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Optima Restore Prospectus

The Optima Restore policy by HDFC ERGO provides health insurance coverage for individuals aged 91 days to 65 years, allowing for family inclusion with specific age and relationship criteria. The policy covers various medical expenses including inpatient treatment, pre and post-hospitalization costs, and offers additional benefits like restore and unlimited restore options. It also outlines specific exclusions and conditions for claims, emphasizing the importance of understanding the policy terms before purchase.

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0% found this document useful (0 votes)

67 views42 pages

Optima Restore Prospectus

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cocedid934

We take content rights seriously. If you suspect this is your content, claim it here.

Available Formats

Download as PDF, TXT or read online on Scribd

You are on page 1/ 42

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

Optima Restore - Prospectus

Suitability:
a) This policy covers persons in the age group 91 days to 65 years. The maximum entry age is restricted
to 65 years. The Minimum entry age for adult dependent: is 18 years and maximum entry age is 65
years.
b) Children between 91 days and 5 years can be insured provided either parent is getting insured under
this policy.
c) There is no maximum cover ceasing age on renewals.
d) The policy will be issued for a period of 1/2/3 year(s) period, the sum insured & benefits will applicable
on policy year basis.
e) This policy can be issued to an individual and/or family. A maximum of 6 members can be added in a
single policy, whether on an individual or family floater basis.
f) The policy offers option of covering on individual sum insured basis and on family floater basis.
g) The family includes following relationships spouse, dependent children and dependent parents and
dependent in laws.
h) In a family floater policy, a maximum of 2 adults and a maximum of 5 children can be included in a
single policy. The 2 adults can be a combination of self, spouse, father, father in law, mother or mother
in law .
i) In a family floater the age of the eldest member will be considered while computing premium for the
family.
j) In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single
policy. The 4 adults can be a combination of self, spouse, father, father in law, mother or mother in
law.
k) The Sum Insured of the dependent insured members should be equal to or less than the sum insured
of the primary insured member. In case where two or more children are covered, the sum insured for
all the children must be same. Sum insured of dependent parents must be the same.

Note:
I. Dependents means only the family members listed below:
i. Your legally married spouse as long as she continues to be married to you;
ii. Your children aged between 91 days and 25 years if they are unmarried
iii. Your natural parents or parents that have legally adopted you, provided that the parent
was below 65 years at his initial participation in the Optima Restore policy.
iv. You’re Parent -in-law as long as your spouse continues to be married to you and were
below 65 years at his initial participation in the Optima Restore policy.
v. All dependent parents must be financially dependent on you.

Dependent Child means a child (natural or legally adopted), who is unmarried, aged between 91 days
and 25 years, financially dependent on the primary Insured or Proposer and does not have his / her
independent sources of income.

Salient Features & Benefits:

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,
HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,
please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |
Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021
| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

1|Page
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

We will cover the Medical Expenses for: In addition to the waiting periods
(Section 5a) and general exclusions
(Section 5c), We will also not cover
expenses
a. In-patient Treatment.
This includes
• Hospital room rent or boarding; If as per any or all of the Medical references
• Nursing; herein below containing guidelines and
• Intensive Care Unit protocols for Evidence Based Medicines,
• Medical Practitioners (Fees) the Hospitalisation for treatment under
• Anaesthesia claim is not necessary or the stay at the
• Blood hospital is found unduly long:
• Oxygen
▪ Medical text books,
• Operation theatre
▪ Standard treatment guidelines as
• Surgical appliances;
stated in clinical establishment act
• Medicines, drugs & consumables; of Government of India,
• Diagnostic procedures. ▪ World Health Organisation (WHO)
protocols,
• Note pertaining specifically to AYUSH Treatments only: ▪ Published guidelines by healthcare
• providers,
• Medical expenses pertaining only to In-patient care ▪ Guidelines set by medical societies
AYUSH treatment are also covered under 'In-patient like cardiological society of India,
treatment' cover if undertaken in an AYUSH Hospital. neurological society of India etc.
Any medical expense other than In-patient care AYUSH
treatment expenses are not covered under this policy
b. Pre-Hospitalisation expenses for consultations, i) Claims which have NOT been admitted
investigations and medicines incurred upto 60 days under Inpatient treatment benefit and
before the date of admission to the hospital (In- day care procedure benefit.
patient OR Day Care OR Domiciliary treatment). ii) Expenses not related to the admission
and not incidental to the treatment for
which the admission has taken place.
c. Post-Hospitalisation expenses for consultations, i. Claims which have NOT been
investigations and medicines incurred upto 180 days admitted under Inpatient treatment
after discharge from the Hospital (In-patient OR Day benefit and day care procedure
Care OR Domiciliary treatment). benefit.
ii. Expenses not related to the
admission and not incidental to the
treatment for which the admission
has taken place
d. Day Care Procedures i) Treatment that can be and is usually
Medical treatment or surgical procedure which is taken on an out-patient basis is not
undertaken under general or local anaesthesia, covered.
which require admission in a Hospital/Day Care ii) Treatment NOT taken at a Hospital or
Centre for stay less than 24 hours. Treatment daycare centre.
normally taken on out-patient basis is not included in
the scope of this definition.

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Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

▪
e. Domiciliary Treatment 1. Treatment of less than 3 days
Medical treatment for an Illness/disease/injury which (Coverage will be provided for
in the normal course would require care and expenses incurred in first three days
treatment at a Hospital but is actually taken while only if treatment period is greater than
confined at home under any of the following three days).
circumstances:
i. The condition of the patient is such that he/she
is not in a condition to be removed to a Hospital
or,
ii. The patient takes treatment at home on account
of non-availability of room in a Hospital.
iii. Pre and Post Hospitalisation expenses for
consultations, investigations and medicines
incurred upto 60 days before hospitalisation and
180 days after hospitalization respectively will be
covered in case of domiciliary treatment.
f. Organ Donor: 1. Claims which have NOT been admitted
Medical and surgical Expenses of the organ donor under Inpatient treatment benefit for
for harvesting the organ where an Insured Person is insured member.
the recipient. 2. Admission not compliant under the
IMPORTANT: Expenses incurred by an insured Transplantation of Human Organs Act,
person while donating an organ is NOT covered. 1994 (as amended).
3. The organ donors Pre and Post-
Hospitalisation expenses.
g. Ambulance Cover 1. Claims which have NOT been admitted
Expenses incurred on transportation of Insured under Inpatient Treatment Benefit and
Person to a Hospital for treatment in case of an Daycare procedure benefit
Emergency, subject to Rs. 2000 per Hospitalisation. 2. Healthcare or ambulance service
provider not registered with road traffic
authority.
h. Daily Cash for choosing shared Accommodation 1. Daily Cash Benefit for time spent by the
Daily cash amount will be payable per day as Insured Person in an intensive care unit
mentioned in schedule of benefits if the Insured 2. Claims which have NOT been admitted
Person is hospitalised in Shared Accommodation in a under Inpatient Treatment benefit
Network Hospital for each continuous and completed
period of 24 hours if the Hospitalisation exceeds 48
hours.

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Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

i. E-Opinion in respect of a Critical Illness 1. More than one claim for this benefit in a
We shall arrange and pay for a second opinion from Policy Year.
Our panel of medical Practitioners, if: 2. Any other liability due to any errors or
-The Insured Person suffers a Critical Illness during omission or representation or
the Policy Period; and consequences of any action taken in
-He requests an E-opinion; and reliance of the E-opinion provided by
the Medical Practitioner
The Insured Person can choose one of Our panel
Medical Practitioners. The opinion will be directly
sent to the Insured Person by the Medical
Practitioner.

“Critical Illness” includes Cancer, Open Chest

CABG, First Heart Attack, Kidney Failure, Major
Organ/Bone Marrow Transplant, Multiple Sclerosis,
Permanent Paralysis of Limbs and Stroke.

j. Emergency Air Ambulance Cover 1. Claims which have NOT been

We will pay for ambulance transportation in an admitted under 1 a) and 1d).
airplane or helicopter subject to maximum limit 2. Expenses incurred in return
prescribed in j (1) , for emergency life threatening transportation to the insured’s
health conditions which require immediate and rapid home by air ambulance is
ambulance transportation to the hospital/medical excluded.
centre that ground transportation cannot provide
subject to:
• Necessary medical treatment not being available
at the location where the Insured Person is
situated at the time of Emergency;
• The Medical Evacuation been prescribed by a
Medical Practitioner and is Medically Necessary;
• The insured person is in India and the treatment
is required in India only and not overseas in any
condition whatsoever; and
• The air ambulance provider being registered in
India.

j(i) The amount payable in case of Air ambulance facility

shall be either the actual expenses or Rs. 2.5 Lacs per
hospitalisation, whichever is lower; upto basic sum
insured limit for a year.

Section II.
a. Restore Benefit
Instant addition of 100% Basic Sum Insured on
complete or partial utilization of Your existing
Policy Sum Insured and Multiplier Benefit (if
applicable) during the Policy Year. The Total

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Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

amount (Basic sum insured, Multiplier benefit and

Restore sum insured) will be available to all
Insured Persons for all claims under In-patient
Benefit during the current Policy Year and subject
to the condition that single claim in a Policy Year
cannot exceed the sum of Basic Sum Insured and
the Multiplier Benefit (if applicable).

Conditions for Restore benefit:

i. The Sum Insured will be restored only once in a
Policy Year.
ii. If the Restored Sum Insured is not utilized in a
Policy Year, it will expire.

In case of a Family Floater Policy, Restore Sum Insured

will be available on floater basis for all Insured Persons
in the Policy.

b. Unlimited Restore Benefit (Optional benefit)

This optional cover will be provide instant addition of
100% Basic Sum Insured on complete or partial
utilization of Your Restore benefit or Unlimited Restore
benefit (as applicable) during the Policy Year. This
optional cover will trigger unlimited times and is available
for all subsequent claims in a Policy Year.

Conditions for Unlimited Restore benefit:

i. The Sum Insured will be restored under this optional
cover for the subsequent claim in the Policy Year.
ii. A single claim in a Policy Year cannot exceed the
sum of Basic Sum Insured and the Multiplier Benefit
(if applicable).

