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HDFC ERGO Optima Restore Health Insurance

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HDFC ERGO Health Insurance
Optima Restore
Cashless Approval TAT45 mins Cashless Claim Processing
Claim Settlement Ratio100%
Network Hospitals12,000+
PED Coverage Starting From3 year
Special Benefits2X Cover from Day 1
Starting Premium Rs. 1090/month

About HDFC ERGO Optima Restore Health Insurance

Health insurance acts as a financial cushion against medical emergencies. Among the numerous health insurance plans available in India, the HDFC ERGO Optima Restore Plan is one of the best options for you. It is a comprehensive health plan that you can buy in two variants: individual or family floater insurance. The policyholders of the Optima Restore Plan who stay healthy and fit during the policy tenure can avail of attractive discounts and rebates on their premiums.

HDFC ERGO Optima Restore Plan is a comprehensive health insurance policy. It is one of the best plans in which you can invest to financially secure yourself and your loved ones against unforeseen medical emergencies. From providing enhanced coverage economically to offering discounts on a premium, this health plan has it all. Want more reasons to buy the Optima Restore Floater Insurance Plan? Read on to find out!

HDFC ERGO Optima Restore Plan At a Glance


Individual and family


Hospital daily cash, Critical illness, etc



Key features

Multiplier benefits, Restoration benefits, etc


Pre and post-hospitalization expenses, AYUSH treatment, Organ donor expenses, etc


Self-inflicted injuries, cosmetic treatment, AIDS, etc

Key Features of HDFC ERGO Optima Restore Plan

The key features of the HDFC ERGO Optima Restore Plan are as follows:

  • Coverage: The HDFC Ergo Optima Restore plan is available on both individual or family floater basis. Depending on your requirements, you can choose adequate coverage for yourself and your loved ones. The plan provides coverage for hospitalization, pre-hospitalization, daycare expenses, and more.
  • Sum Insured: With the HDFC Ergo Optima Restore plan, you can choose the sum insured between Rs. 3 lakh and the maximum is Rs. 50 lakhs. With the extensive sum insured available, you can choose the right sum insured for yourself and your family.
  • Multiplier Benefits: Multiplier benefits will double your coverage amount for not making claims for 2 years. This is an additional feature of the HDFC Ergo Optima Restore Plan that makes it a highly opted choice.
  • Discounts: Earn a discount of up to 8% on renewal premium amount under the Stay Active benefit for living a healthy lifestyle. Individuals purchasing the HDFC Optima Restore Plan on a family floater basis can avail of a 10% additional discount on a premium.
  • No Room-rent Limit: There is no sub-limit on room rent. Therefore, you can select any hospital room of your choice and get the best medical care without any hassle.

Eligibility Criteria For HDFC ERGO Optima Restore Plan

The eligibility criteria to buy the HDFC ERGO Optima Restore Plan are highlighted in the table below:


Eligibility Criteria

Entry age

3 months- 65 years

Policy type

Individual and family floater plan

Waiting period

30 days

3 years for pre-existing conditions

Sum assured

Rs. 3 lakhs- Rs. 50 lakhs

Policy tenure

1 or 2 years



Benefits of HDFC ERGO Optima Restore Plan

The Optima Restore Health Insurance Plan by HDFC Life offers a wide range of advantages to its policyholders. Some of these benefits include:

  • Restore Benefit: In case the sum assured for your HDFC ERGO health insurance plan exhausts, you can restore the coverage amount up to 100%. It will ensure that you are financially covered in case you have to undergo multiple hospitalizations.
  • Multiplier Benefit: HDFC ERGO Health Insurance rewards its healthy and active policyholders by providing increased coverage and discounts on a premium. For instance, Optima Restore health policy provides a 50% increase in the basic sum assured for not making claims in a year.
  • Preventive Health Check-ups: It is good to buy HDFC ERGO Optima Restore Plan as it allows the policyholders to monitor their health regularly. In simple terms, an insurer will pay for the policyholders' yearly health checkups.
  • Tax Benefits: The policyholders of the Optima Restore health insurance plan can claim the tax deductions for a premium paid against their policy under Section 80D of the Income Tax Act, 1961.
  • No Copayment: Copayment is the percentage of the claim amount that policyholders pay from their own pockets. The insurer determines the copayment amount at the time of policy purchase. The HDFC Optima Restore Plan is designed for such emergencies in such a way that you won’t have to incur any costs. Thus, you should buy this health plan as it comes with a 0% copayment amount.

Add-ons of HDFC ERGO Optima Restore Health Insurance

Some of the add-ons you can include in your HDFC ERGO Optima Restore Health Insurance plan:

  • Critical Illness Add-on: This add-on provides coverage for critical illness as listed on the policy document.
  • Hospital Daily Cash: With this add-on, you will get coverage for Daily Cash in case of hospitalization.
  • Unlimited Restoration Benefits: This add-on provides restoration of sum insured for unlimited times up to the sum insured.

