Our first of a kind Optima Restore Family Health Insurance plan offers a unique Restore benefit that automatically reinstates the basic sum insured in case you exhaust it in a policy year.
Optima Restore Family Plan - Benefits
1. In-Patient Hospitalisation
The medical expenses for coverage for hospitalization of more than 24 hrs with no room rent limits.
The medical expenses that you incur due to illness during 60 days immediately before you are hospitalized.
The medical expenses you incur in the 180 days immediately after you are discharged from hospital.
4. Day-Care Procedures
The medical expenses for all day-care procedures covered, which do not require 24 hours hospitalization due to technological advancement, are covered.
5. Domiciliary Treatment
The treatment expenses involved in getting a treatment done at home which otherwise would need hospitalization.
6. Organ Donor
Treatment expenses for the organ donor at the time of organ transplant.
7. Daily Cash for Choosing Shared Accommodation
A lump sum amount given for selecting a shared room in a network hospital.
8. Emergency Ambulance
Expenses incurred if ambulance service is used on the way to hospital for hospitalization (up to Rs. 2000).
9. Health Check-up
A comprehensive health check-up involving a number of medical tests once at the end of a block of one/two continuous policy years
10. Restore Benefit
Automatic re-instatement of the basic sum insured, if the basic sum insured and multiplier benefit has been exhausted during the policy year. Basic sum insured will be re-instated only once in a policy year. An instant addition of 100% basic sum insured to your cover, on your first claim. So if you have a base sum insured of 5 lakhs, and you claim Rs. 1,00,000 at the beginning of the year, we will restore the base Sum Insured of 5 lakhs to your remaining balance, i.e. you will now have Rs. 9,00,000 which can be used for subsequent claims in the remaining policy year for all claims under In-patient Benefits.
On request of the Insured person diagnosed with a crticial illness, We will arrange for a second opinion from a medical practitioner selected by the insured person from Our panel. This benefit can be availed once in a policy year.
12. Stay Active Benefit
In order to reward your healthy lifestyle, we will offer a discount at each renewal if you achieve an average step count target on the mobile application provided by us in the specified time interval.
Optima Restore Family Plan - Other Benefits
You get a bonus of 50% of the basic sum insured for every claim free year accumulating up to 100%. (In the event of a claim, the bonus shall be reduced by 50% of the Basic Sum Insured at the time of renewal).
You need to obtain a pre-authorization for all planned admissions atleast 48 hours prior to actual admission or regularize any an emergency admission within 24 hours post the admission. The details of the process and the documentation requirements are given in the guide-book sent along with the policy
Sum Insured Enhancement
Sum Insured can be enhanced only at the time of renewal subject to no claim have been lodged/ paid under the policy. If the insured increases the sum insured one grid up, no fresh medicals shall be required. In cases where the sum insured increase is more than one grid up, the case shall be subject to medicals. In case of increase in the sum insured waiting period will apply afresh in relation to the amount by which the sum insured has been enhanced. However, the quantum of increase shall be at the discretion of the company.
With the Optima Restore Family Health Insurance Plan you can presently avail tax benefits for the premium amount under Section 80D of the Income Tax Act. (Tax benefits are subject to changes in Tax Laws)
Optima Restore Family Health Insurance - Fact File
|Basic Sum insured per insured person per policy year||5 Lakh||10 Lakh||15 Lakh||20 to 50 Lakh|
|Pre-Hospitalization||Covered, upto 60 days|
|Post-Hospitalisation||Covered, upto 180 days|
|Day Care Procedures||Covered|
|Emergency Ambulance||upto Rs. 2000 per hospitalisation|
|Daily cash for Choosing shared accommodation||Rs.800 per day, Maximum Rs.4,800||Rs.1000 per day, Max Rs.6,000|
|E-Opinion in respect of a Critical Illness||Covered|
|Emergency Air Ambulance Cover||Not Covered||Covered upto rs. 2.5 Lacs per hospitalization and maximum upto sum insured in an year|
|Restore Benefit||Equal to 100% of Basic Sum Insured|
|Health Checkup (per person)||Upto Rs. 1,500||Upto Rs. 2,000||Upto Rs. 4,000||Upto Rs. 5,000|
|Multiplier Benefit||Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%. In case of claim, bonus will be reduced by 50% of the Basic Sum Insured at the time of renewal.|
|Critical Advantage Rider||Not Covered||Offered (where base Sum Insured is Rs.10 lacs & above)|
Things to Know
- All treatments within the first 30 days of cover except any accidental injury?
- Any pre-existing condition will be covered after a waiting period of 3 years
- 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele etc.
- Expenses arising from HIV or AIDS and related diseases.
- Congenital diseases, mental disorder or insanity, cosmetic surgery and weight control treatments.
- Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.
- Hospitalization due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind.
- Pregnancy, dental treatment, external aids and appliances unless covered under the specific Easy Health Insurance Plan.
- Items of personal comfort and convenience.
- Experimental, investigative and unproven treatment devices and pharmacological regimens. Please refer to the Policy Wording for the complete list of exclusions.
- We offer coverage from the age of 5 years onwards with maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
- You and/ or your family members namely spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on floater sum insured basis.
- Maximum 6 members can be added in a Optima Restore Family Floater Health Insurance policy with a maximum of 2 adults and 5 children in a single policy.
- Your premium at renewal may change due to a change in your age or changes in the applicable tax rate.
- The policy period options include period of 1 or 2 years(s). (We offer 7.5% discount if you opt for a 2 year policy)
- Online health assessment
- Customized diet & exercise plan from our experts
- E- storage facilities to store your medical reports for 24X7 access
- Great offers & discounts on heath products & services
- Set alerts to track your health appointments and medicinal intake
- Exclusive health newsletter & helpline services
In addition, Health Line Services & Discounts at our listed partner's network are provided in all sum insured. You just need to call us and quote your customer ID to reach our experts and avail their help in primary consultation, health-related counseling, individual referrals, health information, nutrition and diet.
- Our Optima Restore Family Health Insurance policy offers lifelong renewability i.e there is no maximum cover ceasing age in this policy
- Grace Period of 30 days for renewing the policy is provided under this policy.
- Waiting periods as mentioned in the policy wording gets reduced by 1 year on every continuous renewal of your Optima Restore Family Floater Insurance policy.
- Renewal premium are subject to change with prior approval from IRDA. Any change in benefits or premium (other than due to change in age) will be done with the approval of the IRDA and will be intimated atleast 3 months in advance.