In case of a Family Floater Policy, Unlimited Restore

Sum Insured will be available on floater basis for all
Insured Persons in the Policy.

c. Aggregate Deductible
The Insured Person shall bear an amount equal to the
Aggregate Deductible specified on Policy Schedule for
all admissible claims made by the Insured Person and
assessed by the Company in a Policy Year. The liability
of the Company to pay the admissible claim under that
Policy Year will commence only once the specified
Aggregate Deductible has been exhausted. This Cover
shall be subject to the following conditions:
I. This Cover is applicable on annual aggregate

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Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

basis and can be opted only at inception of the

Policy or at subsequent Renewals.
II. Once the Aggregate Deductible option is opted
by the Insured Person, it cannot be opted out or
reduced at any time during the Policy Year or at
subsequent Renewals. Deductible however can
be increased at the time of Renewal.
III. In case of Individual Policy, the entire amount of
Aggregate Deductible must first be exhausted
on per Insured Person basis, once in a Policy
Year, before the Company pays for claims of
that Insured Person in that Policy Year.
IV. In case of family floater Policy, the entire amount
of Aggregate Deductible must first be exhausted
by any one or more of the Insured Persons once
in a Policy Year before the Company pays for
claims of any Family Member covered under the
Policy in that Policy Year.
V. The Aggregate Deductible is not applicable to
section 3 (Preventive Health checkup), Section
1.i (E-Opinion in respect of a Critical Illness).

d. Co-Payment

I. If opted and mentioned on the Policy Schedule

that a Co-payment is effective, and an
admissible claim has been admitted, then the
insured person shall bear the percentage (%) of
Co-payment mentioned in the policy schedule
on all eligible claims payable under the Policy
and Our liability, if any, shall only be in excess of
that amount and would be subject to the Sum
Insured.
II. Co-payment is not applicable to Section 3
(Preventive Health checkup), Section 1.h (Daily
Cash for choosing shared Accommodation) and
Section 1.i (E-Opinion in respect of a Critical
Illness).
III. This benefit once opted, cannot be opted out at
any time during the Policy Year or at subsequent
Renewals.

6|Page
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

Illustration of Sum Insured utilization in a Policy Year

Basic Sum Insured : 5 Lacs
Multiplier Benefit: 2.5 Lacs

Available Benefit Limit

Admissible
Number Claim Basic Unlimited Utilization of Sum
Multiplier Restore claim
of Claim amount Sum Restore Insured
Benefit Benefit amount
Insured Benefit
Basic + Multiplier
1st claim 7,00,000 5,00,000 2,50,000 0 0 7,00,000
(Partial)
Multiplier (balance)
2nd claim 3,50,000 - 50,000 5,00,000 0 3,50,000
+ Restore (partial)
Restore (balance) +
3rd claim 3,00,000 - - 2,00,000 5,00,000 3,00,000
Unlimited Restore
4th claim 7,00,000 - - - 5,00,000 5,00,000 Unlimited Restore
5th claim 5,00,000 - - - 5,00,000 5,00,000 Unlimited Restore

Basic Sum Insured: Rs. 3Lacs; 5 Lacs; 10 Lacs; 15 Lacs; 20 Lacs; 25 Lacs; 50 Lacs; 100 Lacs on individual
as well as on family floater basis.

Policy Period
▪ The policy will be issued for 1/2/3 year period, the sum insured & benefits will be applicable on Policy
Year basis.

Payment Facility:
▪ Online
▪ Cheque/ / Credit Card Payment
▪ Electronic Clearing System

Renewal Incentives:
▪ Multiplier Benefit:

On Renewal of this Policy with the Company without a break, a sum equal to 50% of the Base Sum Insured of
the expiring Policy shall be provided as multiplier benefit irrespective of any claims and shall be available
under the Renewed Policy subject to the following conditions:

i. The maximum multiplier bonus will not exceed 100% of the Basic Sum Insured in any Policy
Year.
ii. In Family Floater policy, the Multiplier Benefit shall be available on Family Floater basis at
policy level
iii. In Family Floater policy, the accrued Multiplier Benefit is available to all Insured Persons under
the Policy.

7|Page
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

iv. The applicable Multiplier Benefit shall be applied annually only on completion of each Policy
Year, and once added, the accumulated amount will be carried forward to the subsequent
Policy Year, subject to there being no Break in Policy
v. If the Insured Persons in the expiring policy are covered on individual basis and thus have
accrued the multiplier bonus for each member in the expiring policy, and such expiring policy is
renewed with Us on a Family Floater basis, then the multiplier bonus to be carried forward for
credit in the Policy would be the lowest accrued multiplier bonus amongst all the Insured
Persons from the expiring Policy.
vi. Portability/migration benefit will be offered to the extent of sum of previous sum insured and
accrued multiplier bonus, portability/migration benefit shall not apply to any other additional
increased Sum Insured.
vii. In policies with a 2/3 year Policy Period, the application of above guidelines of Multiplier Benefit
shall be post completion of each policy year.

▪ Preventive Health checkup

This benefit is effective only if mentioned in the Schedule of Benefits.
If You have maintained an Optima Restore Policy with Us for the period of time mentioned in the
schedule of benefits without any break, then at the end of each block of continuous years (as
mentioned in the schedule of benefits) We will pay upto the amount mentioned in the Schedule of
Benefits towards the cost of a preventive health check-up for those Insured Persons who were insured
for the number of previous Policy Years mentioned in the Schedule.

Plan/SI 3 Lacs 5 Lacs 10 Lacs 15 Lacs 20/25/50/100

Lacs
Individual Not Upto a maximum of Upto a Upto a maximum Upto a
(Per Applicable Rs.1,500 per insured maximum of of Rs.4,000 per maximum of
Person) person, only once at the Rs.2,000 per insured person, Rs. 5000 per
end of a block of every insured person at the end of each Insured
continuous at the end of year at renewal Person, at the
two policy years. each year at end of each
renewal. year at
renewal
Floater Not Upto a maximum of Upto a Upto a maximum Upto a
(Per Applicable Rs.2,500 per policy, only maximum of of Rs.8,000 per maximum of
Policy) once at the end of a Rs.5,000 per policy, at the end Rs. 10,000 per
block of every continuous policy at the end of each year at policy,
two Policy Years. of each year at renewal. at the end of
renewal each year at
renewal.

Note: Preventive Health Check-up means a package of medical test(s) undertaken for general assessment of
health status, it does not include any diagnostic or investigative medical tests for evaluation of illness or a
disease.

Portability:

8|Page
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

If you are insured continuously and without interruption under a health insurance plan issued by an Indian non-
life insurer and you want to shift to us on renewal, Optima Restore policy offers you transfer of accrued
benefits and make due allowances for waiting periods etc. If the Insured person transfers from any other
insurer and enhances coverage, then the portability benefits will be offered only in respect to the previous sum
insured.
The application for portability should be received by us at least 30 days before the policy renewal date of the
existing policy.

Free Look Period:

You have a period of 30 days from the date of receipt of the Policy document to review the terms and
conditions of this Policy. If you have any objections to any of the terms and conditions, you have the option of
canceling the Policy stating the reasons for cancellation and you shall be refunded the premium paid by you
after adjusting the amounts spent on any medical check-up, stamp duty charges and proportionate risk
premium. You can cancel your Policy only if you have not made any claims under the Policy. All Your rights
under this Policy shall immediately stand extinguished on the free look cancellation of the Policy. Free look
provision is not applicable and available at the time of renewal of the Policy.

Exclusions:

A. Waiting Period
All Illnesses and treatments shall be covered subject to the waiting periods specified below:

i. 30-day waiting period – Code – Excl03

a) 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.
b) This exclusion shall not, however, apply if the insured person has continuous coverage for more
than twelve months.
c) The within referred waiting period is made applicable to the enhanced sum insured in the event of
granting higher sum insured subsequently.

ii. Specified disease/procedure waiting period – Code – Excl02

a) 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 or underlying
cause is cancer(s).
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum
insured increase.
c) If any of the specified disease/procedure falls under the waiting period specified for pre-existing
diseases, then the longer of the two waiting periods shall apply.
d) The waiting period for listed conditions shall apply even if contracted after the policy or declared
and accepted without a specific exclusion.
e) If the Insured Person is continuously covered without any break as defined under the applicable
norms on portability/migration stipulated by IRDAI, then waiting period for the same would be
reduced to the extent of prior coverage.
f) List of specific diseases/procedures: -

9|Page
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

Organ / Organ System Illness / diagnoses (irrespective of Surgeries / procedure

treatments medical or surgical) (irrespective of any illness /
diagnosis other than cancers)
Ear, Nose & Throat • Sinusitis • Adenoidectomy
(ENT) • Rhinitis • Mastoidectomy
• Tonsillitis • Tonsillectomy
• Tympanoplasty
• Surgery for Nasal septum
deviation
• Surgery for Turbinate
hypertrophy
• Nasal concha resection
• Nasal polypectomy
Gynaecological • Cysts, polyps including breast • Hysterectomy
lumps
• Polycystic ovarian diseases
• Fibromyoma
• Adenomyosis
• Endometriosis
• Prolapsed Uterus
Orthopaedic • Non infective arthritis • Joint replacement surgeries
• Gout and Rheumatism
Osteoporosis
• Ligament, Tendon and Meniscal
tear
• Prolapsed inter vertebral disk
Gastrointestinal • Cholelithiasis • Cholecystectomy
• Cholecystitis • Surgery of hernia
• Pancreatitis
• Fissure/fistula in anus,
Hemorrhoids, Pilonidal sinus
• Gastro Esophageal Reflux Disorder
(GERD), Ulcer and erosion of
stomach and duodenum
• Cirrhosis (However Alcoholic
cirrhosis is permanently excluded)
• Perineal and Perianal Abscess
• Rectal Prolapse
Urogenital • Calculus diseases of Urogenital • Surgery on prostate
system including Kidney, ureter, • Surgery for Hydrocele/
bladder stones Rectocele
• Benign Hyperplasia of prostate
• Varicocele
Eye • Cataract • Nil
• Retinal detachment

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Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

• Glaucoma
Others • NIL • Surgery of varicose veins
and varicose ulcers
General • Benign tumors of Non-infectious • Nil
( Applicable to all organ etiologye.eg. cysts, nodules,
systems/organs polyps, lump, growth, etc.
whether or not
described above)

iii. Pre-Existing Diseases – Code – Excl01

a) Expenses related to the treatment of a pre-existing disease (PED) and its direct complications
shall be excluded until the expiry of 36 months of continuous coverage after the date of inception
of the first policy with insurer.
b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum
insured increase.
c) If the insured person is continuously covered without any break as defined under the
portability/migration norms of the extant IRDAI (Health Insurance) Regulations, then waiting period
for the same would be reduced to the extent of prior coverage.
d) Coverage under the policy after the expiry of 36 months for any pre-existing disease is subject to
the same being declared at the time of application and accepted by insurer.

