New Born limit of Rs. 2,000) [waiting period 4 years] |
Normal Delivery Rs. 25,000* Caesarean Delivery Rs. 40,000* (* Including Pre/Post Natal limit of Rs.2,500 and New Born limit of Rs. 3,500) [waiting period 4 years] |
Normal Delivery Rs. 30,000* Caesarean Delivery Rs. 50,000* (* Including Pre/Post Natal limit of Rs.5,000 and New Born limit of Rs. 5,000) [waiting period 3 years] |
Outpatient Dental Treatment with Waiting Period of 3 years | Not Covered | Upto 1 % of Sum insured subject to a Maximum of Rs.5,000 | Upto 1 % of Sum insured subject to a Maximum of Rs.10,000 | ||||
Spectacles, Contact Lenses, Hearing Aid Every Third Year | Not Covered | Upto Rs.5,000 | Upto Rs.10,000 | ||||
E-Opinion in respect of a Critical Illness | Not Covered | Covered | |||||
Critical Illness Rider | Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured subject to minimum of Rs. 100,000 | Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured | Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured upto a Maximum of Rs 10 lakhs | Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured | Optional, if opted then the critical illness Sum insured 50% or 100% of in-patient Sum insured upto a Maximum of Rs 10 lakhs | ||
Health Checkup | Upto 1% of Sum Insured per Policy, only once at the end of a block of every continuous four claim free years. | Upto 1% of Sum Insured per Policy subject to a Maximum of Rs.5,000 per Insured Person, only once at the end of a block of every continuous three policy years. | Upto 1% of Sum Insured per Policy subject to a Maximum of Rs.5,000 per Insured Person, only once at the end of a block of every continuous two policy years. | ||||
Benefits under 3b), 3c), 3d) and 5) are subject to pre-authorisation by HDFC ERGO Health Formerly Apollo Munich |
Health Wallet – Individual | |
---|---|
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 |
1a) Inpatient treatment | Covered |
1b)Pre-hospitalisation | Covered, upto 60 days |
1c) Post-Hospitalization | Covered, upto 90 Days |
1d) Day Care Procedures | Covered |
1e) Domiciliary Treatment | Covered |
1f) Organ Donor | Covered |
1g) Ambulance | Upto 2,000 per Hospitalisation |
1h) Ayush Treatment | Covered |
This benefit is not applicable if optional Deductible is chosen | |
1i) Recovery Benefit | 10,000 for hospitalisation exceeding consecutive 10 days |
This benefit is not applicable if optional Deductible is chosen | |
1j) Worldwide Emergency Care | 50% of Sum Insured upto a maximum of 20 lacs |
2) Restore Benefit | Equal to 100% of Basic Sum Insured |
3) Preventive Health Check-up | As per grid mentioned in the benefit |
4) 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 at the time of renewal |
5) Reserve Benefit per Insured Person per Policy Year ( Rs) | 5,000, 10,000, 15,000, 20,000 & 25,000 |
6) Deductible (Optional) per Insured Person per Policy Year ( figs in ₹ INR) | 2,00,000 / 3,00,000 / 5,00,000 & 10,00,000 |
*10 deductible available for SI of 20 lacs and above | |
7) Optional Rider - Critical Advantage Cover per Insured Person per Policy Year ( USD) | USD 250,000, USD 500,000 & USD 10,00,000 |
Offered with base policy Sum Insured of Rs. 10 lacs & above | Offered if base policy Sum Insured is 10 lacs & above Illness covered under the rider are as following - Cancer Treatment / Coronary Artery By-pass surgery / Heart Valve Replacement or Repair, Neurosurgery / Live-donor Organ Transplant / Bone Marrow Transplant / Aorta Graft Surgery /Pulmonary Artery Graft Surgery |
Product Variant | iCan Essential | iCan Enhance |
---|---|---|
Sum Insured options | 5, 10, 15, 20, 25, 50 (in lakhs) | |
Second Opinion | Covered | |
MyCare Benefit Covers in-patient, outpatient & daycare costs for: Conventional Treatments, such as chemotherapy, radiotherapy, onco-surgery Advanced Treatments, such as targeted therapy, proton therapy, immunotherapy |
Up to sum insured | |
