{"uin":"HDFHLIP26058V082526","name":"my:Optima Secure","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526","insurer":{"slug":"hdfc-ergo-general-insurance","name":"HDFC ERGO General Insurance Company Limited","url":"https://indiainsurances.com/insurer/hdfc-ergo-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":"Individual","kind":"product","status":"active","approved_on":"2021-05-12","withdrawn_on":null,"summary":"my:Optima Secure is an HDFC ERGO indemnity health policy with eight plans, Base Sum Insured from 5 to 200 Lakhs depending on plan, and cover in India (worldwide in the two Global plans). Most plans pay room rent at actuals, pre- and post-hospitalisation for 60 and 180 days and restore 100% of the Base Sum Insured, while pre-existing diseases wait 36 months, listed illnesses 24 months and other illnesses 30 days.","analysis":{"state":"extracted","analysed_at":"2026-10-16 04:48:12.477432+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Optima Suraksha","Optima Secure","Optima Super Secure","Optima Secure Global","Optima Secure Global Plus","Optima Select","Optima Lite","Optima Secure +"],"display":"Eight plans: Optima Suraksha, Optima Secure, Optima Super Secure, Optima Secure Global, Optima Secure Global Plus, Optima Select, Optima Lite, Optima Secure +","note":"Benefits, sum insured options, room rent, bonus type and geography differ by plan (Annexure C).","quote":"Optima Suraksha | Optima Secure | Optima Super Secure | Optima | Optima | Optima Select | Optima Lite | Optima Secure + ... This optional cover can only be opted along with Optima Secure Global Plan or Optima Secure Global Plus Plan","sources":[{"clause":"Annexure C","heading":"Plan Chart Schedule of Benefits for all plans under my: Optima Secure","page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-annexure-c"},{"clause":"2.11","heading":"Overseas Travel Secure","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-11"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"Policies can run for more than one Policy Year: the wording refers to Policy Periods of two or three years and illustrates a 4-year policy tenure.","display":"Multi-year terms allowed (two/three years mentioned; a 4-year tenure is illustrated)","note":"No clause lists the allowed terms; each Policy Year is twelve months, and the claims-experience discount table runs to a 5th policy year.","quote":"If the Policy Period is of two/three years, any CB that has accrued for the first/second Policy Year shall be credited post completion of each Policy Year. ... buys a 4-year Optima Secure + plan","sources":[{"clause":"1.8","heading":"Cumulative Bonus (CB) [Applicable to ‘Optima Suraksha’, ‘Optima Lite’ and ‘Optima Select’ plans]","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-8"},{"clause":"1.28(f)","heading":null,"page":48,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-28-f"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Within 24 hours of emergency hospitalisation or before discharge, whichever is earlier; at least 48 hours before a planned admission or Home Health Care.","display":"Emergency: within 24 hours or before discharge; planned: 48 hours before admission","note":"Reimbursement documents are due within 30 days of discharge (post-hospitalisation: within 15 days of completing treatment). Delay may be condoned for reasons beyond the insured's control.","quote":"a) Within 24 hours from the date of emergency Hospitalization required or before the Insured Person’s discharge from Hospital, whichever is earlier.\nb) At least 48 hours prior to admission in Hospital in case of a planned Hospitalization or decision to avail treatment under Section B-1.2 (Home Health Care).","sources":[{"clause":"1.1","heading":"Notification of a Claim","page":49,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-4"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"quote-verified","value":["Duly completed claim form","Photo ID and Age Proof","Hospital registration certificate/number (non-Network Provider)","Discharge Card / Day Care Summary / Transfer Summary","Final Hospital bill with deposit, final payment and refund receipts","Implant invoices and stickers","Previous consultation papers","Diagnostic reports with prescription and bills","Medicine / pharmacy bills with prescription","MLC / FIR copy (accident cases)","Alcohol/intoxication history certified by first treating doctor (accident cases)","Death Summary and Death Certificate (death claims)","Indoor case papers with nursing sheet (where required)","Invoice for vaccination and payment receipt","Original ambulance invoices","KYC documents (claims above Rs. 1 lakh)","NEFT form with cancelled cheque","Legal heir/succession certificate (where applicable)","For claims outside India: passport copy with stamps, flight tickets and boarding pass, accommodation invoices, overseas doctor's advice for accompanying person","Any other relevant document required by Company"],"display":"Claim form, ID, discharge summary, bills, reports, prescriptions, KYC, NEFT form and others","note":"Bills must be in the insured person's name; certified copies accepted if originals went to another insurer.","quote":"a) Duly Completed claim form,\nb) Photo ID and Age Proof,\nc) Copy of the Hospital’s Registration Certificate/Hospital Registration number in case of Hospitalization in any non-Network Provider of the Company ... d) Discharge Card / Day Care Summary / Transfer Summary,\ne) Final Hospital bill with all original deposit and final payment receipt and refund receipt(s), if advance amount refunded,\nf) Invoice with payment receipt and implant stickers for all implants used during Surgeries ... g) All previous consultation papers indicating history and treatment details for current Illness and advice for current Hospitalization,\nh) All diagnostic reports (including imaging and laboratory) along with prescription by Medical Practitioner and invoice / bill with receipt from diagnostic centre,\ni) All medicine / pharmacy bills along with prescription by Medical Practitioner,\nj) MLC / FIR Copy – in Accident cases only,\nk) History of alcohol consumption or any intoxication certified by first treating doctor in case of Accident cases,\nl) Copy of Death Summary and copy of Death Certificate (in death claims only),\nm) Copy of indoor case papers with nursing sheet ... (to be submitted wherever required by the Company). ... n) Invoice for vaccination and payment receipt,\no) Original invoices for the expenses incurred towards ambulance facility ... p) KYC documents (in all claims above Rs. 1 lakh) of the Policyholder as per AML guidelines,\nq) Duly filled NEFT form with cancelled blank cheque ... r) Legal heir/succession certificate, wherever applicable, ... i) Passport copy with entry and exit stamps\nii) Flight Tickets and Boarding Pass, if applicable\niii) Accommodation Invoices, if applicable\niv) Written advice from the overseas treating Medical Practitioner for requirement of an accompanying person during treatment. ... t) Any other relevant document required by Company for assessment of the claim. ... The Company shall only accept bills/invoices/medical treatment related documents only in the Insured Person’s name for whom the claim is submitted. ... the Company shall accept the copy of the documents and claim settlement advice, duly certified by the other insurer","sources":[{"clause":"1.7","heading":"List of documents required for a Claim","page":50,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-7-3"},{"clause":"1.7(t)(i)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-7-t-i"},{"clause":"1.7(t)(ii)","heading":null,"page":52,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-7-t-ii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"Reimbursement claims are settled within 15 days of claim intimation; cashless authorisation is decided within 1 hour and final bill authorisation within 