B. General exclusions

We will not pay for any claim in respect of any Insured Person for, caused by, arising from or attributable
to:

Non- 1. War or similar situations:

Medical Treatment arising from or consequent upon war or any act of war,
Exclusions invasion, act of foreign enemy, (whether war be declared or not or caused
during service in the armed forces of any country), civil war, public
defence, rebellion, revolution, insurrection, military or usurped acts,
nuclear weapons/materials, chemical and biological weapons, radiation of
any kind.
2. Intentional self-injury or attempted suicide.
3. Breach of law: Code – Excl10
Expenses for treatment directly arising from or consequent upon any Insured
Person committing or attempting to commit a breach of law with criminal
intent.

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Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

4. Hazardous or Adventure sports: Code – Excl09

Expenses related to any treatment necessitated due to participation as a
professional in hazardous or adventure sports, including but not limited to,
para-jumping, rock climbing, mountaineering, rafting, motor racing, horse
racing or scuba diving, hand gliding, sky diving, deep-sea diving.
5. Any Insured Person’s participation or involvement in naval, military or air
force operation.
Medical 6. Treatment for Alcoholism, drug or substance abuse or any addictive
Exclusions condition and consequences thereof. Code – Excl12
7. Prosthetic and other devices which are self-detachable /removable without
surgery involving anaesthesia.
8. Treatment availed outside India
9. Treatment at a healthcare facility which is NOT a Hospital.
10. Obesity/ Weight Control: Code – Excl06
Expenses related to the surgical treatment of obesity that does not fulfil all
the below conditions:
i. Surgery to be conducted is upon the advice of the Doctor
ii. The surgery/Procedure conducted should be supported by clinical
protocols
iii. The member has to be 18 years of age or older and
iv. Body Mass Index (BMI);
a. greater than or equal to 40 or
b. greater than or equal to 35 in conjunction with any of the following
severe co-morbidities following failure of less invasive methods of
weight loss:
i. Obesity-related cardiomyopathy
ii. Coronary heart disease
iii. Severe Sleep Apnoea
iv. Uncontrolled Type2 Diabetes
11.
Expenses related to the treatment for correction of eye sight due to
refractive error less than 7.5 dioptres. Code – Excl15
12. Cosmetic or plastic Surgery: Code – Excl08
Expenses for cosmetic or plastic surgery or any treatment to change
appearance unless for reconstruction following an Accident, Burn(s) or
Cancer or as part of medically necessary treatment to remove a direct and
immediate health risk to the insured. For this to be considered a medical
necessity, it must be certified by the attending Medical Practitioner.
13. Circumcisions (unless necessitated by Illness or injury and forming
part of treatment)
14. Change-of-Gender treatments: Code – Excl07
Expenses related to any treatment, including surgical management, to
change characteristics of the body to those of the opposite sex.
15. Any non-allopathic treatment except to the extent of coverage
provided for under 'In-patient Hospitalization treatment' cover..
16. Conditions for which treatment could have been done on an outpatient
basis without any Hospitalisation.
17. Unproven Treatments:

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Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

Expenses related to any unproven treatment, services and supplies for or in

connection with any treatment. Unproven treatments are treatments,
procedures or supplies that lack significant medical documentation to
support their effectiveness. Code – Excl16
18. Investigation & Evaluation: Code – Excl04
a. Expenses related to any admission primarily for diagnostics and
evaluation purposes only are excluded.
b. Any diagnostic expenses which are not related or not incidental to the
current diagnosis and treatment are excluded.
19. Rest Cure, rehabilitation and respite care: Code – Excl05
a. Expenses related to any admission primarily for enforced bed rest and
not for receiving treatment. This also includes:
i.Custodial care either at home or in a nursing facility for personal care
such as help with activities of daily living such as bathing, dressing,
moving around either by skilled nurses or assistant or non-skilled
persons.
ii.Any services for people who are terminally ill to address physical,
social, emotional and spiritual needs.
20. Preventive care, vaccination including inoculation and immunisations
(except in case of post-bite treatment);
21. Provision or fitting of hearing aids, spectacles or contact lenses
including optometric therapy, any treatment and associated expenses for
alopecia, baldness, wigs, or toupees, medical supplies including elastic
stockings, diabetic test strips, and similar products.
22. Treatments received in heath hydros, nature cure clinics, spas or
similar establishments or private beds registered as a nursing home
attached to such establishments or where admission is arranged wholly or
partly for domestic reasons. Code – Excl13
23. Dietary supplements and substances that can be purchased without
prescription, including but not limited to Vitamins, minerals and organic
substances unless prescribed by a medical practitioner as part of
hospitalization claim or day care procedure. Code – Excl14
24. Sleep-apnoea.
25. Congenital external diseases, defects or anomalies
26. Maternity: Code – Excl18
a. Medical treatment expenses traceable to childbirth (including
complicated deliveries and caesarean sections incurred during
hospitalization) except ectopic pregnancy;
b. Expenses towards miscarriage (unless due to an accident) and lawful
medical termination of pregnancy during the policy period.
27. Sterility and Infertility: Code – Excl17
Expenses related to sterility and infertility. This includes:
a. Any type of contraception, sterilization
b. Assisted Reproduction services including artificial insemination and
advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
c. Gestational Surrogacy
d. Reversal of sterilization
28. The expense incurred by the insured on organ donation.

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29. Treatment and supplies for analysis and adjustments of spinal

subluxation, diagnosis and treatment by manipulation of the skeletal
structure; muscle stimulation by any means except treatment of fractures
(excluding hairline fractures) and dislocations of the mandible and
extremities.
30. Any non-medical expenses mentioned in Annexure I.
31. Excluded Providers: Code – Excl11
Expenses incurred towards treatment in any hospital or by any Medical
Practitioner or any other provider specifically excluded by the Insurer and
disclosed in its website / notified to the policyholders are not admissible.
However, in case of life threatening situations or following an accident,
expenses up to the stage of stabilization are payable but not the complete
claim.
32. Treatment rendered by a Medical Practitioner which is outside his
discipline or the discipline for which he is licensed.
33. Treatments rendered by a Medical Practitioner who is a member of
the Insured Person’s family or stays with him, however proven material
costs are eligible for reimbursement in accordance with the applicable
cover.
34. Any treatment or part of a treatment that is not of a reasonable charge
and not Medically Necessary.
35. Drugs or treatments which are not supported by a prescription.
36. Any specific time bound or lifetime exclusion(s) applied by us and
specified in the Schedule and accepted by the insured.
37. Admission for administration of Intra-articular or Intra-lesional
injections, Supplementary medications like Zolendronic acid (Trade name
Zometa, Reclast, etc) or IV immunoglobulin infusion
38. Dental treatment and surgery of any kind, unless requiring
Hospitalisation.

Claim Procedure:

HDFC ERGO General Insurance Company Limited will process all claims under this policy.

Intimation & Assistance - Please contact HDFC ERGO General Insurance Company at least 7 days
prior to an event which might give rise to a claim. For any emergency situations, kindly contact HDFC
ERGO General Insurance Company Limited within 24 hours of the event.

Procedure for Reimbursement of Medical Expenses –

• HDFC ERGO General Insurance Company Limited must be informed no later than 7 days of
completion of such treatment, consultation or procedure using the Claim Intimation Form.
• Please send the duly signed claim form and all the information/documents mentioned therein
to HDFC ERGO General Insurance Company Limited 15 days of the occurrence of the
Incident. The Company may accept claims where documents have been provided after a
delayed interval only in special circumstances and for the reasons beyond the control of the
insured.

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* Please refer to claim form for complete documentation.

• In the case of delay in the payment of a claim, the Company shall be liable to pay interest to
the Policyholder from the date of receipt of intimation to the date of payment of claim at a rate
2% above the bank rate.
• The Company shall settle or reject a claim, as the case may be, within 15 days from the date
of receipt of intimation.
• The payment will be made in the name of the Policyholder.
Note: Payment will only be made for items covered under your policy and upto the limits
therein.

Procedure to avail Cashless facility -

• For any emergency Hospitalization, HDFC ERGO General Insurance Company Limited must
be informed no later than 24 hours after hospitalization.
• For any planned hospitalization, kindly seek cashless authorization from HDFC ERGO
General Insurance Company Limited at least 48 hours prior to the hospitalization.
• HDFC ERGO General Insurance Company Limited will check your coverage as per the
eligibility and send an authorization letter to the provider. In case there is any deficiency in the
documents sent, the same shall be communicated to the hospital within one hours of receipt of
documents.
• Please pay the non-medical and expenses not covered to the hospital prior to the discharge.
• In case the ailment /treatment is not covered under the policy a rejection letter would be sent
to the provider within one hours.

Note:
▪ Insured person is entitled for cashless coverage only in our empanelled hospitals.
▪ Please refer to the list of empanelled hospitals on our website or the list provided along with
Policy kit or call us on our customer care number at 0226234 6234 / 0120 6234 6234.
▪ Rejection of cashless facility in no way indicates rejection of the claim.

Renewal of Policy:

A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure or
misrepresentation by the insured, provided the policy is not withdrawn and also subject to conditions stated
under Moratorium clause

i. Renewal of a health insurance policy shall not be denied on the ground that the insured had made
a claim or claims in the preceding policy years, except for benefit based policies where the policy
terminates following payment of the benefit covered under the policy like critical illness policies.
ii. The company shall condone a delay in renewal up to the grace period from the due date of
renewal without considering such condonation as a break in policy.
iii. No loading shall apply on renewals based on individual claims experience
iv. The Company shall not resort to fresh underwriting unless there is an increase in sum insured. In
case increase in sum insured is requested by the Policyholder, the Insurer may underwrite only to
the extent of increased sum insured.
v. Renewal premium due can be paid prior to the due date as per norms set out by the Company.