CritiCare Benefit: On diagnosis of cancer, of specified severity | Not available | 60% of sum insured as lump sum payment, over and above the base sum insured |
FamilyCare Benefit: On diagnosis of stage IV cancer/recurrence of cancer | Not available | 100% of sum insured as lump sum payment, over and above the base sum insured |
Pre-Hospitalisation | 30 Days | |
Post Hospitalisation | 60 Days | |
Emergency Ambulance | INR 2000 per hospitalisation | |
Follow-up care post treatment | Up to INR 3000, twice a year | |
Waiting period | 120 days | |
Payout basis | Cashless & reimbursement | Cashless, reimbursement & 2 lump sum payouts* |
Dengue Care Plan | |
---|---|
Benefits (figs in ₹ INR) | 50,000 / 100,000 |
In-patient Treatment | Upto Sum Insured |
Room Rent | Single Private A/c Room |
Shared Accommodation Benefit | Covered |
Pre-hospitalization | 15 Days |
Post-hospitalization | 15 Days |
Outpatient Treatment : Pharmacy, Diagnostics, Outpatient Consultation, Home Nursing | 10,000 |
Wellness Offers | From time to time, we will provide insured the opportunity to purchase items or services curated by Us and related to prevention of Dengue on AMHI website or through other means. These items or services, which may be offered by Us or selected partners, may be offered with a discount or as part of a special scheme. |
Optima Plus Daily Hospital Cash | ||
---|---|---|
BENEFIT | COVERAGE | DURATION |
Sum Insured Options (in ₹ INR) | 2,000 / 3,000 | |
Tenure Options (in years) | 2 / 3 years | |
Sickness Hospital Cash | Daily cash amount for each continuous and completed period of 24 hours if the insured is hospitalised due to any sickness. | Maximum up to 90 days per policy year. |
Sickness ICU Cash* | Twice the Daily cash amount for each continuous and completed period of 24 hours if the insured is admitted in ICU due to any sickness. | Maximum up to 15 days per policy year. |
Accident Hospital Cash | Daily cash amount for each continuous and completed period of 24 hours if the insured is hospitalised due to any accident. | Maximum up to 90 days per policy year. |
Accident ICU Cash# | Twice the Daily cash amount for each continuous and completed period of 24 hours if the insured is admitted in ICU due to any accident. | Maximum up to 15 days per policy year. |
Day Care Procedure Cash | 50% of the Daily cash amount if the insured undergoes any of the 10 identified day care procedures which does not require 24 hours hospitalisation due to technological advancement. | Maximum up to 6 day care procedures per policy year. |
Joint Hospitalisation due to an Accident^ | Twice the Daily cash amount for each continuous and completed period of 24 hours where two or more Insured person(s) are concurrently hospitalised due to an accident. | Maximum up to 10 days per policy year. |
Convalescence Cash^^ | Lumpsum amount paid if insured person is hospitalised beyond 7 continuous days. | Payable once per policy year |
Child Birth+ | Lumpsum amount equivalent to twice the Daily Cash amount for maternity to female Insured in event of child birth. | Payable twice during the life time of the insured. |
Parent Accommodation^^ | Daily Cash amount for parent’s accommodation if the Insured child is aged 12 years or less and is hospitalised for more than 72 hours. | Maximum up to 30 days per policy year. |
* Benefit 1a ii) sublimit under 1a i) | ||
# Benefit 1b ii) sublimit under 1b i) | ||
^ In addition to benefits 1b i) and 1b ii) | ||
^^ In addition to benefits 1a i), 1a ii), 1b i) and 1b ii) | ||
+ waiting period of 2 years for availing this benefit. |
Optima Super - Aggregate Top Up | |
---|---|
BENEFIT | COVERAGE |
Sum Insured per Insured Person per Policy Year (figs in ₹ INR) | 500,000 / 7,00,000 / 10,00,000 |
Deductible (Rs. In Lacs) | The customer can choose either of the option 1,00,000 / 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 6,00,000 / 7,00,000 / 10,00,000 |
