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Plans > Health Insurance Plans > Family > Optima Super Family

Our Top up Plan Optima Super is an aggregate plan that offers you varied sum insured & deductible combinations to choose so you can opt for the optimum coverage as per your needs. In addition, it is the only plan that gives you an option to convert to a Fully Nil Deductible plan near your retirement.

  • 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 parent is covered under this policy).
  • You and/ or your family members namely spouse, dependent children, dependent parents are eligible for buying this cover on a floater sum insured basis.
  • Maximum 4 members can be added in a floater policy with a maximum of 2 adults and a maximum of 2 children. The 2 adults can be a combination of Self, Spouse, Father or Mother.
  • 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)

Plan Benefits

  • In-Patient Hospitalisation - The medical expenses covered for hospitalization of more than 24 hrs.
  • Pre-Hospitalisation - The medical expenses that you incur on consultations, investigations and medicines during 60 days before you are hospitalized.
  • Post-Hospitalisation - The medical expenses you incur on consultations, investigations and medicines in 90 days immediately after you are discharged from hospital.
  • Day-Care Procedures - The medical expenses for 144 day-care procedures, which do not require 24 hours hospitalization due to technological advancement, are covered.
  • Organ Donor - Treatment expenses for the organ donor at the time of organ transplant.
  • Ambulance Service- Expenses incurred if ambulance service is used on the way to hospital for hospitalization (up to Rs. 2000).

Other Benefits

  • Waiver of Deductible benefit - The option to convert the plan to a fully fledged Indemnity Health Insurance plan with no underwriting or medicals is available only at renewal between 55-60 years provided you have enrolled with Us under this policy before the age of 50 years and have renewed with us continuously without a break.
  • Cashless Service - You need to obtain a pre-authorization for all planned admissions atleast 48 hours prior to actual admission or regularize any ‘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.
  • Portability - If you are insured with some other company’s health insurance and you want to shift to us on renewal, you can. Our portability policy is customer friendly and aims to achieve the transfer of most of the accrued benefits and makes due allowances for waiting periods etc.
  • Tax Benefits - With the Optima Super 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)
Value Added Services

We offer you a range of value-added services to promote your well- being, prevent illnesses as well as make hospitalization stress-free for you and your family.

  • Healthline - Just ring 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. The services on the Healthline would be available at no extra cost to the customers. They will be constantly augmented to cover further areas of health and wellbeing to include personalized health and wellness solutions.
  • Health Risk Assessment - Every HDFC Ergo Health Insurance Ltd. (formerly Apollo Munich Health Insurance) customer will be provided with an access to a health risk assessment tool, which helps to profile each member’s health status through our website. Upon assessment, members will be offered personalized wellness recommendations on diet, lifestyle and nutrition regimen.
Renewal Benefits
  • Our Optima Super 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 Super 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.
  • 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 4 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.
  • 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.

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