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HDFC ERGO General Insurance Company Limited

▪ Basic Sum Insured Enhancement – Basic sum insured can be enhanced only at the time of renewal
subject to the underwriting norms and acceptability criteria of the policy. If the insured enhances the
basic sum insured one grid up, no fresh medicals shall be required. In cases where the basic sum
insured enhanced is more than one grid up, the case may be subject to medicals. In case of
enhancement in the basic sum insured waiting period will apply afresh in relation to the amount by
which the basic sum insured has been enhanced. However the quantum of increase shall be at the
discretion of the company.

Tax Benefit:
The premium amount paid under this policy qualifies for deduction under Section 80D of the Income Tax Act.

Requirement:
Completed proposal form

Pre- Policy Check-up:

Pre-Policy Check-up at our network may be required based upon the age and basic sum insured.
▪ We will reimburse 100% of the expenses incurred per Insured Person on the acceptance of the proposal.
▪ If Proposal is declined post PPC, 100% of Medical test charges will be borne by the customer for Rs.
3,00,000 & 500,000 sum insured, 50% for Rs. 10,00,000 Sum Insured and NIL for other Sum Insureds.
▪ In case of any adverse medical declaration on the proposal form, we may request for additional medical
tests

Discounts:
▪ Online Discount: The Insured Person is eligible for 5% discount on premium in case he / she purchase the
Policy online from the Company’s website or the Company’s mobile app. The subsequent Renewal of the
same Policy will continue to enjoy the 5% discount, provided the Policy remains without the involvement of
any other insurance agent or insurance intermediary.

▪ Employee Discount: A discount of 5 % on the Premium is applicable if any Insured Person is a HDFC
Group employee (full time employee) / Munich Re Group employee (full time employee) at the time of
enrolment, or subsequent renewal; provided that such Policy is purchased through the Company’s website
or the Company’s mobile app and without the involvement of any insurance agent or insurance
intermediary.

▪ Loyalty Discount: If any Insured Person has an active retail insurance Policy with premium above Rs.
2,000 with the Company, a discount of 2.5% on the Policy premium will be applicable at the time of
enrolment as well as subsequent renewals.

▪ Family Discount: The Insured Person will be entitled to receive 10% discount on the premium if two or
more family members are covered under the same Policy under the individual Policy option.
The above mentioned discounts are cumulative in nature and the total discount offered under
Employee discount, Online discount, Loyalty discount and Family discount shall not exceed 20%.
▪ Long Term Policy Discount: If the Policy Period is more than one year, the Insured Person will be entitled
to receive a discount of 7.5% and 10% will be offered in case a Policy is purchased for 2-year and 3-year
tenure respectively, provided he has paid the premium in advance as a single premium.

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▪ Aggregate Deductible Discount: If Aggregate Deductible is opted for all Insured Person, following discount
will be applicable on the Policy premium

Discount % by Aggregate Deductible for All Ages

Deductible (INR)
For Base Sum Insured < = For Base Sum Insured >
20,00,000 20,00,000

25,000 25% 15%

50,000 40% 30%

1,00,000 50% 40%

▪ Co-payment Discount: A premium discount of 10% or 20% shall apply, if you choose to opt for a co-
payment of 10% or 20% respectively.

▪ Stay Active
We will offer a discount at each renewal if the insured member achieves the average step count target
on the mobile application provided by Us in the specified time interval ( calculated from the policy risk
start date) as per the grid below. In an individual policy, the average step count would be calculated
per adult member and in a floater policy it would be an average of all adult members covered.
Dependent children covered either in individual or floater plan will not be considered for calculation of
average steps.
This discount will be accrued at defined time intervals as given in table below. The discount will be
cumulated and offered as discount on the renewal premium.

In individual policies the discount percentage (%) would be applied on premium applicable per insured
member (Dependent Children are not eligible for this stay active discount in an individual policy) and in
a floater policy it would be applied on premium applicable on policy.

The discount grid would be as per the table below:

1 Year Policy
Time Interval (calculated from policy risk start date)
Average Step Risk start date or 91-180 181-270 271-300 Maximum
Target date of download of days days days Discount at
mobile application - the end of
90 days the year
5000 or below 0% 0% 0% 0% 0%
5001 to 8000 0.5% 0.5% 0.5% 0.5% 2%
8001 to 10000 1.25% 1.25% 1.25% 1.25% 5%

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HDFC ERGO General Insurance Company Limited

Above 10000 2% 2% 2% 2% 8%

2 Year Policy

Time Interval (calculated from policy risk start date)

Risk start 91-180 181- 271- 361- 451- 541- 631- Maximum
Averag date or days 270 360 450 540 630 660 Discount
e Step date of days days days days days days at the
target download end of 2
of mobile years
applicatio
n -90 days
5000 or 0% 0% 0% 0% 0% 0% 0% 0% 0%
below
5001 to 0.25% 0.25% 0.25% 0.25% 0.25% 0.25% 0.25 0.25% 2%
8000 %
8001 to .625% .625% .625% .625% .625% .625% .625 .625% 5%
10000 %
Above 1% 1% 1% 1% 1% 1% 1% 1% 8%
10000

3 Year policy

Time Interval (calculated from policy risk start date)

Risk start 91-180 181-270 271-360 361-450 451-540
Average date or days days days days days
Step date of
target download
of mobile
application
-90 days

5000 or 0% 0% 0% 0% 0% 0%
below
5001 to 0.1667% 0.1667% 0.1667% 0.1667% 0.1667% 0.1667%
8000
8001 to 0.41667% 0.41667% 0.41667% 0.41667% 0.41667% 0.41667%
10000
Above 0.6667% 0.6667% 0.6667% 0.6667% 0.6667% 0.6667%
10000

Time Interval (calculated from policy risk start date)

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541-630 631-720 721-810 811-900 901-990 991-1020 Maximum

days days days days days days Discount
at the
end of 3
years

0% 0% 0% 0% 0% 0% 0%

0.1667% 0.1667% 0.1667% 0.1667% 0.1667% 0.1667% 2%

0.41667% 0.41667% 0.41667% 0.41667% 0.41667% 0.41667% 5%

0.6667% 0.6667% 0.6667% 0.6667% 0.6667% 0.6667% 8%

The mobile app must be downloaded within 30 days of the policy risk start date to avail this benefit.
The average step count completed by an Insured member would be tracked on this mobile application.

We reserve the right to remove or reduce any count of steps if found to be achieved in unfair manner
by manipulation.

Illustration

Policy start date 1st Jan 2016

Policy Tenure 1 year

Time Interval
Risk start date or date
of download of mobile 91 days-180 181 days-270
application -90 days days days 271- 300 days
average steps taken in
the defined time period 8500 10000 5001 7500
Discount %applicable 1.25% 1.25% 0.5% 0.5%

Total discount applicable on renewal premium = 3.5%

Loadings

▪ We may apply a risk loading on the premium payable (based upon the declarations made in the
proposal form and the health status of the persons proposed for insurance). The maximum risk loading
applicable for an individual shall not exceed above 100% per diagnosis / medical condition and an
overall risk loading of over 150% per person. These loadings are applied from Commencement Date

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of the policy including subsequent renewal(s) with us or on the receipt of the request of enhancement
in sum insured (for the enhanced Sum Insured).
For Example: Consider a male aged 35 who is undergoing treatment for hypertension.

Age Hypertension Treatment Systolic Diastolic loading

35 Yes Yes 110-145 70-95 10%
35 Yes Yes 146-160 70-95 20%
35 Yes Yes 110-140 96-105 20%
35 Yes Yes >160 Any Reject
35 Yes Yes Any >105 Reject
Please note that this example is for enumerative purposes only, the decisions may vary based on age,
co morbidities etc.

▪ We will inform you about the applicable risk loading or exclusion or both as the case may be through a
counter offer letter. You need to revert to us with consent and additional premium (if any), within 7
days of the receipt of such counter offer letter. In case, you neither accept the counter offer nor revert
to us within 7 days, we shall cancel your application and refund the premium paid within next 7 days.
▪ The application of loading does not mean that the illness/ condition, for which loading has been
applied, would be covered from inception. Any waiting period as mentioned in Section 5 A i), ii) & iii) of
the policy wordings or specifically mentioned on the Policy Schedule shall be applied on
illness/condition, as applicable.
▪ Please note that we will issue Policy only after getting your consent and additional premium, if any.
▪ We will not apply any additional loading on your policy premium at renewal based on claim experience.
▪ Please visit our nearest branch to refer our underwriting guidelines, if required.

Cancellation

i. 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.
ii. Note : For Policies where premium is paid by instalment : In case of admissible claim under the Policy,
future instalment for the current Policy Year will be adjusted in the claim amount and no refund of any
premium will be applicable during the Policy Year.
iii. The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure of
material facts, fraud by the insured person by giving 15 days’ written notice. There would be no
refund of premium on cancellation on grounds of misrepresentation, non-disclosure of material
facts or fraud.
iv. Refund of Policy premium in case of death of Insured Person/s: Policy premium shall be refunded
proportionately for the deceased Insured Person, for the unexpired Policy Period in case of death of
any Insured Person/s
v. Notwithstanding anything contained herein or otherwise, 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.

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Renewability
▪ There shall be no cover ceasing age on renewal.

Free Look Period

The Free Look Period shall be applicable on new individual health insurance policies and not on
renewals or at the time of porting/migrating the Policy.

The Insured Person shall be allowed free look period of 30 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.

If the Insured has not made any claim during the Free Look Period, the insured shall be entitled to

i. a refund of the premium paid less any expenses incurred by the Company on medical examination
of the Insured Person and the stamp duty charges or
ii. where the risk has already commenced and the option of return of the Policy is exercised by the
Insured Person, a deduction towards the proportionate risk premium for period of cover or
iii. Where only a part of the insurance coverage has commenced, such proportionate premium
commensurate with the insurance coverage during such period.

Disclosure of Information

The policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of
misrepresentation, mis description or non-disclosure of any material fact by the policyholder.