In-patient Treatment | Covered; Hospitalization for minimum 24 hours required. |
Pre-hospitalization | Medical expenses incurred in 60 days immediately before hospitalisation. |
Post-hospitalization | Medical expenses incurred in 90 days immediately after discharge from hospital. |
Day Care Procedures | Coverage for enlisted 144 day care procedures which do not require 24 hours hospitalization. |
Organ Donor | Medical expenses for harvesting of the organ donated to the Insured person. |
Ambulance Services | Expenses up to 2,000 per hospitalization. |
Optima Vital - Critical Illness Plan | |
---|---|
BENEFIT | COVERAGE |
Critical illness Sum Insured Options (figs in ₹ INR) on individual basis | 1,00,000 / 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 30,00,000 / 35,00,000 / 40,00,000 / 45,00,000 / 50,00,000 |
Coverage for 37 Critical Illnesses |
1. Cancer of Specified Severity 2. Kidney Failure requiring Regular Dialysis 3. Multiple Sclerosis with Persisting Symptoms 4. End Stage Liver Disease of Specified Severity 5. First Heart Attack of Specified Severity 6. COMA of Specified Severity 7. Major Burns 8. Goodpasture’s Syndrome 9. Apallic Syndrome 10. Aplastic Anaemia 11. Systemic Lupus Erythematosis 12. Bacterial Meningitis 13. Multiple System Atrophy 14. Progressive Scleroderma 15. Open Chest CABG 16. Major Organ/Bone Marrow Transplant 17. Aorta Graft Surgery 18. Open Heart Replacement or Repair of Heart Valve 19. Pneumonectomy 20. Pulmonary Artery Graft Surgery 21. Primary Parkinson’s Disease 22. Alzheimer’s Disease 23. Motor Neuron Disease with Permanent Symptoms 24. Stroke resulting in Permanent Symptoms 25. Permanent Paralysis of Limbs 26. Primary Pulmonary Arterial Hypertension 27. Benign Brain Tumour [resulting in permanent neurological symptoms] 28. Cardiomyopathy 29. End stage Lung Disease 30. Brain Surgery 31. Progressive Supranuclear Palsy 32. Creutzfeldt-Jakob Disease (CJD) 33. Major Head Trauma 34. Encephalitis 35. Blindness 36. Deafness 37. Total Loss of Speech |
E-opinion in respect of a Critical Illness | Second opinion from a medical practitioner selected by the insured person from AMHI panel. |
The maximum sum insured available above 55 years of age is restricted up to 20,00,000. |
Energy - Diabetes Plan | |
---|---|
BENEFIT | COVERAGE |
Basic Sum Insured Per Person Per Policy Year (figs in ₹ INR) | 2,00,000 / 3,00,000 / 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000 |
In Patient Hospitalization | Covered |
Pre-Hospitalization | Covered, 30 Days |
Post-Hospitalization | Covered, 60 Days |
Day Care Procedures | 182 daycare procedures |
Organ Donor | Covered |
Emergency Ambulance | Upto 2,000 per Hospitalisation |
Shared Accommodation Benefit | Covered |
Restore Benefit | Covered |
Cumulative Bonus | 10% upto a maximum of 100% |
HbA1c Checkup Benefit | Covered |
Wellness discount | Upto 25% of Renewal Premium |
Optima Plus Top Up | |
---|---|
BENEFIT | COVERAGE |
Sum Insured per Insured Person per Policy Year | 500, 000 |
Deductible (figs in ₹ INR) (As mentioned in Policy Schedule) | The customer can choose either of the option : 100,000; 200,000; 300,000; 400,000; 500,000 |
In-patient Treatment | Covered; Hospitalization for minimum 24 hours required. |
Pre-hospitalization | Medical expenses incurred in 60 days immediately before hospitalisation. |
Post-hospitalization | Medical expenses incurred in 90 days immediately after discharge from hospital. |
Day Care Procedures | Coverage for enlisted 140 day care procedures which do not require 24 hours hospitalization. |
Organ Donor | Medical expenses for harvesting of the organ donated to the Insured person. |
Emergency Ambulance | Expenses up to 2,000 per hospitalization. |
Domiciliary Treatment | Medical expenses incurred by an Insured person for availing medical treatment at his home which would otherwise have required hospitalization. |