3 hours. Delay attracts interest at 2% above bank rate.","display":"Within 15 days of claim intimation (reimbursement); cashless decision within 1 hour, final bill within 3 hours","note":"The wording clause D.1.3(a) is truncated in the document; the 1-hour and 3-hour cashless times and the full reimbursement TAT sentence come from the CIS. Interest for delay: 2% above bank rate.","quote":"a) The Company shall (other than cashless), within 15 days from the date of receipt of intimation of claims.. ... TAT for Claim settlement – Within 15 days of claim intimation. ... Decision on cashless authorization to be provided within 1 hour from the time of receipt of request. ... Within 3 hours of the receipt of discharge authorization request from the hospital. ... at a rate 2% above the bank rate","sources":[{"clause":"1.3(a)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-3-a"},{"clause":"1.3(b)","heading":null,"page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-3-b"},{"clause":"B.2.1","heading":null,"page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/2#c-b-2-1"},{"clause":"B.2.1(i)","heading":"TAT for preauthorization of cashless facility","page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/2#c-b-2-1-i"},{"clause":"B.2.1(ii)","heading":"TAT for cashless final bill authorization","page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/2#c-b-2-1-ii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"quote-verified","value":["Pre-existing diseases until 36 months of continuous coverage (Excl01)","Listed conditions and surgeries until 24 months of continuous coverage (Excl02)","Any illness in the first 30 days, except accidents (Excl03)","Admission primarily for diagnostics and evaluation (Excl04)","Surgical treatment of obesity unless set conditions are met (Excl06)","Cosmetic or plastic surgery (Excl08)","Hazardous or adventure sports as a professional (Excl09)","Alcoholism, drug or substance abuse (Excl12)","Sterility and infertility, including IVF and surrogacy (Excl17)","Maternity, childbirth, miscarriage and termination (Excl18)","War, invasion, nuclear, chemical or biological attack","Intentional self-injury, attempted suicide or suicide","Non-Medical expenses listed in Annexure B","Treatment taken on outpatient basis","Hearing aids, spectacles or contact lenses"],"display":"Pre-existing diseases (36 months), listed conditions (24 months), first 30 days, maternity, infertility, cosmetic surgery, substance abuse, OPD, non-medical items, spectacles and others","note":"Non-medical expenses are paid under Protect Benefit where that cover is in force. PED waiting can be cut to 24 or 12 months by a channel-level option. Full lists: Standard Exclusions Excl04 to Excl18 and Specific Exclusions (a) to (q).","quote":"Pre-Existing Diseases: Code – Excl01 ... shall be excluded until the expiry of 36 months (Unless specified otherwise in the Policy Schedule) of continuous coverage ... Specified Disease/Procedure waiting period: Code – Excl02 ... shall be excluded until the expiry of 24 months of continuous coverage ... 30-day waiting period: Code – Excl03 ... Expenses related to the treatment of any illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an accident ... Investigation & Evaluation: Code Excl04 ... Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. ... Obesity/Weight control: Code – Excl06: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Cosmetic or plastic Surgery: Code – Excl08 ... Hazardous or Adventure Sports: Code – Excl09: Expenses related to any treatment necessitated due to participation as a professional in Hazardous or Adventure sports ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... Sterility and Infertility: Code – Excl17: Expenses related to sterility and infertility. ... advanced reproductive technologies such as IVF ... Gestational Surrogacy ... Maternity: Code – Excl18: ... Medical treatment expenses traceable to childbirth ... Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy ... War or any act of war, invasion, act of foreign enemy ... Nuclear, Chemical or Biological attack or weapons ... intentional self-injury or attempted suicide or suicide. ... Non-Medical expenses such as food charges ... Full list of Non-Medical Expenses is attached as ANNEXURE B ... Treatment taken on outpatient basis. ... The provision or fitting of hearing aids, spectacles or contact lenses.","sources":[{"clause":"1","heading":"Waiting Periods","page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-9"},{"clause":null,"heading":"Surgical Procedures","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-surgical-procedures"},{"clause":"2","heading":"Standard Exclusions","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-18"},{"clause":"3","heading":"Specific Exclusions","page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-3-2"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"First contact HDFC ERGO by phone or website; then write to the Complaints & Grievance Cell (grievance@hdfcergo.com); then the Chief Grievance Officer (cgo@hdfcergo.com); then the Council for Insurance Ombudsmen or the Insurance Ombudsman.","display":"HDFC ERGO first, then Complaints & Grievance Cell, then Chief Grievance Officer, then Ombudsman","note":"Escalate to Level 2 if no response within 15 days. Dedicated helplines for senior citizens and women. Complaints can also go to IRDAI Bima Bharosa.","quote":"First Point of Contact | Call us at 022 6158 2020 / 022 6234 6234 / www.hdfcergo.com ... Write to The Complaints & Grievance Cell (C&G Cell) HDFC ERGO General Insurance Company Limited ... You can also write an email to grievance@hdfcergo.com ... Write to the Chief Grievance Officer HDFC ERGO General Insurance Company Limited ... You can also write an email to cgo@hdfcergo.com","sources":[{"clause":"1.17","heading":"Redressal of Grievance","page":41,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-17"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Base Sum Insured from 5 to 200 Lakhs depending on plan (for example 5/10/15/20/25/50/100/200 Lakhs in Optima Secure; 5/7.5 Lakhs in Optima Lite).","display":"5 to 200 Lakhs Base Sum Insured, depending on plan","note":"Suraksha 5-50 L; Secure and Secure + 5-200 L; Super Secure 10-200 L; Secure Global 100/200 L; Secure Global Plus 25-200 L; Select 5-25 L; Lite 5/7.5 L. Total cover can grow through Secure Benefit, bonuses and Restore.","quote":"Base Sum Insured [BSI] (in Lakh) | 5/10/15/20/25/50 Lakhs | 5/10/15/20/25/50/ 100/200 Lakhs | 10/15/20/25/50/100/200 Lakhs | 100/200 Lakhs | 25/50/75/100/ 200 Lakhs | 5/7.5/10/15/ 20/ 25 Lakhs | 5/7.5 Lakhs | 5/10/15/20/25/50/ 100/200 Lakhs","sources":[{"clause":"Annexure C","heading":"Plan Chart Schedule of Benefits for all plans under my: Optima Secure","page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-annexure-c"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (accidents covered)","note":"Does not apply if the insured has continuous coverage for more than twelve months; applies afresh to an enhanced Sum Insured.","quote":"Expenses related to the treatment of any illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":null,"heading":"Surgical Procedures","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-surgical-procedures"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Can be reduced to 24 or 12 months through the PED waiting period modification option, which is opted at channel level only at inception (individual customers cannot opt it).","quote":"Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 36 months (Unless specified otherwise in the Policy Schedule) of continuous coverage after the date of inception of the first policy with insurer. ... Modification of PED waiting period from 36 months (as specified under Section C.1.a – Pre- Existing Diseases) to 24 months (2 years)","sources":[{"clause":"1","heading":"Waiting