Utilization of Sum Insured

The sequence of utilization of the Sum Insured in this Policy, subject to the optional covers in force
under the Policy, will be as follows;
i. Aggregate deductible (if applicable)
ii. Co-payment (if applicable)
iii. Basic Sum Insured / Benefit sub-limit
iv. Multiplier Benefit (if applicable and available)
v. Restore Benefit
vi. Unlimited Restore (if applicable)

Complete Discharge

Any payment to the Policyholder, Insured Person or his/ her nominees or his/ her legal
representative or assignee or to the Hospital, as the case may be, for any benefit under the Policy
shall be a valid discharge towards payment of claim by the Company to the extent of that amount for
the particular claim.

Moratorium Period

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HDFC ERGO General Insurance Company Limited

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. This period of sixty continuous months is called as moratorium
period. The moratorium would be applicable for the sums insured of the first policy.
Wherever, the sum insured is enhanced, completion of sixty continuous months
would be applicable from the date of enhancement of sums insured only on the
enhanced limits

Portability

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.

Migration

The Insured Person will have the option to migrate the Policy to other health insurance
products/plans offered by the Company by applying for Migration of the policyatleast30 days before
the policy renewal date as per IRDAI guidelines on Migration. If such person is presently covered and
has been continuously covered without any lapses under any health insurance product/plan offered by
the Company, the Insured Person will get the accrued continuity benefits in waiting periods as per
IRDAI guidelines on Migration.

Possibility of Revision of terms of the Policy including the Premium Rates

The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy including the
premium rates. The Insured Person shall be notified three months before the changes are effected.

Withdrawal of Policy

i. In the likelihood of this product being withdrawn in future, the Company will intimate the Insured
Person about the same 90 days prior to expiry of the policy.

ii. Insured Person will have the option to migrate to similar health insurance product available with the
Company at the time of renewal with all the accrued continuity benefits such as Cumulative Bonus,

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waiver of waiting period as per IRDAI guidelines, provided the policy has been maintained without a
break.

Nomination:

The Policyholder is required at the inception of the Policy to make a nomination for the purpose of
payment of claims under the Policy in the event of death of the Policyholder. Any change of
nomination shall be communicated to the Company in writing and such change shall be effective only
when an endorsement on the Policy is made. In the event of death of the Policyholder, the Company
will pay the nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in
case

Condition Precedent to admission of Liability

The terms and conditions of the Policy must be fulfilled by the Insured Person for the Company to
make any payment for claim(s) arising under the Policy.

Fraud
If any claim made by the Insured Person, is in any respect fraudulent, or if any false statement, or
declaration is made or used in support thereof, or if any fraudulent means or devices are used by the
Insured Person or anyone acting on his/her behalf to obtain any benefit under this Policy, all benefits
under this policy and the premium paid shall be forfeited.

Any amount already paid against claims made under this Policy but which are found fraudulent later
shall be repaid by all recipient(s)/policyholder(s), who have made that particular claim, who shall be
jointly and severally liable for such repayment to the Insurer.

For the purpose of this clause, the expression "fraud" means any of the following acts committed by the
Insured Person or by his agent or the hospital/doctor/any other party acting on behalf of the Insured
Person, with intent to deceive the insurer or to induce the insurer to issue an insurance policy:
a) the suggestion, as a fact of that which is not true and which the Insured Person does not
believe to be true;
b) the active concealment of a fact by the Insured Person having knowledge or belief of the
fact;
c) any other act fitted to deceive; and
d) any such act or omission as the law specially declares to be fraudulent

The Company shall not repudiate the claim and / or forfeit the Policy benefits on the ground of Fraud,
if the Insured Person / beneficiary can prove that the misstatement was true to the best of his
knowledge and there was no deliberate intention to suppress the fact or that such misstatement of or
suppression of material fact are within the knowledge of the Insurer.

Premium Payment in Instalments

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HDFC ERGO General Insurance Company Limited

If the Insured Person has opted for payment of Premium on an installment basis i.e. Half Yearly, Quarterly or
Monthly, as mentioned in the Policy Schedule, the following Conditions shall apply (notwithstanding any
terms contrary elsewhere in the Policy):

a. Grace Period as mentioned in the table below would be given to pay the installment premium due for the
Policy

Options Instalment Premium Option Grace Period applicable

Option 1 Multi-Year / Yearly 30 days

Option 2 Half Yearly 30 days
Option 3 Quarterly 30 days
Option 4 Monthly 15 Days

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
d. No interest will be charged If the installment premium is not paid on due date
e. In case of installment premium due not received within the Grace Period, the Policy will get cancelled
f. In the event of a claim, all subsequent premium installments shall immediately become due and payable
g. The Company has the right to recover and deduct all the pending installments from the claim amount due
under the Policy.

Instalment premium payment through Auto Debit/ECS Facility

a. If Option of Premium payment by instalment is opted through auto Debit/ECS facility, Electronic Clearing
Service (ECS) Mandate form needs to be completely filled & signed by the Insured Person.
b. The Premium amount which would be auto debited & frequency of instalment should be duly filled in the
ECS Mandate form.
c. New ECS Mandate Form is required to be filled in case of any change in the Premium due to change of
Sum Insured / age / plan /coverages/revision in premium.
d. The Company should be informed at least 15 days prior to the due date of instalment premium if the
Insured Person wishes to discontinue the ECS facility.
Non-payment of premium on due date as opted by the Insured Person in the mandate form subject to an
additional 15 days of relaxation period will lead to termination of the Policy.

Multiple Policies

i. In case of multiple policies taken by an Insured Person during a period from one or more insurers
to indemnify treatment costs, the Insured Person shall have the right to require a settlement of
his/her claim in terms of any of his/her policies. In all such cases the Insurer chosen by the

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Insured Person shall be obliged to settle the claim as long as the claim is within the limits of and
according to the terms of the chosen Policy.
ii. Insured Person having multiple policies shall also have the right to prefer claims under this Policy
for the amounts disallowed under any other policy / policies even if the Sum Insured is not
exhausted. Then the insurer shall independently settle the claim subject to the terms and conditions
of this Policy.
iii. If the amount to be claimed exceeds the Sum Insured under a single Policy, the Insured Person
shall have the right to choose Insurer from whom he/she wants to claim the balance amount.
iv. Where an Insured Person has policies from more than one Insurer to cover the same risk on
indemnity basis, the Insured Person shall only be indemnified the treatment costs in accordance
with the terms and conditions of the chosen Policy.

Redressal of Grievance

In case of any grievance the insured person may contact the Company through:
• Website: www.hdfcergo.com
• Toll free: 022 6234 6234 / 0120 6234 6234
• E-mail: [email protected]
• Contact Details for Senior Citizen: 022 – 6242 – 6226
• E-mail specific for Senior citizens : [email protected]

Insured Person may also approach the grievance cell at any of the Company’s branches with the
details of grievance.

If Insured Person is not satisfied with the redressal of grievance through one of the above methods,
Insured Person may contact the grievance officer at [email protected]

For updated details of grievance officer, kindly refer the link: https://www.hdfcergo.com/customer-
voice/grievances

Schedule of Benefits

Optima Restore Individual

Basic Sum 3.00 5.00 10.00 15.00 20.00,
Insured per 25.00,
Insured Person 50.00,
per Policy Year 100.00
(Rs. in Lakh)
1a) In-patient Covered upto Covered upto Covered upto Covered upto Covered upto
Treatment sum insured sum insured sum insured sum insured sum insured
1b) Pre- Covered, upto Covered, upto Covered, upto Covered, upto Covered, upto
Hospitalization 60 Days 60 Days 60 Days 60 Days 60 Days
1c) Post- Covered, upto Covered, upto Covered, upto Covered, upto Covered, upto

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Hospitalization 180 Days 180 Days 180 Days 180 Days 180 Days
1d) Day Care Covered upto Covered upto Covered upto Covered upto Covered upto
Procedures sum insured sum insured sum insured sum insured sum insured
1e) Domiciliary Covered upto Covered upto Covered upto Covered upto Covered upto
Treatment sum insured sum insured sum insured sum insured sum insured
1f) Organ Covered upto Covered upto Covered upto Covered upto Covered upto
Donor sum insured sum insured sum insured sum insured sum insured
Upto Rs.2,000 Upto Rs.2,000 Upto Rs.2,000 Upto Rs.2,000 Upto Rs.2,000
1g) Emergency
per per per per per
Ambulance
Hospitalization Hospitalization Hospitalization Hospitalization Hospitalization
1h) Daily Cash Rs.800 per Rs.800 per Rs.800 per Rs.800 per Rs.1000 per
for choosing day, day, day, day, day,
Shared Maximum Maximum Maximum Maximum Maximum
Accommodation Rs.4,800 Rs.4,800 Rs.4,800 Rs.4,800 Rs.6,000
1i) E-Opinion in Covered Covered Covered Covered Covered
respect of a
Critical Illness
Not Covered Not Covered Covered upto Covered upto Covered upto
rs. 2.5 Lacs per rs. 2.5 Lacs per rs. 2.5 Lacs per
1j) Emergency hospitalization hospitalization hospitalization
Air Ambulance and maximum and maximum and maximum
Cover upto sum upto sum upto sum
insured in an insured in an insured in an
year year year
Equal to 100% Equal to 100% Equal to 100% Equal to 100% Equal to 100%
2) Restore
of Basic Sum of Basic Sum of Basic Sum of Basic Sum of Basic Sum
Benefit
Insured Insured Insured Insured Insured
2b. Unlimited
Restore Benefit Applicable if Applicable if Applicable if Applicable if Applicable if
(Optional opted opted opted opted opted
Benefit)
2c) Aggregate
Deductible
25K/50K/1L 25K/50K/1L 25K/50K/1L 25K/50K/1L 25K/50K/1L
(Optional
Benefit)
2d) Co-
Payment
10% / 20% 10% / 20% 10% / 20% 10% / 20% 10% / 20%
(Optional
Benefit)
3)Preventive Not Applicable Upto Rs. 1500 Upto Rs. 2000 Upto Rs. 4000 Upto Rs. 5000
Health Checkup
(per person)

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50% of the 50% of the 50% of the 50% of the 50% of the
Basic Sum Basic Sum Basic Sum Basic Sum Basic Sum
Insured Insured Insured Insured Insured
maximum upto maximum upto maximum upto maximum upto maximum upto
4) Multiplier 100% post 100% post 100% post 100% post 100% post
Benefit completion of completion of completion of completion of completion of
each policy each policy each policy each policy each policy
year year year year year
irrespective of irrespective of irrespective of irrespective of irrespective of
claims claims claims claims claims