Inclusions And Exclusions For HDFC ERGO Optima Restore Plan

Similar to all other health insurance plans, the HDFC ERGO Optima Restore Plan comes with certain inclusions and exclusions. Here’s a detailed list of the expenses that are covered and not covered under this plan:

Inclusions For Optima Restore Plan

  • Emergency road ambulance - Up to Rs. 2000 per hospitalization
  • Organ donor expenses - Covered up to the sum insured
  • Daycare procedures - All daycare procedures are covered
  • Pre-hospitalization expenses - Up to 60 days
  • Post-hospitalization expenses - Up to 180 days
  • Domiciliary hospitalization - Medical expenses for domiciliary hospitalization are covered up to the sum insured
  • Preventive health check-ups - Preventive health check-up is provided on a sum insured for Rs. 3 lakhs and above
  • Daily hospital cash - Maximum up to Rs. 6000/-
  • E-opinion: One policy per year

Exclusions For Optima Restore Plan

  • Expenses incurred due to foreign treatment
  • Obesity surgery
  • Cosmetic treatments
  • HIV/ AIDS treatment
  • Sexually transmitted diseases
  • The damage happened due to the war
  • Self-inflicted injuries

Documents Required To Buy Optima Restore Plan

Listed below are the documents required to buy the HDFC Ergo Optima Restore plan:

  • Income proof
  • Identity proof
  • Bank details
  • Nominee information
  • Recent medical reports
  • Policy form
  • Address proof

Steps You Should Follow To Buy HDFC Ergo Optima Restore Plan

Listed below are the steps in which you can buy HDFC

  • Visit the official website of HDFC ERGO Insurance.
  • Click on the “health insurance” section.
  • Select Optima Restore Insurance Plan from a displayed list of plans.
  • Hit the “buy online” tab
  • Additionally, select the coverage requirements like the sum assured, no. of family members you want to cover, and more.
  • Once the above process is completed, you will navigate to the payment page.
  • Make a premium payment online to complete the purchase of the Optima Restore Plan.

Process To Claim HDFC ERGO Optima Restore Plan

The policyholders of the HDFC ERGO Optima Restore Plan can claim their health insurance plan online. When making claims for your plan, ensure that you keep all the necessary documents handy. Continue reading to find out the documents and the steps that you need to take while claiming your Optima Restore Health Insurance Plan.

HDFC Life provides two claim settlement options to its health insurance policyholders. If you have bought the HDFC Optima Restore Insurance Plan, then you can either opt for a cashless claim settlement process or a reimbursement process. Read on to find out the steps you need to follow in each case:

For Cashless Claims

  • Get the treatment at any network hospital associated with HDFC ERGO Health Insurance.
  • Inform the insurer about the hospitalization
  • Download the pre-authorization form from the company’s official website.
  • Duly fill out the pre-authorization form and attach all the documents to it.
  • Submit the form to the insurer.
  • HDFC ERGO will verify the information and documents submitted by you.
  • Once the verification process is complete, an insurer will either process or reject your claim request.
  • A health insurance company may reject your claim request for numerous reasons, such as providing false information, policy expiration, and making claims for exclusions.

For Reimbursement Claims

  • Visit and get treatment at any hospital of your preference.
  • Intimate your insurance provider within 24 hours of hospitalization.
  • Pay for medical bills and treatment costs from your pocket.
  • Go to the official website of the company to download the claim application form.
  • Fill out the claim form thoroughly.
  • Attach all the necessary documents to the form and submit them to your insurance provider.
  • HDFC ERGO Health Insurance will assess the documents you submitted.
  • If the company is satisfied with the information you provided, HDFC ERGO will either process or reject your application.

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Key Inclusions and Exclusions of the Plan

What's Included

  • Domiciliary treatment, which otherwise would need hospitalisation
  • Expenses incurred in road ambulance or air ambulance in an emergency
  • Medical expenses for all daycare procedures under the Optima Restore policy
  • Coverage for in-patient hospitalisation. But, a minimum of 24 hours of hospitalisation is required
  • Cover for medical costs for the illness incurred 60 days before the hospitalisation

What's Not Included

  • Investigative, experimental and unproven treatment tools, and pharmacological regimens
  • Abuse of intoxicant or hallucinogenic substances such as intoxicating drugs and alcohol
  • Insanity, congenital diseases, mental disorders, cosmetic surgery, and weight control treatments
  • All treatments within the first 30 days of the policy purchased except any accidental injury
  • Expenses incurred for the treatment of HIV or AIDS and related diseases

3624 HDFC ERGO Cashless Network Hospitals in India

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HDFC ERGO Optima Restore Brochure

  • 263.12 KB
  • PDF Document
  • Nov 09, 2020

Claim Process at HDFC ERGO Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

FAQs on Optima Restore Health Insurance Plan

  • Can I buy HDFC ERGO Health's Optima Restore plan online?

    Yes, you can buy HDFC ERGO Health's Optima Restore plan online by visiting our website

  • Is daily cash for choosing a shared room available under this policy?

    Yes, Optima Restore provides daily cash for choosing shared accommodation. The cash amount depends on the sum insured chosen.

  • What is a Multiplier benefit?

    Multiplier Benefit is a feature that offers a 100% increment in the Sum Insured after 2 claim free years.

  • What is ‘Stay Active benefit under the Optima Restore plan?

    Stay Active benefit under the Optima Restore plan is a feature, which rewards you premium discounts by leading an active lifelessly. For Detail, call our toll-free number 7551196989.

  • What is “Health Jinn”?

    “Health Jinn” is a mobile application provided to the insured by HDFC ERGO Health Insurance. This application allows you to track your progress of staying active.

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