Periods","page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-9"},{"clause":"2.12","heading":"PED waiting period modification","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-12"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months","note":"Not applicable to accident claims; if a listed condition is also a PED, the longer waiting period applies.","quote":"Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with us. This exclusion shall not be applicable for claims arising due to an Accident.","sources":[{"clause":"1","heading":"Waiting Periods","page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-9"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"cross-checked","value":["Non infective Arthritis","Pilonidal sinus","Diseases of gall bladder including cholecystitis","calculus diseases of Urogenital system e.g.Kidney stone,Urinary Bladder Stone","Benign tumors, cysts, nodules, polyps including breast lumps","Pancreatitis","Ulcer and erosion of stomach and duodenum","Polycystic ovarian diseases","All forms of Cirrhosis","Gastro Esophageal Reflux Disorder (GERD)","Sinusitis, Rhinitis","Perineal Abscesses","Perianal Abscesses","Skin tumors","Cataract and other disorders of lens and Retina","Fissure/fistula in anus, Haemorrhoids","Gout and rheumatism","Tonsillitis","Osteoarthritis and osteoporosis","Fibroids ( fibromyoma)","Benign Hyperplasia of Prostate","Adenoidectomy, tonsillectomy","Tympanoplasty, Mastoidectomy","Hernia","Dilatation and curettage (D&C)","Nasal concha resection","Surgery for prolapsed inter vertebral disc","Myomectomy for fibroids","Surgery of Genito urinary system unless necessitated by Malignancy","Surgery for varicose veins and varicose ulcers","Surgery on prostate","Cholecystectomy","Surgery for Perianal Abscesses","Hydrocele/Rectocele","Joint replacement surgeries","Surgery for Nasal septum deviation","Ligament, Tendon and Meniscal tear","Hysterectomy","Fissurectomy, Haemorrhoidectomy, Fistulectomy","ENT surgeries","Endometriosis","Prolapsed Uterus","Rectal Prolapse","Varicocele","Retinal detachment","Glaucoma","Nasal polypectomy"],"display":"Listed illnesses and surgical procedures, including cataract, hernia, joint replacement, kidney stone and hysterectomy","note":"The document prints 'Fissure/fistula in anus, Haemorrhoids including Gout and rheumatism' as one cell, apparently two merged items; listed here as two.","quote":"Non infective Arthritis | Pilonidal sinus\nDiseases of gall bladder including cholecystitis | calculus diseases of Urogenital system e.g.Kidney stone,Urinary Bladder Stone | Benign tumors, cysts, nodules, polyps including breast lumps\nPancreatitis | Ulcer and erosion of stomach and duodenum | Polycystic ovarian diseases\nAll forms of Cirrhosis | Gastro Esophageal Reflux Disorder (GERD) | Sinusitis, Rhinitis\nPerineal Abscesses | Perianal Abscesses | Skin tumors\nCataract and other disorders of lens and Retina | Fissure/fistula in anus, Haemorrhoids including Gout and rheumatism | Tonsillitis\nOsteoarthritis and osteoporosis | Fibroids ( fibromyoma) | Benign Hyperplasia of Prostate ... Adenoidectomy, tonsillectomy | Tympanoplasty, Mastoidectomy | Hernia\nDilatation and curettage (D&C) | Nasal concha resection | Surgery for prolapsed inter vertebral disc\nMyomectomy for fibroids | Surgery of Genito urinary system unless necessitated by Malignancy | Surgery for varicose veins and varicose ulcers\nSurgery on prostate | Cholecystectomy | Surgery for Perianal Abscesses\nHydrocele/Rectocele | Joint replacement surgeries | Surgery for Nasal septum deviation\nLigament, Tendon and Meniscal tear | Hysterectomy | Fissurectomy, Haemorrhoidectomy, Fistulectomy, ENT surgeries\nEndometriosis | Prolapsed Uterus | Rectal Prolapse\nVaricocele | Retinal detachment | Glaucoma\nNasal polypectomy","sources":[{"clause":null,"heading":"Illnesses","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-illnesses"},{"clause":null,"heading":"Surgical Procedures","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-surgical-procedures"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"Runs afresh on any enhanced Sum Insured from the date of enhancement.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":"1.6","heading":"Moratorium Period","page":37,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-6-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The policy can be ported to another insurer by applying at least 30 days, but not earlier than 60 days, before the renewal date, with accrued continuity benefits in waiting periods.","display":"Yes; apply 30 to 60 days before renewal, waiting-period credit carried over","note":"Migration to other HDFC ERGO products is also allowed (apply at least 30 days before renewal).","quote":"The Insured Person will have the option to port the Policy to other insurers by applying to such Insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to Portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":"1.10","heading":"Portability","page":38,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-10-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes, no maximum cover ceasing age","note":"Renewal can be refused for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn. Children are moved to a new policy at age 25.","quote":"There is no maximum cover ceasing age on renewals.","sources":[{"clause":"1.27","heading":"Eligibility","page":44,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-27"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No loading applies on renewals based on individual claims experience, but the Favourable Claims Experience Discount on premium is lower or nil after claims in the last two policy years.","display":"No claim-based loading; claims-free discount reduces after claims","note":"Discount for 2+ years served: 10% with no claims, 6% with a claim in one of the last two years, 0% with claims in both (lower figures for Optima Secure Global Plus); not given to insured persons aged 60 or above.","quote":"c) No loading shall apply on renewals based on individual claims experience ... This policy is eligible for a discount on premium basis Hospitalization claims (which includes either In-patient Care or Day Care treatment) made in the last 2 policy years.","sources":[{"clause":"1.9","heading":"Renewal of Policy","page":38,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-9-2"},{"clause":"1.28","heading":"Favourable Claims Experience Discount","page":46,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-28"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"quote-verified","value":["Excl04 Investigation & Evaluation","Excl05 Rest Cure, rehabilitation and respite care","Excl06 Obesity/Weight control (unless conditions met)","Excl07 Change-of-Gender treatments","Excl08 Cosmetic or plastic Surgery","Excl09 Hazardous or Adventure Sports","Excl10 Breach of Law","Excl11 Excluded Providers","Excl12 Alcoholism, drug or substance abuse or any addictive condition","Excl13 Health hydros, nature cure clinics, spas or similar establishments","Excl14 Dietary supplements and substances purchasable without prescription","Excl15 Refractive Error less than 7.5 dioptres","Excl16 Unproven Treatments","Excl17 Sterility and Infertility","Excl18 Maternity","War, invasion, nuclear, chemical or biological attack, radiation","Intentional self-injury, attempted suicide or suicide","Naval, military or air force operations","Investigative treatment for sleep-apnoea, general debility or exhaustion","Congenital external diseases, defects or anomalies","Stem cell harvesting","Spinal sub luxation / manipulation treatments (except fractures and dislocations)","Circumcisions (unless necessitated by Illness or Injury)","Vaccination (except post animal bite)","Non-Medical expenses (Annexure B)","Treatment taken on outpatient basis","Hearing aids, spectacles or contact lenses","Alopecia and baldness treatment, wigs, optometric