Optima Restore Family

Basic Sum Insured 3.00 5.00 10.00 15.00 20.00,
per Insured Person 25.00,
per Policy Year 50.00,
(Rs. in Lakh) 100.00
1a) In-patient Covered upto Covered upto Covered upto Covered upto Covered upto sum
Treatment sum insured sum insured sum insured sum insured insured
1b) Pre- Covered, upto Covered, upto Covered, upto Covered, upto Covered, upto 60
Hospitalization 60 Days 60 Days 60 Days 60 Days Days
1c) Post- Covered, upto Covered, upto Covered, upto Covered, upto Covered, upto 180
Hospitalization 180 Days 180 Days 180 Days 180 Days Days
1d) Day Care Covered upto Covered upto Covered upto Coveredupto Covered upto sum
Procedures sum insured sum insured sum insured sum insured insured
1e) Domiciliary Covered upto Covered upto Covered upto Covered upto Covered upto sum
Treatment sum insured sum insured sum insured sum insured insured
Covered upto Covered upto Covered upto Covered upto Covered upto sum
1f) Organ Donor
sum insured sum insured sum insured sum insured insured
Upto Rs.2,000 Upto Rs.2,000 Upto Rs.2,000 Upto Rs.2,000
1g) Emergency Upto Rs.2,000 per
per per per per
Ambulance Hospitalization
Hospitalization Hospitalization Hospitalization Hospitalization
Rs.800 per Rs.800 per Rs.800 per Rs.800 per
1h) Daily Cash for Rs.1000 per day,
day, day, day, day,
choosing Shared Maximum
Maximum Maximum Maximum Maximum
Accommodation Rs.6,000
Rs.4,800 Rs.4,800 Rs.4,800 Rs.4,800
1i) E-Opinion in Covered Covered Covered Covered Covered
respect of a Critical
Illness
Not Covered Not Covered Covered upto Covered upto Covered upto rs.
rs. 2.5 Lacs rs. 2.5 Lacs 2.5 Lacs per
1j) Emergency Air per per hospitalization and
Ambulance Cover hospitalization hospitalization maximum upto
and maximum and maximum sum insured in an
upto sum upto sum year

27 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

insured in an insured in an
year year
Equal to 100% Equal to 100% Equal to 100% Equal to 100% Equal to 100% of
2a) Restore Benefit of Basic Sum of Basic Sum of Basic Sum of Basic Sum Basic Sum
Insured Insured Insured Insured Insured
2b) Unlimited
Applicable if Applicable if Applicable if Applicable if
Restore Benefit Applicable if opted
opted opted opted opted
(Optional Benefit)
2c) Aggregate
Deductible 25K/50K/1L 25K/50K/1L 25K/50K/1L 25K/50K/1L 25K/50K/1L
(Optional Benefit)
2d) Co-Payment
10% / 20% 10% / 20% 10% / 20% 10% / 20% 10% / 20%
(Optional Benefit)
3) Preventive Not Applicable Upto Rs 2500 Upto Rs.5000 Upto Rs. 8000 Upto Rs. 10,000
Health Checkup
(per policy)
50% of the 50% of the 50% of the 50% of the 50% of the Basic
Basic Sum Basic Sum Basic Sum Basic Sum Sum Insured
Insured Insured Insured Insured maximum upto
maximum maximum maximum upto maximum 100% post
upto 100% upto 100% 100% post upto 100% completion of
4) Multiplier Benefit post post completion of post each policy year
completion of completion of each policy completion of irrespective of
each policy each policy year each policy claims
year year irrespective of year
irrespective of irrespective of claims irrespective of
claims claims claims

Premium rates:
▪ The premium under individual coverage will be charged on the completed age of the individual insured
member.
▪ In case of Family Floater policies Floater discount of 55% will be applied on all the members except
the oldest member.
▪ The premium for the policy will remain the same for the Policy Period mentioned in the policy
schedule.
▪ Please note that your premium at renewal may change due to a change in your age or changes in the
applicable tax rate.
▪ Premium rates are subject to change with prior approval from IRDA.
▪ The Sum Insured of the dependent insured members should be equal to or less than the Sum Insured
of the Primary Insured member. In case where two or more children are covered, the Sum Insured for
all the children must be same. Sum insured of all Dependent Parents and Dependent Parent in law
must be same.

28 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

▪ The premium will be computed basis the city of residence provided by the insured person in the
application form. The premium that would be applicable zone wise and the cities defined in each zone
are as under:
o Tier 1 : Delhi, NCR, Mumbai, Thane, Mumbai Suburban and Navi Mumbai, Surat, Ahmedabad
& Vadodara
o Tier 2 : Rest of India- All other cities

Pl Note. Premium rates and policy terms and conditions are for standard healthy individuals. These may
change post underwriting of proposal based on medical tests (where applicable) and information provided
on the proposal form.

Add – On Covers:

‘Optima Restore’ offers following Add on Covers:

• Optima Wellbeing (Add on) : Covers expenses for various outpatient benefits
• lndividual Personal Accident Rider: Provides Lumpsum pay out in case of Accidental Death,
Permanent Total Disablement and Permanent Partial Disablement. Sum Insured shall be 5 (five) times
the Sum Insured of Base Plan up to a maximum of Rs. 1 Crore
• Protector Rider: Covers expenses which are not payable under the Base Plan as per the List of
Excluded items released by IRDA along with benefits such as Sum Insured protector
• Hospital daily cash rider: Daily cash benefit upto 1K/2K/3K
• Critical Advantage rider: covers planned treatment abroad for listed 8 major illness
• my:health Critical Illness: Comprehensive policy with coverage for 50 Critical Illnesses

(For in depth details on terms and conditions applicable to add-ons, Kindly refer to the Prospectus &
Policy wording documents of the respective add-on available under downloads section on our website).

Gross Premium Tables (Exclusive of Taxes)

Optima Restore - Risk Premium (Excl. GST) - Tier 1 (Delhi, NCR, Mumbai, Thane, Mumbai Suburban and
Navi Mumbai, Surat, Ahmedabad & Vadodara)
Age/
Sum 3,00,000 5,00,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000 1,00,00,000
Insured
0 6,300 7,350 7,950 8,900 9,700 10,350 12,550 15,550

29 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

1 6,400 7,450 8,050 9,000 9,800 10,500 12,700 15,800

2 6,500 7,550 8,150 9,100 9,900 10,650 12,850 16,050
3 6,600 7,650 8,250 9,200 10,000 10,800 13,000 16,300
4 6,700 7,750 8,350 9,300 10,100 10,950 13,150 16,550
5 6,800 7,850 8,450 9,400 10,200 11,100 13,300 16,800
6 6,900 7,950 8,550 9,500 10,300 11,250 13,450 17,050
7 7,000 8,050 8,650 9,600 10,400 11,400 13,600 17,300
8 7,100 8,150 8,750 9,700 10,500 11,550 13,750 17,550
9 7,200 8,250 8,850 9,800 10,600 11,700 13,900 17,800
10 7,300 8,350 8,950 9,900 10,700 11,850 14,050 18,050
11 7,400 8,450 9,050 10,000 10,800 12,000 14,200 18,300
12 7,500 8,550 9,150 10,100 10,900 12,150 14,350 18,550
13 7,600 8,650 9,250 10,200 11,000 12,300 14,500 18,800
14 7,700 8,750 9,350 10,300 11,100 12,450 14,650 19,050
15 7,800 8,850 9,450 10,400 11,200 12,600 14,800 19,300
16 7,900 8,950 9,550 10,500 11,300 12,750 14,950 19,550
17 8,000 9,050 9,650 10,600 11,400 12,900 15,100 19,800
18 9,550 10,850 11,900 12,300 13,100 14,050 16,250 20,900
19 9,650 10,950 12,050 12,500 13,300 14,250 16,500 21,200
20 9,750 11,050 12,200 12,700 13,500 14,450 16,750 21,500
21 9,850 11,150 12,350 12,900 13,700 14,650 17,000 21,800
22 9,950 11,250 12,500 13,100 13,900 14,850 17,250 22,100
23 10,050 11,350 12,650 13,300 14,100 15,050 17,500 22,400
24 10,150 11,450 12,800 13,500 14,300 15,250 17,750 22,700
25 10,250 11,550 12,950 13,700 14,500 15,450 18,000 23,000
26 10,350 11,650 13,100 13,900 14,700 15,650 18,250 23,300
27 10,450 11,750 13,250 14,100 14,900 15,850 18,500 23,600
28 10,550 11,850 13,400 14,300 15,100 16,050 18,750 23,900
29 10,650 11,950 13,550 14,500 15,300 16,250 19,000 24,200
30 10,750 12,050 13,700 14,700 15,500 16,450 19,250 24,500
31 10,850 12,150 13,850 14,900 15,700 16,650 19,500 24,800
32 10,950 12,250 14,000 15,100 15,900 16,850 19,750 25,100
33 11,050 12,350 14,150 15,300 16,100 17,050 20,000 25,400
34 11,150 12,450 14,300 15,500 16,300 17,250 20,250 25,700
35 11,250 12,550 14,450 15,700 16,500 17,450 20,500 26,000