Maxima - Comprehensive Plan | |||
---|---|---|---|
Sum Insured per Policy (all figs in ₹ INR) | 1 Member | 2 Members | 2 Adults + Upto 2 Children |
a) Out-patient Consultations* | 4 Consultations | 6 Consultations | 8 Consultations |
b) Diagnostic Tests# | 5,000 | 5,000 | 7,000 |
c) Pharmacy# | |||
e) Spectacles, Contact Lenses# | |||
e) Spectacles, Contact Lenses# | |||
f) Annual Health Check-up within specified Network^ | 1 Entitlement Certificate | 2 Entitlement Certificates | 2 Entitlement Certificates |
* The reimbursement against non-network Outpatient Consultations is restricted up to lower of actual expenses or 400. # The reimbursement against non-network Diagnostic Tests, Pharmacy, Outpatient Dental Treatment, Spectacles, Contact Lenses is restricted up to lower of actual expenses or the Sum Insured mentioned above. ^ One Entitlement Certificate of Annual Health Check-up includes following tests: Hb, PCV, RBC, MCHC, MCV, MCH, Total WBC, Differential Count, ESR, PLT, Peripheral Smear, Complete Urine Analysis, GTT, Serum Calcium, Serum Creatinine, Lipid Profile (Total Cholesterol, HDL Cholesterol, LDL Cholesterol, Triglycerides, Cardiac Risk Ratio), Liver Function Test (Total Protein, Albumin, Globulin, Total bilirubin, ALT, AST, GGTP), Blood group, ECG (Resting), X-ray (chest), Ultrasound (Upper abdomen screening), Consultation by General Physician, Consultation by Gynaecologist. | |||
1 Member | 2 Members | 2 Adults + Upto 2 Children | |
Part B- Inpatient Module | |||
Sum Insured per Policy (all figs in ₹ INR) | 3,00,000 | 3,00,000 | 3,00,000 |
a) In-patient Treatment | Covered | ||
b) Pre-Hospitalization | 30 days; can be increased to 60 days | ||
c) Post-Hospitalization | 60 days; can be increased to 90 days | ||
d) Day Care Procedures | Covered | ||
e) Domiciliary Treatment | Covered | ||
f) Daily Cash for choosing Shared Accommodation | 500 per day, Maximum 3,000 | ||
g) Organ Donor | Covered | ||
h) Emergency Ambulance | Upto 2000 per hospitalisation | ||
i) Daily Cash for Accompanying an Insured child | 300 per day; Maximum 9,000 | ||
j) Maternity Expenses ** Waiting Period 4 years | Normal Delivery-15,000; Caesarean Delivery- 25,000 (Including Pre/Post Natal limit of 1,500 and Infant baby limit of 2,000) | ||
k) New born baby | Optional | ||
Optional Benefit | |||
Critical Illness ** [Offered on Individual Sum Insured basis] | 3,00,000 | ||
* *These benefits do not dip into inpatient Sum Insured |
Health Wallet - Family Option | |
---|---|
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 |
1a) Inpatient treatment | Covered |
1b)Pre-hospitalisation | Covered, upto 60 days |
1c) Post-Hospitalization | Covered, upto 90 Days |
1d) Day Care Procedures | Covered |
1e) Domiciliary Treatment | Covered |
1f) Organ Donor | Covered |
1g) Ambulance | Upto 2,000 per Hospitalisation |
1h) Ayush Treatment (This benefit is not applicable if optional Deductible is chosen) | Covered |
1i) Recovery Benefit (This benefit is not applicable if optional Deductible is chosen) | Rs 10,000 for hospitalisation exceeding consecutive 10 days |
1j) Worldwide Emergency Care | 50% of Sum Insured upto a maximum of 20 lacs |
2) Restore Benefit | Equal to 100% of Basic Sum Insured |
3) Preventive Health Check-up | As per grid mentioned in the benefit |
4) 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 at the time of renewal |
5) Reserve Benefit per Insured Person per Policy Year ( ₹ INR) | 5,000, 10,000, 15,000, 20,000 & 25,000 |
6) Deductible (Optional) per Insured Person per Policy Year ( Rs in Lakh) | 2,00,000 / 3,00,000 / 5,00,000 / 10,00,000 (*10 deductible available for SI of 20 lacs and above) |
7) Optional Rider - Critical Advantage Cover per Insured Person per Policy Year ( USD) | USD 250,000, USD 500,000 & USD 10,00,000 |