therapy","Artificial limbs, external devices and durable medical equipment, cochlear implants unless due to Accident","Treatment not of reasonable charge or not Medically Necessary","Any permanent exclusion specified in the Policy Schedule"],"display":"Standard exclusions Excl04 to Excl18 plus specific exclusions such as war, self-injury, OPD, non-medical items and spectacles","note":"Excl01 to Excl03 are waiting periods, not permanent. Non-medical expenses are paid under Protect Benefit where in force. Specific exclusion (b) also excludes amounts within an opted Aggregate Deductible.","quote":"Investigation & Evaluation: Code Excl04 ... Rest Cure, rehabilitation and respite care: Code – Excl05 ... Obesity/Weight control: Code – Excl06: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Change-of-Gender treatments: Code – Excl07 ... Cosmetic or plastic Surgery: Code – Excl08 ... Hazardous or Adventure Sports: Code – Excl09 ... Breach of Law: Code – Excl10 ... Excluded Providers: Code – Excl11 ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... Treatments received in health hydros, nature cure clinics, spas or similar establishments ... Code – Excl13 ... Dietary supplements and substances that can be purchased without prescription ... Code – Excl14 ... Refractive Error: Code – Excl15: Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. ... Unproven Treatments: Code – Excl16 ... Sterility and Infertility: Code – Excl17 ... Maternity: Code – Excl18 ... War or any act of war, invasion, act of foreign enemy ... Nuclear, Chemical or Biological attack or weapons, radiation of any kind. ... intentional self-injury or attempted suicide or suicide. ... naval, military or air force operation. ... Investigative treatment for sleep-apnoea, general debility or exhaustion ... Congenital external diseases, defects or anomalies. ... Stem cell harvesting. ... Investigative treatments for analysis and adjustments of spinal sub luxation, diagnosis and treatment by manipulation of the skeletal structure or for muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities. ... Circumcisions (unless necessitated by Illness or Injury and forming part of treatment). ... Vaccination including inoculation and immunisations (except post animal bite treatment). ... Non-Medical expenses such as food charges ... Full list of Non-Medical Expenses is attached as ANNEXURE B ... Treatment taken on outpatient basis. ... The provision or fitting of hearing aids, spectacles or contact lenses. ... Any treatment and associated expenses for alopecia, baldness including cortico steroids and topical immuno therapy wigs, toupees, hair pieces, any non-surgical hair replacement methods, optometric therapy. ... Expenses for Artificial limbs and/or device used for diagnosis or treatment ... corrective devices external durable medical equipment of any kind ... cost of cochlear implant(s) unless necessitated by an Accident. ... not of a reasonable charge and not Medically Necessary. ... Any permanent exclusion applied on any medical or physical condition or treatment of an Insured Person as specifically mentioned in the Policy Schedule","sources":[{"clause":"2","heading":"Standard Exclusions","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-18"},{"clause":"3","heading":"Specific Exclusions","page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-3-2"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"The policyholder can cancel with 7 days' written notice and gets a pro-rata refund of premium for the unexpired Policy Period, but no refund if any claim has been admitted or benefit availed.","display":"Pro-rata refund for the unexpired period; nothing if a claim was admitted","note":"For instalment policies with an admissible claim, future instalments for the year are adjusted in the claim and no refund applies during that Policy Year.","quote":"The Policyholder may cancel this Policy by giving 7 days’ written notice and in such an event, the Company shall refund to the Insured a pro-rata premium for the unexpired Policy Period. ... no refunds of premium shall be made in respect of Cancellation where any claim has been admitted or any benefit has been availed by the Insured Person under the Policy.","sources":[{"clause":"1.12(a)","heading":null,"page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-12-a"},{"clause":"1.12(d)","heading":null,"page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-12-d"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"India only, except the Optima Secure Global and Optima Secure Global Plus plans, which cover worldwide including India.","display":"India; worldwide including India in the two Global plans","note":"Overseas cover: emergency only in Optima Secure Global, emergency and planned in Optima Secure Global Plus; overseas claims carry a Rs. 10,000 per-claim deductible and treatment must start within 45 days of a trip (emergency cover). E-Opinion for Critical Illness is 'Global' in Optima Super Secure and both Global plans.","quote":"This Policy provides coverage throughout the territory of India, except under Section B- 2.8 (E-Opinion for Critical Illness), Section B-2.9 Global Health Cover (Emergency Treatments Only), Section B-2.10 Global Health Cover (Emergency & Planned Treatments), B-2.11 Overseas Travel Secure ... ^Geography | India only | India only | India only | Worldwide including India | Worldwide including India | India only | India only | India only","sources":[{"clause":"1.20","heading":"Geography","page":43,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-20"},{"clause":"Annexure C","heading":"Plan Chart Schedule of Benefits for all plans under my: Optima Secure","page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-annexure-c"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"thirty days from receipt of the policy document","note":"New individual policies only, not renewals or porting/migration. Refund is premium less medical examination and stamp duty costs (or proportionate risk premium if risk has started). CIS summary line says '30 days from the beginning of the policy'; the wording and the CIS process text say from date of receipt of the policy document.","quote":"The insured person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable. ... Free Look cancellation: You may cancel the insurance policy if you do not want it, within 30 days from the beginning of the policy.","sources":[{"clause":"1.8","heading":"Free look Period","page":37,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-8-2"},{"clause":"E.2","heading":null,"page":7,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/2#c-e-2"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for monthly instalments)","note":"15 days where premium is paid monthly. Cover continues during the grace period only for instalment premiums.","quote":"Option 1 | Multi-Year / Yearly | 30 days\nOption 2 | Half Yearly | 30 days\nOption 3 | Quarterly | 30 days\nOption 4 | Monthly | 15 Days","sources":[{"clause":"1.13","heading":"Premium Payment in Instalments","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-13"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Adults from 18 years with no maximum entry age; dependent children from 91 days to 25 years.","display":"Adults 18 years and above, no maximum; children 91 days to 25 years","note":"A child aged 91 days to 5 years can be insured only if a parent is insured under the Policy.","quote":"The minimum entry age for an adult is 18 years and there is no limit on maximum entry age. ... The minimum entry age for a dependent child (i.e. natural or legally adopted) is 91 days and maximum entry age is 25 years.","sources":[{"clause":"1.27","heading":"Eligibility","page":44,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-27"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Single premium for the entire policy period (non-instalment)","Multi-Year / Yearly","Half Yearly","Quarterly","Monthly"],"display":"Single (non-instalment), yearly or multi-year, half-yearly, quarterly or monthly","note":"Instalments can be paid through auto debit/ECS.","quote":"Non-instalment Premium Payment refers to payment of premium for the entire policy period made in advance as a single premium. ... If the Insured Person has opted for payment of Premium on an instalment basis i.e. Yearly, Half Yearly, Quarterly or Monthly, as mentioned in the Policy Schedule","sources":[{"clause":"Def. 18","heading":"Non-instalment Premium Payment","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-def-18-2"},{"clause":"1.13","heading":"Premium Payment in Instalments","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-13"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"quote-verified","value":["Protect Benefit","Plus Benefit","Aggregate Deductible","Overseas Travel Secure","PED wait period modification","Modification of Room Rent","Infinite Benefit","Preventive Health Check-up (Optima Select)","my: health Critical Illness Add On","my: health Hospital Cash Benefit Add On","Individual Personal Accident Rider","Unlimited Restore (Add on)","Optima Wellbeing (Add on)","ABCD Chronic Care","Limitless","Parenthood"],"display":"Optional by plan: Protect Benefit, Plus Benefit, Aggregate Deductible, Overseas Travel Secure, PED and room-rent modifications, Infinite Benefit, health check-up; add-ons: Critical Illness, Hospital Cash, Personal Accident, Unlimited Restore, Optima Wellbeing, ABCD Chronic Care, Limitless, Parenthood","note":"Which covers are optional depends on the plan (Annexure C): Protect Benefit and Plus Benefit are optional in Optima Select and Optima Lite (Protect Benefit is inbuilt in most other plans and can be removed); Infinite Benefit is optional in Optima Super Secure (inbuilt in Optima Secure +); Overseas Travel Secure only with the two Global plans, for additional premium; the health check-up is optional only in Optima Select; PED wait period modification is opted at channel level only, not by individual customers. Room rent modification: up to Single Private room in Secure, Super Secure and Secure +; At Actuals or Shared room in Select. Section B-2 is headed 'Optional Covers' but most of its covers are inbuilt in the plans.","quote":"‘Optional’ means that particular benefit is NOT an inbuilt feature BUT can be opted by the Proposer/Policyholder either at inception or at renewal subject to company’s discretion. ... 2.3 | Protect Benefit ... Covered upto sum insured | Optional | Optional ... 2.4 | Plus Benefit ... Optional (Bonus of 50% of the Base Sum Insured, maximum upto 100%) | Optional ... 2.7 | Aggregate Deductible# (Optional) ... 2.11 | Overseas Travel Secure (Optional) ... 2.12 | PED wait period modification (Optional) ... 2.13 | Modification of Room Rent (Optional) ... 2.17 | Infinite Benefit | Not Covered | Not Covered | Optional ... 3 | Preventive Health Check-up (India only) [This is an optional cover under Optima Select plan and an inbuilt cover in all other plans] ... This optional cover can only be opted along with Optima Secure Global Plan or Optima Secure Global Plus Plan on payment of additional premium. ... ‘my: Optima Secure’ offers following Add on Covers: ... 1. my: health Critical Illness Add On ... 2. my: health Hospital Cash Benefit Add On ... 3. lndividual Personal Accident Rider ... Unlimited Restore (Add on): Provides unlimited restoration in a Policy Year. ... Optima Wellbeing (Add on): Covers expenses for various outpatient benefits. ... ABCD Chronic Care: Covers hospitalization expenses for Asthma, Blood pressure, Cholesterol and Diabetes ... Limitless: Specified number of claims of infinite value shall be payable in the lifetime of the policy. ... Parenthood: Covers Maternity Expenses, Embryo freezing costs and IVF treatments","sources":[{"clause":null,"heading":"Key to read above table","page":68,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-key-to-read-above-table"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"},{"clause":"2.11","heading":"Overseas Travel Secure","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-11"},{"clause":"1.1.1(h)","heading":null,"page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-h"},{"clause":"4","heading":"Unlimited Restore (Add on)","page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-4"},{"clause":"5","heading":"Optima Wellbeing (Add on)","page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-5"},{"clause":"6","heading":"ABCD Chronic Care","page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-6"},{"clause":"7","heading":"Limitless","page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-7"},{"clause":"8","heading":"Parenthood","page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-8"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"quote-verified","value":"Yes when premium is paid in instalments: cover continues during the grace period. With a non-instalment premium, there is no cover for the period for which no premium is received.","display":"Yes for instalment premiums; not for a non-instalment premium until it is paid","note":"Waiting-period continuity is kept if premium is paid within the grace period; an instalment not received within the grace period cancels the policy.","quote":"b) If premium is paid in instalments then coverage will be available during the grace period also. (Note: In case of non-instalment premium payment, coverage shall not be available for the period for which no premium is received). ... c) The Insured Person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific Waiting Periods” in the event of payment of premium within the stipulated Grace Period ... e) In case of instalment premium due not received within the Grace Period, the Policy will get cancelled","sources":[{"clause":"1.13","heading":"Premium Payment in Instalments","page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-13"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"At Actuals in most plans; Optima Select covers up to a Single Private room; Optima Lite covers up to 1% of base sum insured per day.","display":"At Actuals (Optima Select: Single Private room; Optima Lite: 1% of base sum insured per day)","note":"Optional 'Modification of Room Rent': Secure, Super Secure and Secure + can choose up to Single Private room (subject to underwriting); Optima Select can switch to At Actuals or Shared room.","quote":"Room rent limit shall be ‘At Actuals’ unless otherwise specified in the Policy Schedule. ... 1.1.a | Room Rent | At Actuals | At Actuals | At Actuals | At Actuals | At Actuals | Upto Single Private room | Upto 1% of base sum insured per day | At Actuals","sources":[{"clause":"1.1","heading":"Hospitalization Expenses","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-2"},{"clause":"Annexure C","heading":"Plan Chart Schedule of Benefits for all plans under my: Optima Secure","page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-annexure-c"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"quote-verified","value":"No room category limit (room rent At Actuals) in most plans; Optima Select covers up to a Single Private room. Optima Lite has a rupee limit (1% of base sum insured per day) rather than a room type.","display":"At Actuals, no category limit (Optima Select: up to Single Private room)","note":"Optional 'Modification of Room Rent': Optima Secure, Super Secure and Secure + can choose up to Single Private room (subject to underwriting); Optima Select can switch to At Actuals or Shared room.","quote":"Room rent limit shall be ‘At Actuals’ unless otherwise specified in the Policy Schedule. ... 