30 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

36 11,450 13,150 14,850 16,000 16,800 17,950 20,900 26,450

37 11,650 13,350 15,100 16,250 17,100 18,250 21,250 26,850
38 11,850 13,550 15,350 16,500 17,400 18,550 21,600 27,250
39 12,050 13,750 15,600 16,750 17,700 18,850 21,950 27,650
40 12,250 13,950 15,850 17,000 18,000 19,150 22,300 28,050
41 12,450 14,150 16,100 17,250 18,300 19,450 22,650 28,450
42 12,650 14,350 16,350 17,500 18,600 19,750 23,000 28,850
43 12,850 14,550 16,600 17,750 18,900 20,050 23,350 29,250
44 13,050 14,750 16,850 18,000 19,200 20,350 23,700 29,650
45 13,250 14,950 17,100 18,250 19,500 20,650 24,050 30,050
46 16,250 17,400 20,700 22,350 23,500 24,900 29,400 36,050
47 17,100 18,300 21,800 23,550 24,950 26,250 31,200 38,450
48 17,950 19,200 22,900 24,750 26,400 27,600 33,000 40,850
49 18,800 20,100 24,000 25,950 27,850 28,950 34,800 43,250
50 19,650 21,000 25,100 27,150 29,300 30,300 36,600 45,650
51 20,600 22,250 26,300 29,950 30,950 31,950 38,500 48,300
52 21,250 23,300 27,500 31,400 32,400 33,500 40,400 50,350
53 21,900 24,350 28,700 32,850 33,850 35,050 42,300 52,400
54 22,550 25,400 29,900 34,300 35,300 36,600 44,200 54,450
55 23,200 26,450 31,100 35,750 36,750 38,150 46,100 56,500
56 26,300 28,850 34,850 38,300 39,350 40,950 49,400 61,250
57 27,250 30,100 36,250 40,500 41,900 43,450 52,400 65,000
58 28,200 31,350 37,650 42,700 44,450 45,950 55,400 68,750
59 29,150 32,600 39,050 44,900 47,000 48,450 58,400 72,500
60 30,100 33,850 40,450 47,100 49,550 50,950 61,400 76,250
61 31,100 35,200 46,400 49,600 53,600 56,050 67,300 83,450
62 31,950 36,550 47,850 52,100 57,400 60,750 72,750 90,200
63 32,800 37,900 49,300 54,600 61,200 65,450 78,200 96,950
64 33,650 39,250 50,750 57,100 65,000 70,150 83,650 1,03,700
65 34,500 40,600 52,200 59,600 68,800 74,850 89,100 1,10,450
66 41,950 47,700 64,500 69,900 78,300 81,650 1,01,150 1,22,750
67 43,150 49,450 66,500 72,900 81,650 85,650 1,04,950 1,28,800
68 44,350 51,200 68,500 75,900 85,000 89,650 1,08,750 1,34,850
69 45,550 52,950 70,500 78,900 88,350 93,650 1,12,550 1,40,900
70 46,750 54,700 72,500 81,900 91,700 97,650 1,16,350 1,46,950

31 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

71 49,150 56,500 74,950 85,200 95,650 1,01,900 1,22,100 1,53,050

72 50,150 57,800 77,350 88,450 98,700 1,05,100 1,27,350 1,58,750
73 51,150 59,100 79,750 91,700 1,01,750 1,08,300 1,32,600 1,64,450
74 52,150 60,400 82,150 94,950 1,04,800 1,11,500 1,37,850 1,70,150
75 53,150 61,700 84,550 98,200 1,07,850 1,14,700 1,43,100 1,75,850
76 56,300 64,750 88,450 1,03,350 1,13,600 1,20,300 1,49,750 1,84,700
77 58,250 67,250 92,350 1,07,300 1,18,500 1,25,850 1,55,350 1,92,150
78 60,200 69,750 96,250 1,11,250 1,23,400 1,31,400 1,60,950 1,99,600
79 62,150 72,250 1,00,150 1,15,200 1,28,300 1,36,950 1,66,550 2,07,050
80 64,100 74,750 1,04,050 1,19,150 1,33,200 1,42,500 1,72,150 2,14,500
81 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
82 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
83 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
84 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
85 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
86 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
87 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
88 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
89 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274
90 68,574 79,256 1,10,832 1,29,379 1,44,879 1,54,292 1,88,931 2,34,274

*Only for Renewal Purposes

Optima Restore Risk Premium (Excl. GST) - Tier 2 (Rest of India)

Age/
Sum 3,00,000 5,00,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000 1,00,00,000
Insured
0 5,300 6,400 7,100 8,450 9,500 10,100 12,300 15,150
1 5,400 6,500 7,200 8,550 9,600 10,250 12,450 15,350
2 5,500 6,600 7,300 8,650 9,700 10,400 12,600 15,550
3 5,600 6,700 7,400 8,750 9,800 10,550 12,750 15,750
4 5,700 6,800 7,500 8,850 9,900 10,700 12,900 15,950
5 5,800 6,900 7,600 8,950 10,000 10,850 13,050 16,150
6 5,900 7,000 7,700 9,050 10,100 11,000 13,200 16,350

32 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

7 6,000 7,100 7,800 9,150 10,200 11,150 13,350 16,550

8 6,100 7,200 7,900 9,250 10,300 11,300 13,500 16,750
9 6,200 7,300 8,000 9,350 10,400 11,450 13,650 16,950
10 6,300 7,400 8,100 9,450 10,500 11,600 13,800 17,150
11 6,400 7,500 8,200 9,550 10,600 11,750 13,950 17,350
12 6,500 7,600 8,300 9,650 10,700 11,900 14,100 17,550
13 6,600 7,700 8,400 9,750 10,800 12,050 14,250 17,750
14 6,700 7,800 8,500 9,850 10,900 12,200 14,400 17,950
15 6,800 7,900 8,600 9,950 11,000 12,350 14,550 18,150
16 6,900 8,000 8,700 10,050 11,100 12,500 14,700 18,350
17 7,000 8,100 8,800 10,150 11,200 12,650 14,850 18,550
18 7,150 8,250 9,500 10,800 11,800 13,100 15,900 20,400
19 7,250 8,350 9,650 11,000 12,000 13,300 16,100 20,600
20 7,350 8,450 9,800 11,200 12,200 13,500 16,300 20,800
21 7,450 8,550 9,950 11,400 12,400 13,700 16,500 21,000
22 7,550 8,650 10,100 11,600 12,600 13,900 16,700 21,200
23 7,650 8,750 10,250 11,800 12,800 14,100 16,900 21,400
24 7,750 8,850 10,400 12,000 13,000 14,300 17,100 21,600
25 7,850 8,950 10,550 12,200 13,200 14,500 17,300 21,800
26 7,950 9,050 10,700 12,400 13,400 14,700 17,500 22,000
27 8,050 9,150 10,850 12,600 13,600 14,900 17,700 22,200
28 8,150 9,250 11,000 12,800 13,800 15,100 17,900 22,400
29 8,250 9,350 11,150 13,000 14,000 15,300 18,100 22,600
30 8,350 9,450 11,300 13,200 14,200 15,500 18,300 22,800
31 8,450 9,550 11,450 13,400 14,400 15,700 18,500 23,000
32 8,550 9,650 11,600 13,600 14,600 15,900 18,700 23,200
33 8,650 9,750 11,750 13,800 14,800 16,100 18,900 23,400
34 8,750 9,850 11,900 14,000 15,000 16,300 19,100 23,600
35 8,850 9,950 12,050 14,200 15,200 16,500 19,300 23,800
36 9,000 10,100 12,450 14,500 15,500 16,950 19,850 24,750
37 9,150 10,250 12,650 14,700 15,800 17,250 20,150 25,050
38 9,300 10,400 12,850 14,900 16,100 17,550 20,450 25,350
39 9,450 10,550 13,050 15,100 16,400 17,850 20,750 25,650
40 9,600 10,700 13,250 15,300 16,700 18,150 21,050 25,950
41 9,750 10,850 13,450 15,500 17,000 18,450 21,350 26,250

33 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

42 9,900 11,000 13,650 15,700 17,300 18,750 21,650 26,550

43 10,050 11,150 13,850 15,900 17,600 19,050 21,950 26,850
44 10,200 11,300 14,050 16,100 17,900 19,350 22,250 27,150
45 10,350 11,450 14,250 16,300 18,200 19,650 22,550 27,450
46 13,500 13,900 18,000 20,250 22,650 23,900 28,250 34,250
47 14,100 14,650 18,950 21,350 23,850 25,200 29,800 36,550
48 14,700 15,400 19,900 22,450 25,050 26,500 31,350 38,850
49 15,300 16,150 20,850 23,550 26,250 27,800 32,900 41,150
50 15,900 16,900 21,800 24,650 27,450 29,100 34,450 43,450
51 16,600 18,000 23,250 26,400 29,050 30,750 36,400 45,850
52 17,250 18,750 24,100 28,000 30,550 32,400 38,250 47,800
53 17,900 19,500 24,950 29,600 32,050 34,050 40,100 49,750
54 18,550 20,250 25,800 31,200 33,550 35,700 41,950 51,700
55 19,200 21,000 26,650 32,800 35,050 37,350 43,800 53,650
56 21,950 23,400 30,150 35,300 37,700 39,850 46,950 57,550
57 22,600 24,400 31,450 37,450 40,350 42,300 49,800 61,450
58 23,250 25,400 32,750 39,600 43,000 44,750 52,650 65,350
59 23,900 26,400 34,050 41,750 45,650 47,200 55,500 69,250
60 24,550 27,400 35,350 43,900 48,300 49,650 58,350 73,150
61 25,200 28,650 38,000 46,700 51,950 54,050 63,950 80,200
62 25,700 29,350 40,300 48,700 55,450 58,400 69,100 86,150
63 26,200 30,050 42,600 50,700 58,950 62,750 74,250 92,100
64 26,700 30,750 44,900 52,700 62,450 67,100 79,400 98,050
65 27,200 31,450 47,200 54,700 65,950 71,450 84,550 1,04,000
66 33,650 37,900 55,200 64,900 75,450 79,650 95,050 1,16,600
67 34,900 39,700 57,250 67,500 78,700 82,600 99,150 1,22,350
68 36,150 41,500 59,300 70,100 81,950 85,550 1,03,250 1,28,100
69 37,400 43,300 61,350 72,700 85,200 88,500 1,07,350 1,33,850
70 38,650 45,100 63,400 75,300 88,450 91,450 1,11,450 1,39,600
71 40,100 47,500 65,700 78,900 91,750 95,750 1,16,350 1,45,400
72 41,350 48,350 68,000 81,400 94,900 99,300 1,21,200 1,50,850
73 42,600 49,200 70,300 83,900 98,050 1,02,850 1,26,050 1,56,300
74 43,850 50,050 72,600 86,400 1,01,200 1,06,400 1,30,900 1,61,750
75 45,100 50,900 74,900 88,900 1,04,350 1,09,950 1,35,750 1,67,200
76 47,150 53,900 77,950 92,800 1,08,750 1,14,950 1,41,650 1,75,450