Offered with base policy Sum Insured of 10 lacs & above | Offered if base policy Sum Insured is 10 lacs & above Illness covered under the rider are as following - Cancer Treatment / Coronary Artery By-pass surgery / Heart Valve Replacement or Repair, Neurosurgery / Live-donor Organ Transplant / Bone Marrow Transplant / Aorta Graft Surgery /Pulmonary Artery Graft Surgery |
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) |
Easy Health Standard Plan - Family Option | |
---|---|
Sum Insured per Policy per Policy Year (figs in ₹ INR)) | 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 7,50,000 / 10,00,000 / 15,00,000 |
1 a) In-patient Treatment | Covered |
1 b) Pre-hospitalization | Covered |
1 c) Post-hospitalization | Covered |
1 d) Day Care Procedures | Covered |
1 e) Domiciliary Treatment | Covered |
1 f) Organ Donor | Covered |
1 g)) Emergency Ambulance | Upto 2,000 per hospitalisation |
1 h) Ayush Benefit | Upto 20,000 |
1 i) Daily Cash for choosing Shared Accommodation | 500 per day, Maximum 3,000 |
2 a) Daily Cash for accompanying an insured child | Not Covered |
2 b) Newborn baby | Not Covered |
2 c) Recovery Benefit | Not Covered |
2 d) Emergency Air ambulance | Not Covered |
3 a) Maternity Expenses | Not Covered |
3 b) Outpatient Dental Treatment (Waiting Period 3 years) | Not Covered |
3 c) Spectacles, Contact Lenses, Hearing Aid (Every Third Year) | Not Covered |
3 d) E-Opinion in respect of a Critical Illness | Not Covered |
4 Critical Illness Rider | Optional, if opted then the Critical Illness Sum Insured 50% or 100% of In-patient Sum Insured subject to minimum of 1,00,000 |
5 Health Check up | Upto 1% of Sum Insured per Policy, only once at the end of a block of every continuous four claim free years |
6 Critical Advantage Rider | Offered (where base Sum Insured is 10 lacs & above) |
Optima Super Aggregate Top Up – Family | |
---|---|
BENEFIT | COVERAGE |
Sum Insured per Policy per Policy Year (in ₹ INR) | 5,00,000 / 7,00,000 / 10,00, 000 |
Deductible (in ₹ INR)) | The customer can choose either of the option 1,00,000 / 2,00,000 / 3,00,000 / 4,00,000 / 5,00,000 / 6,00,000 / 7,00,000 / 10,00,000 |
In-patient Treatment | Covered; Hospitalization for minimum 24 hours required. |
Pre-hospitalization | Medical expenses incurred in 60 days immediately before hospitalisation. |
Post-hospitalization | Medical expenses incurred in 90 days immediately after discharge from hospital. |
Day Care Procedures | Coverage for enlisted 144 day care procedures which do not require 24 hours hospitalization. |
Organ Donor | Medical expenses for harvesting of the organ donated to the Insured person. |
Ambulance Services | Expenses up to 2,000 per hospitalization. |
Optima Senior | |
---|---|
BENEFIT | COVERAGE |
Sum Insured per Policy per Policy Year (in ₹ INR) | 2,00,000 / 3,00,000 / 5,00, 000 |
1a) Inpatient Treatment | Covered |
1b) Pre Hospitalisation | Covered, upto 30 days |
1c) Post Hospitalisation | Covered, upto 60 days |
1d) Day Care Procedures | Coverage for enlisted 144 day care procedures which do not require 24 hours hospitalization. |
1e) Domiciliary Expenses | Covered |
1f) Organ Donor | Medical expenses for harvesting of the organ donated to the Insured person covered |
1g) Ambulance Services | Expenses up to 2,000 per hospitalization. |
2a) E-Opinion | One opinion per policy year |
Medical examinations may be required in some cases, based on the sum insured and the age of the individual.
Yes, the insurer will pay the admissible amount for the medical expenses incurred subject to the terms and conditions (sum insured) of the policy. The insured might have to pay for the non-medical and expenses not covered under the policy, directly to the hospital prior to being discharged.
HDFC ERGO Health Formerly Apollo Munich has a hospital network of more than 4650 hospitals pan India where the insured can be treated.
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