1.1.a | Room Rent | At Actuals | At Actuals | At Actuals | At Actuals | At Actuals | Upto Single Private room | Upto 1% of base sum insured per day | At Actuals ... i. This option is inbuilt in Optima Select plan where in by default Room rent expenses shall be covered upto Single Private room ... ii. In Optima Secure plan, Optima Super Secure plan and Optima Secure + plan, customers may choose to be covered upto Single Private room while ICU / ICCU expenses shall be covered at Actuals. Selection of this option is subject to Underwriting. ... 2.13 | Modification of Room Rent (Optional) | Not Covered | Upto Single Private room | Upto Single Private room | Not Covered | Not Covered | At Actuals OR Shared room | Not Covered | Upto Single Private room","sources":[{"clause":"1.1","heading":"Hospitalization Expenses","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-2"},{"clause":"Annexure C","heading":"Plan Chart Schedule of Benefits for all plans under my: Optima Secure","page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-annexure-c"},{"clause":"2.13(ii)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-13-ii"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"At Actuals in all plans except Optima Lite, where ICU is covered up to 2% of base sum insured per day.","display":"At Actuals (Optima Lite: 2% of base sum insured per day)","note":null,"quote":"ICU limit (including ICCU) for bed charges shall be ‘At Actuals’ unless otherwise specified in the Policy Schedule. ... 1.1.b | ICU | At Actuals | At Actuals | At Actuals | At Actuals | At Actuals | At Actuals | Upto 2% of base sum insured per day | At Actuals","sources":[{"clause":"1.1","heading":"Hospitalization Expenses","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-2"},{"clause":"Annexure C","heading":"Plan Chart Schedule of Benefits for all plans under my: Optima Secure","page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-annexure-c"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"cross-checked","value":"Yes. If the room exceeds the category or limit in the Policy Schedule, Room Rent and Associated Medical Expenses are paid in the proportion of the admissible to the actual room rate; pharmacy, consumables, implants, devices and diagnostics are not reduced, and it does not apply to ICU charges or to hospitals without room-based differential billing.","display":"Yes, where a room limit applies; not on ICU, pharmacy, consumables, implants or diagnostics","note":"Only relevant where a room limit applies (Optima Select, Optima Lite, or the room-rent modification option); most plans have room rent At Actuals. For an ICU above limit, only ICU room charges are reduced.","quote":"In case the Insured Person is admitted in a room that exceeds the category/limit stipulated in the Policy Schedule, the reimbursement/payment of Room Rent charges including all Associated Medical Expenses incurred at Hospital shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent charges. This condition is not applicable in respect of Hospitals where differential billing for Associated Medical Expenses is not followed based on Room Rent. ... Such associated medical expenses do not include Cost of pharmacy and consumables, Cost of implants and medical devices and Cost of diagnostics. Proportionate deduction shall not be applicable to ‘ICU charges’.","sources":[{"clause":"1.1.1(iv)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-iv"},{"clause":"Def. 5","heading":"Associated Medical Expenses","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-def-5-2"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"No co-payment is set out in the documents; the wording states that no co-payment applies when an insured from a lower premium tier is treated in a higher tier city.","display":"None stated; no co-payment for treatment in a higher-tier city","note":"Only the zone/tier co-payment is expressly ruled out; the documents are silent on any age-based co-payment.","quote":"No co-payment shall apply if Insured Person from a lower tier avails a treatment in higher tier.","sources":[{"clause":"1.24","heading":"Premium Tier","page":43,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-24"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"quote-verified","value":"None unless the optional Aggregate Deductible is chosen. In the two Global plans a Per Claim Deductible of Rs. 10,000 applies to each claim arising outside India.","display":"None unless opted (Global plans: Rs. 10,000 per claim outside India)","note":"Optional Aggregate Deductible of INR 10,000 to 25,00,000 a year, for claims in India only. Options vary by plan: Optima Lite 10K/25K/50K; Optima Select up to 10L; 5L/10L only with Base Sum Insured of 25 L or more, 20L/25L only with 50 L or more. A deductible of 10 Lakhs or more removes several benefits.","quote":"2.7 | Aggregate Deductible# (Optional) ... Aggregate Deductible if opted, shall apply only for claims arising in India. However, a Per Claim Deductible of Rs. 10,000 will apply separately for each and every claim arising out of India in Global plans ... 1. Aggregate Deductible (Optional Cover on Annual Aggregate basis in INR: • 10,000 / 25,000 / 50,000 / 1,00,000 / 2,00,000 / 3,00,000 / 5,00,000 / 10,00,000 /20,00,000 / 25,00,000 ... The Insured Person shall bear an amount equal to the Aggregate Deductible specified on Policy Schedule once in a Policy Year post which coverage shall commence under this policy for that Policy Year. ... f) 5L / 10L Deductible can only be opted with Base Sum Insured >= 25 L ... g) 20L / 25L Deductible can only be opted with Base Sum Insured >= 50 L","sources":[{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"},{"clause":"1.1.1(e)","heading":null,"page":68,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-e"},{"clause":"B.2.1","heading":null,"page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/2#c-b-2-1"},{"clause":"2.7","heading":"Aggregate Deductible","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-7"},{"clause":"1.1.1(f)","heading":null,"page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-f"},{"clause":"1.1.1(g)","heading":null,"page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-g"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"not-stated","value":null,"display":null,"note":"No disease or procedure sub-limits are listed; benefits in Annexure C are 'Covered upto sum insured'.","quote":null,"sources":[],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days (Optima Lite: 30 days)","note":"Optima Lite: 30 days. Must relate to an admissible hospitalisation.","quote":"Such expenses shall be indemnified if the same were incurred upto 60 days unless otherwise specified in the Policy Schedule, immediately prior to the date of admission. ... 1.5 | Pre-Hospitalization | 60 days | 60 days | 60 days | 60 days (India only) | 60 days | 60 days | 30 days | 60 days","sources":[{"clause":"1.5","heading":"Pre-Hospitalization Expenses","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-5"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":180},"display":"180 days (Optima Lite: 60 days)","note":"Optima Lite: 60 days. Must relate to an admissible hospitalisation.","quote":"Such expenses shall be indemnified if the same were incurred upto 180 days unless otherwise specified in the Policy Schedule, immediately post the date of discharge from the Hospital. ... 1.6 | Post-Hospitalization | 180 days | 180 days | 180 days | 180 days (India only) | 180 days | 180 days | 60 days | 180 days","sources":[{"clause":"1.6","heading":"Post-Hospitalization Expenses","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-6"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"All Day Care Treatments are covered up to the sum insured in every plan.","display":"All day care treatments, up to sum insured","note":null,"quote":"iv) All Day Care Treatments. ... 