34 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

77 49,000 56,200 81,000 96,550 1,13,000 1,19,900 1,47,250 1,82,500

78 50,850 58,500 84,050 1,00,300 1,17,250 1,24,850 1,52,850 1,89,550
79 52,700 60,800 87,100 1,04,050 1,21,500 1,29,800 1,58,450 1,96,600
80 54,550 63,100 90,150 1,07,800 1,25,750 1,34,750 1,64,050 2,03,650
81 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
82 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
83 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
84 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
85 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
86 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
87 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
88 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
89 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561
90 58,573 67,368 98,641 1,17,735 1,37,635 1,46,578 1,79,484 2,22,561

*Only for Renewal Purposes

Premium for Unlimited Restore Benefit (Optional benefit) : 0.50% will be applied on the Final Policy Premium in
respect of all the base/in-built coverages under this product

▪ Premium Computation Illustration

Illustration 1

• Plan Name – Optima Restore

• Tenure – 1 Year
• Location – Delhi - Tier 1

Age of the
Coverage opted on individual basis Coverage opted on individual basis covering multiple members
members
covering each member of the family of the family under a single policy (Sum Insured is available for
insured (in
separately (at a single point in time) each member of the family)
Years)
Family Premium Sum Insured
Sum Insured in Premium
Premium (INR) Discount of after discount in Lakhs
Lakhs (INR) (INR)
10% (if any) (INR) (INR)
5 8450 10 8450 845 7605 10
25 12,950 10 12,950 1295 11655 10
37 15100 10 15100 1510 13590 10
47 21800 10 21800 2180 19620 10

35 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

57 36250 10 36250 3625 32625 10

63 49,300 10 49300 4930 44370 10
Total Premium (exclusive of
1,43,850 1,29465
taxes)

Total premium (exclusive of taxes) for

all members of the family is INR
Total premium (exclusive of taxes) for all members of the
1,43,850, when each member is
family is INR 129465, when they are covered under a single
covered separately (at a single point in
policy (Sum Insured is available for each member of the
time).
family).
Sum Insured available for each individual is INR 10 Lakhs.
Sum Insured available for each
individual is INR 10 Lakhs.

36 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

Illustration 2

• Plan Name – Optima Restore

• Tenure – 1 Year
• Location – Lucknow - Tier 2

Age of
the
members Coverage opted on family floater basis with overall Sum Insured (only one Sum Insured is available for the
insured entire family)
(in
Years)
Premium or consolidated Floater discount of 55% applied on all
Premium after Sum Insured
premium for all family the members except the oldest
discount (Rs.) in Lakhs (Rs.)
members of the family (Rs.) member
8 7900 4345 3,555 10
19 9650 5307 4343 10
37 12650 6958 5692 10
42 13650 0 13650 10
Total Premium
27240
(exclusive of taxes)
Total premium (exclusive of taxes) when policy is opted on floater basis is INR 27240.

Sum Insured of Rs. 10 Lakhs is available for the entire family.

▪ 2 year & 3year Premium Calculation

7.5% Discount on premium if Insured Person is paying premium of 2 years in advance & 10% Discount on
premium if Insured Person is paying premium of 3 years in advance
Example
1) Proposed Insured Age 32 years from Delhi opting for Optima Restore Individual 2 year policy with
Sum Insured of 5 Lac
Calculation – 9753 x 2 x 92.5% = Rs. 18043.05/- plus taxes.

2) Proposed Insured Age 45 years from Lucknow opting for Optima Restore Individual 3 year policy
with Sum Insured of 15 Lac
Calculation – (14818+21496+21496) x 90% = Rs. 52029/- plus taxes.

Section 41 of Insurance Act 1938 as amended by Insurance Laws Amendment Act, 2015 (Prohibition of
Rebates):
1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to
take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in
India, any rebate of the whole or part of the commission payable or any rebate of the premium shown
on the policy, nor shall any person taking out or renewing or continuing a Policy accept any rebate,

37 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

except such rebate as may be allowed in accordance with the published prospectuses or tables of the
insurers.
2. Any person making default in complying with the provision of this section shall be liable for a penalty
which may extend to ten lakh rupees.

Note: Policy Term and Conditions & Premium rates are subject to change with prior approval from IRDA.

Disclaimer
This is only a summary of the product features. The actual benefits available are as described in the policy,
and will be subject to the policy terms, conditions and exclusions. Please seek the advice of your insurance
advisor if you require any further information or clarification.

38 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

Annexure I

List I – Items for which coverage is not available in the policy

S. Item S. Item
No. No.
1 BABY FOOD 35 OXYGEN CYLINDER (FOR USAGE
OUTSIDE THE HOSPITAL)
2 BABY UTILITIES CHARGES 36 SPACER
3 BEAUTY SERVICES 37 SPIROMETRE
4 BELTS/ BRACES 38 NEBULIZER KIT
5 BUDS 39 STEAM INHALER
6 COLD PACK/HOT PACK 40 ARMSLING
7 CARRY BAGS 41 THERMOMETER
8 EMAIL / INTERNET CHARGES 42 CERVICAL COLLAR
9 FOOD CHARGES (OTHER THAN 43 SPLINT
PATIENT'S DIET PROVIDED BY
HOSPITAL)
10 LEGGINGS 44 DIABETIC FOOT WEAR
11 LAUNDRY CHARGES 45 KNEE BRACES (LONG/ SHORT/ HINGED)
12 MINERAL WATER 46 KNEE IMMOBILIZER/SHOULDER
IMMOBILIZER
13 SANITARY PAD 47 LUMBO SACRAL BELT
14 TELEPHONE CHARGES 48 NIMBUS BED OR WATER OR AIR BED
CHARGES
15 GUEST SERVICES 49 AMBULANCE COLLAR
16 CREPE BANDAGE 50 AMBULANCE EQUIPMENT
17 DIAPER OF ANY TYPE 51 ABDOMINAL BINDER
18 EYELET COLLAR 52 PRIVATE NURSES CHARGES- SPECIAL
NURSING CHARGES
19 SLINGS 53 SUGAR FREE TABLETS
20 BLOOD GROUPING AND CROSS 54 CREAMS POWDERS LOTIONS
MATCHING OF DONORS SAMPLES (TOILETRIES ARE NOT PAYABLE, ONLY
PRESCRIBED MEDICAL
PHARMACEUTICALS PAYABLE)
21 SERVICE CHARGES WHERE 55 ECG ELECTRODES
NURSING CHARGE ALSO CHARGED
22 TELEVISION CHARGES 56 GLOVES
23 SURCHARGES 57 NEBULISATION KIT
24 ATTENDANT CHARGES 58 ANY KIT WITH NO DETAILS MENTIONED
[DELIVERY KIT, ORTHOKIT, RECOVERY
KIT, ETC]
25 EXTRA DIET OF PATIENT (OTHER 59 KIDNEY TRAY
THAN THAT WHICH FORMS PART OF
BED CHARGE)

39 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

26 BIRTH CERTIFICATE 60 MASK

27 CERTIFICATE CHARGES 61 OUNCE GLASS
28 COURIER CHARGES 62 OXYGEN MASK
29 CONVEYANCE CHARGES 63 PELVIC TRACTION BELT
30 MEDICAL CERTIFICATE 64 PAN CAN
31 MEDICAL RECORDS 65 TROLLY COVER
32 PHOTOCOPIES CHARGES 66 UROMETER, URINE JUG
33 MORTUARY CHARGES 67 AMBULANCE
34 WALKING AIDS CHARGES 68 VASOFIX SAFETY

List II – Items that are to be subsumed into Room Charges

Sl Item
No
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED)
2 HAND WASH
3 SHOE COVER
4 CAPS
5 CRADLE CHARGES
6 COMB
7 EAU-DE-COLOGNE / ROOM FRESHNERS

8 FOOT COVER
9 GOWN
10 SLIPPERS
11 TISSUE PAPER
12 TOOTH PASTE
13 TOOTH BRUSH
14 BED PAN
15 FACE MASK
16 FLEXI MASK
17 HAND HOLDER
18 SPUTUM CUP

19 DISINFECTANT LOTIONS

20 LUXURY TAX

21 HVAC

22 HOUSE KEEPING CHARGES

23 AIR CONDITIONER CHARGES

40 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

24 IM IV INJECTION CHARGES

25 CLEAN SHEET

26 BLANKET/WARMER BLANKET

27 ADMISSION KIT
28 DIABETIC CHART CHARGES
29 DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES
30 DISCHARGE PROCEDURE CHARGES
31 DAILY CHART CHARGES
32 ENTRANCE PASS / VISITORS PASS CHARGES
33 EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE

34 FILE OPENING CHARGES

35 INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)
36 PATIENT IDENTIFICATION BAND / NAME TAG
37 PULSEOXYMETER CHARGES

List III – Items that are to be subsumed into Procedure Charges

Sl Item
No.
1 HAIR REMOVAL CREAM
2 DISPOSABLES RAZORS CHARGES (for site preparations)
3 EYE PAD
4 EYE SHEILD
5 CAMERA COVER
6 DVD, CD CHARGES

7 GAUSE SOFT
8 GAUZE
9 WARD AND THEATRE BOOKING CHARGES

10 ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS

11 MICROSCOPE COVER

12 SURGICAL BLADES, HARMONICSCALPEL,SHAVER

13 SURGICAL DRILL

14 EYE KIT

15 EYE DRAPE

16 X-RAY FILM

41 | P a g e
Optima Restore – Prospectus
HDFC ERGO General Insurance Company Limited

17 BOYLES APPARATUS CHARGES

18 COTTON

19 COTTON BANDAGE

20 SURGICAL TAPE

21 APRON

22 TORNIQUET

23 ORTHOBUNDLE, GYNAEC BUNDLE

List IV – Items that are to be subsumed into costs of treatment

Sl Item
No.
1 ADMISSION/REGISTRATION CHARGES

2 HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE

3 URINE CONTAINER
4 BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES
5 BIPAP MACHINE
6 CPAP/ CAPD EQUIPMENTS
7 INFUSION PUMP– COST
8 HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC

9 NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES

10 HIV KIT

11 ANTISEPTIC MOUTHWASH
12 LOZENGES
13 MOUTH PAINT
14 VACCINATION CHARGES

15 ALCOHOL SWABES

16 SCRUB SOLUTION/STERILLIUM

17 Glucometer& Strips

18 URINE BAG

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