1.1.1. iv. | Day Care Treatment | Covered upto sum insured","sources":[{"clause":"1.1.1(iv)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-iv"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Yes. Domiciliary hospitalisation is covered up to sum insured when the insured cannot be moved to a hospital or no hospital room is available; separately, Home Health Care covers treatment at home that would otherwise need in-patient care, on a pre-authorised cashless basis.","display":"Yes, up to sum insured (plus cashless Home Health Care)","note":"In the two Global plans these covers apply in India only. Home Health Care must be prescribed and pre-authorised.","quote":"a) the condition of the Insured Person is such that he/she could not be removed/admitted to a Hospital. or,\nb) the Medically Necessary Treatment is taken at Home on account of non-availability of room in a Hospital. ... 1.3 | Domiciliary Hospitalization | Covered upto sum insured ... This Cover is not available on reimbursement basis.","sources":[{"clause":"1.3","heading":"Domiciliary Hospitalization","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-3"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"},{"clause":"1.2","heading":"Home Health Care","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-2-2"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"In-patient AYUSH treatment in an AYUSH Hospital is covered; Annexure C shows it covered up to sum insured in all plans.","display":"In-patient care, covered up to sum insured","note":"The wording refers to a sub-limit in the Policy Schedule; the plan chart shows 'Covered upto sum insured'.","quote":"The Company shall indemnify the Medical Expenses incurred by the Insured Person only for Inpatient Care under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy systems of medicines during each Policy Year up to the Sub-limit specified against this Cover in the Policy Schedule, in any AYUSH Hospital. ... 1.4 | AYUSH Treatment | Covered upto sum insured","sources":[{"clause":"1.4","heading":"AYUSH Treatment","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-4"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"not-stated","value":null,"display":null,"note":"No clause on robotic surgery, immunotherapy, oral chemotherapy or similar; specific exclusion (g) excludes stem cell harvesting.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"cross-checked","value":"Yes. The organ donor's hospitalisation for harvesting the organ is covered up to sum insured when the insured is the recipient, excluding the donor's pre- and post-hospitalisation, organ transport or preservation, and later complications.","display":"Yes, donor's harvesting hospitalisation, up to sum insured","note":"The recipient's claim must be admissible.","quote":"which are incurred by the Insured Person during the Policy Year towards the organ donor’s Hospitalization for harvesting of the donated organ where an Insured Person is the recipient ... i) The organ donor’s Pre-Hospitalization Expenses and Post-Hospitalization Expenses.\nii) Expenses related to organ transportation or preservation. ... 1.7 | Organ Donor Expenses | Covered upto sum insured","sources":[{"clause":"1.7","heading":"Organ Donor Expenses","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-7"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance is covered up to sum insured; Emergency Air Ambulance up to 500,000 in all plans except Optima Select.","display":"Road: up to sum insured; air: up to 500,000 (not in Optima Select)","note":"Air ambulance must be advised in writing, from the site of first occurrence to the nearest hospital, no return trip; its limit does not reduce the Sum Insured.","quote":"i) Expenses incurred on road Ambulance if the Insured Person is required to be transferred to the nearest Hospital for Emergency Care or from one Hospital to another Hospital or from Hospital to Home (within same city) following Hospitalization. ... Road Ambulance | Covered upto sum insured ... 2.1 | Emergency Air Ambulance | Covered Up to 500,000 | Covered Up to 500,000 | Covered Up to 500,000 | Covered Up to 500,000 | Covered Up to 500,000 | Not Covered | Covered Up to 500,000 | Covered Up to 500,000","sources":[{"clause":"1.1.1(i)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-i"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"cross-checked","value":"Automatic Restore Benefit adds 100% of the Base Sum Insured after an admissible claim partly or fully uses the Sum Insured, once a year (unlimited times in Optima Select, Optima Lite and Optima Secure +); usable for subsequent claims, including the same illness, and not carried forward.","display":"100% of Base Sum Insured, once a year (unlimited in Select, Lite and Secure +), same illness allowed","note":"Restored amount only for later claims in the same year; a single claim cannot exceed Base Sum Insured plus remaining bonuses and Secure Benefit. Not available with an Aggregate Deductible of 10 Lakhs or more. In the two Global plans it applies in India only. A separate 'Unlimited Restore' add-on gives unlimited restoration.","quote":"The company shall instantly add 100% of the Base Sum Insured under this benefit in the event of an admissible claim during the Policy Year due to which Sum Insured was partially or completely exhausted. ... Automatic Restore Benefit shall be applied only once during the Policy Year unless specified otherwise in the Policy Schedule. ... vi. The restored Sum Insured can be used even for the same illness for which an admissible claim has been paid during the Policy Year ... Unlimited times | Unlimited times | Unlimited times","sources":[{"clause":"2.6","heading":"Automatic Restore Benefit","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-6"},{"clause":null,"heading":"Specific Conditions applicable to Automatic Restore Benefit","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-specific-conditions-applicable-to-automatic-rest"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"cross-checked","value":"The cover grows every year irrespective of claims, by plan: Cumulative Bonus of 10% of Base Sum Insured a year up to 100% (Suraksha, Lite) or 25% up to 100% (Select); Plus Benefit of 50% a year up to 100% (Secure, Super Secure, Global plans); Infinite Benefit of 100% a year with no maximum (Secure +, optional in Super Secure).","display":"10% to 50% of Base Sum Insured a year up to 100% (unlimited 100% a year with Infinite Benefit), irrespective of claims","note":"Not reduced after a claim. Lost on a break in policy; reduced proportionately if Sum Insured is reduced. Plus Benefit (50% a year up to 100%) is optional in Optima Select and Optima Lite; once opted, Cumulative Bonus ceases. Not available with an Aggregate Deductible of 10 Lakhs or more.","quote":"a sum equal to 10% (unless otherwise specified in the policy schedule) of the Base Sum Insured of the expiring Policy shall be provided as CB irrespective of any claims ... a sum equal to 50% of the Base Sum Insured under the expiring Policy will be added to the Sum Insured available under the Renewed Policy ... can only be accumulated up to 100% of Base Sum Insured ... a sum equal to 100% of the expiring policy year’s Base Sum Insured shall be provided as an incentive irrespective of claims ... There is no maximum limit on accumulation of Infinite benefit. ... 25% of the Base Sum Insured maximum upto 100% post completion of each policy year irrespective of claims","sources":[{"clause":"1.8","heading":"Cumulative Bonus (CB) [Applicable to ‘Optima Suraksha’, ‘Optima Lite’ and ‘Optima Select’ plans]","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-8"},{"clause":"2.4","heading":"Plus Benefit","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-4"},{"clause":"2.17","heading":"Infinite Benefit","page":28,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-17"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"quote-verified","value":"Allowable consumables are part of hospitalisation cover. Non-Medical Expenses in Annexure B (gloves, masks and similar) are excluded unless Protect Benefit is in force; it is inbuilt by default in Optima Secure, Super Secure, both Global plans and Secure +, optional in Select and Lite, and not available in Suraksha.","display":"Paid under Protect Benefit (default in most plans); otherwise non-medical items excluded","note":"Without Protect Benefit, specific exclusion (k) excludes Non-Medical expenses listed in Annexure B.","quote":"The Company shall indemnify the Insured Person for the Non-Medical Expenses listed under Annexure B to this Policy incurred in relation to a claim admissible as per Section B-1 (Base Coverage) during the Policy Year. ... 2.3 | Protect Benefit | Not Covered | Default: Covered upto sum insured Optional: To remove benefit | Default: Covered upto sum insured Optional: To remove benefit | Covered upto sum insured | Covered upto sum insured | Optional | Optional | Default: Covered upto sum insured Optional: To remove benefit ... allowable consumables ... Annexure B List I - Items for which Coverage is not available in the Policy (Non-Medical ... 56 | GLOVES ... 60 | MASK","sources":[{"clause":"2.3","heading":"Protect Benefit","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-3"},{"clause":"1.1.1","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-1-2"},{"clause":"1.1","heading":"Hospitalization Expenses","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-1-2"},{"clause":"Annexure A","heading":null,"page":53,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-annexure-a"},{"clause":null,"heading":"Expenses)","page":57,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-expenses"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Not covered: childbirth, caesarean, miscarriage and termination expenses are excluded (except ectopic pregnancy).","display":"Not covered (Excl18)","note":"The separate 'Parenthood' add-on covers maternity after a waiting period of 2 years.","quote":"Maternity: Code – Excl18:\ni) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ... ii) Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy Period.","sources":[{"clause":"2","heading":"Standard Exclusions","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-18"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"No newborn cover from birth: the policy covers insured persons aged 91 days and above.","display":"Not from birth; children covered from 91 days","note":null,"quote":"This Policy covers Insured Persons in the age group of 91 days and above.","sources":[{"clause":"1.27","heading":"Eligibility","page":44,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-27"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"cross-checked","value":"A Preventive Health Check-up every Policy Year after the first, up to Rs. 1,500 to Rs. 8,000 per person (individual) or Rs. 2,500 to Rs. 15,000 per policy (floater) depending on Base Sum Insured.","display":"Every year after the first: Rs. 1,500 to Rs. 8,000 (individual), Rs. 2,500 to Rs. 15,000 (floater)","note":"Inbuilt in all plans except Optima Select (optional); India only; not carried forward; not available with an Aggregate Deductible of 5 Lakhs or more.","quote":"This benefit is available every Policy Year post completion of the first Policy Year irrespective of the policy tenure opted. ... Limit of Cover | Rs. 1,500 | Rs. 2,000 | Rs. 4,000 | Rs. 5,000 | Rs. 8,000 ... Limit of Cover | Rs. 2,500 | Rs. 5,000 | Rs. 8,000 | Rs. 10,000 | Rs. 15,000","sources":[{"clause":"3(i)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-3-i"},{"clause":"3(vi)","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-3-vi"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Not covered: treatment taken on an outpatient basis is excluded.","display":"Not covered","note":"The separate 'Optima Wellbeing' add-on covers outpatient benefits.","quote":"l) Treatment taken on outpatient basis.","sources":[{"clause":"3","heading":"Specific Exclusions","page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-3-2"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"cross-checked","value":"Yes. Premium depends on the city of residence, in six tiers (Tier 1 Delhi, Surat, Gurugram and others to Tier 6 Rest of India); no co-payment applies for treatment in a higher tier.","display":"Yes, premium by city tier (Tier 1 to Tier 6); no co-pay for treatment elsewhere","note":null,"quote":"The premium payable under the Policy will be computed basis the city of residence provided by the Insured Person in the Proposal Form. ... f) Tier 6: Rest of India. No co-payment shall apply if Insured Person from a lower tier avails a treatment in higher tier.","sources":[{"clause":"1.24","heading":"Premium Tier","page":43,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-24"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"cross-checked","value":"Cashless treatment is available at the Company's Network Providers in India, subject to pre-authorisation. Outside India claims are normally reimbursed, with cashless arranged case to case.","display":"Yes, at Network Providers in India with pre-authorisation","note":"Pre-authorisation is valid for 15 days. Home Health Care is available only cashless (not on reimbursement).","quote":"Cashless facility can be availed only at Company’s Network Provider. ... Treatment may be taken in a Network Provider and is subject to pre authorization by the Company. ... Claims shall normally be payable on Reimbursement basis only. Cashless facility may be arranged on case to case basis.","sources":[{"clause":"1.5","heading":"Conditions for obtaining Cashless Facility within India","page":50,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-5-3"},{"clause":"1.2","heading":"Procedure for Cashless Claims In India","page":49,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-2-4"},{"clause":"2.9(iii)","heading":null,"page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-2-9-iii"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"The Company (HDFC ERGO) receives claim intimation and issues cashless pre-authorisation itself; no TPA is named.","display":"HDFC ERGO itself (no TPA named)","note":"Claim intimation goes to the Company's customer service and healthclaims@hdfcergo.com; the documents do not mention a third-party administrator for this product.","quote":"The Company upon getting cashless request form and related medical information from the Insured Person/ Network Provider shall issue pre-authorization letter to the Network Provider after verification.","sources":[{"clause":"1.2","heading":"Procedure for Cashless Claims In India","page":49,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-1-2-4"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes","note":"Up to 4 adults and 6 dependent children in one floater policy.","quote":"In case of Family Floater policies, a common Base Sum Insured shall be available on a floating basis amongst all the Insured Persons.","sources":[{"clause":"Def. 8","heading":"Base / Basic Sum Insured","page":8,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1#c-def-8-2"}],"law":[]}],"documents":[{"kind":"wording","label":"my:Optima Secure (for policies with period of Insurance starting 02-April- 2026 onwards)","pages":69,"fetched_at":"2026-10-16 04:47:11.920207+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/PolicyWordings_myOptimaSecure-76673175551.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/1"},{"kind":"cis","label":"my:Optima Secure","pages":8,"fetched_at":"2026-10-16 04:47:13.572854+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/CIS_Website_myOptimaSecure-751325733632.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526/document/2"}],"versions":[{"uin":"HDFHLIP21016V012122","version":null,"approved_on":null},{"uin":"HDFHLIP26058V082526","version":null,"approved_on":null}],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"my:Optima Secure (UIN HDFHLIP26058V082526), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/my-optima-secure-hdfhlip26058v082526"}