Optima Senior Plan
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HDFC ERGO Health Optima Senior Plan (formerly known as Apollo Munich Health Insurance)

Optima Senior plan is served by HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance). It is a health plan for senior citizens. Optima Senior Plan can be bought to make the old age comfortable and stress-free. The human body falls weak with the growing age so plans like Optima Senior can be taken as a support to the old age. To buy Optima Senior Plan, you need several pieces of information regarding the same. So, here is the relevant information for your help.

Eligibility Criteria

The eligibility criteria have been mentioned below:

Minimum Entry Age61 Years
Maximum Entry AgeNo Limit
Policy Tenure1 or 2 Years
Coverage AmountRs.2 Lacs, Rs.3 Lacs or Rs. 5 Lacs

Features Of HDFC Ergo Health Optima Senior?

The features are as follows:

  • Lifelong Renewability
    After you have bought the Optima Senior Plan, you are covered and the policy can be renewed forever.
  • Second E-Opinion
    In case you are suffering from critical illness then the HDFC Ergo Health Optima Senior Plan has a provision under which you can take a second opinion from a team of medical experts relating your treatment.
  • Portability
    The services provided by HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) is to its best and adorable. But still, HDFC ERGO Health Insurance company (formerly known as Apollo Munich Health Insurance) provides you with the liberty to choose an insurance company of your choice in case you are not satisfied with the services provided by the company or the terms and conditions of the company.
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  • No Claim Discount
    HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) Health Insurance company provides no claim discount under the Optima Senior Policy. The insured gets a 5% discount on the renewal premiums payable for the claim-free years. It is subjected to a condition that the policy renewal should be done frequently without any pause or break.
  • Cashless Transactions
    The 4000+ huge spread network hospital of HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) Optima Senior Policy across 800 cities gives the policyholder the golden opportunity to take the service of the HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) Health Insurance company.
  • Waiting Period
    There is a waiting period of 3 years under the plan for certain illnesses.
  • Medical Check-up
    Under the HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) Optima Senior Policy the policy buyer is cross-examined before getting the custody of the policy. The medical examination is subjected to the age of the policy buyer and the medical test includes tests like a blood test, cardiac status, cholesterol levels, blood sugar, urine analysis, and cardiac test to check the condition of the heart and kidney.
    After the medical test is finished and you pass the medical examination then you are eligible to buy the HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) Optima Senior Plan and 50% of the medical examination expenses incurred are paid by the insurance company under the terms and conditions.
  • Tax Benefit
    The premiums paid under HDFC Ergo Health Optima Senior are tax exempted under section 80D of the income tax act, 1961

Coverage Under HDFC Ergo Health Optima Senior Policy

Other than the insured sum coverage there are many other coverages provided under this policy. The same has been presented in tabular form for your convenience:

CriteriaDetails
In-patient TreatmentCoverage Available
Pre-HospitalizationCoverage Available up to 30 days before hospitalization
Post HospitalizationCoverage Available till 60 days after discharge from the hospital
Day Care ProceduresCoverage Available for 140 Day Care Procedures
Domiciliary treatmentCoverage Available
Organ DonorCoverage Available
Emergency AmbulanceCoverage up to Rs. 2000 per hospitalization
E-OptionOnce a policy year

Optima Senior Policy Premium Calculation

Here is a table to give you a rough idea about the premiums that have to be paid for a particular sum insured (SI).

Age Of InsuredIf SI Rs. 2 LacsIf SI Rs. 3 LacsIf SI Rs. 5 Lacs
61 Years - 65 YearsRs. 11,932Rs. 14,615Rs .22,553
66 Years - 70 YearsRs. 15,137Rs. 19,201Rs. 30,719
71 Years - 75 YearsRs. 18,367Rs. 23,986Rs. 39,428
76 Years - 80 YearsRs. 24,219Rs. 31,629Rs. 52,125
81 Years - 85 YearsRs. 32,051Rs. 42,433Rs. 70,849
> 85 YearsRs. 42,497Rs. 57,032Rs. 96,402

CoPayments In HDFC Ergo Health Optima Senior Plan

In HDFC Ergo Health Optima Senior Policy, co-payments are applicable. The insured needs to bear a percentage of medical expenses in collaboration with the HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) Health Insurance company. Details are mentioned below:

  • A co-payment of 15% is applied for twin sharing and 30% is for a single private room.
  • Copayment for 30% applies to certain illnesses surgery. The list contains cataract, hysterectomy, arthroscopy, etc. other than this, there are no additional co-payments applicable under this case.
  • All daycare falls under co-payment applicability of 15%.

Exclusions Of The Policy

  • In the initial 30 days of cover, no treatment relating to any illness is entertained, except accidental injury.
  • Pre-existing conditions are only considered after the completion of the waiting period of three years.
  • Costs arising from HIV or AIDS treatment.
  • Psychiatric treatment expenses, mental disorder, congenital disease, non-allopathic treatment, cosmetic surgery, hair-fall treatment, etc are not covered.
  • Medical treatment for alcoholism and drug addiction is also not covered.
  • Any injury in war or due to nuclear, chemical or biological weapons does not get a cover.
  • Items bought for personal comfort and luxury are not entertained.
  • 2 years of the waiting period for treatment like hernia, hysterectomy, joint replacement, hydrocele, cataracts do not get coverage.

HDFC Ergo Health Optima Senior Policy Renewal

Here are few facts relating the terms for renewal of the policy:

  • A grace period of 30 days is provided to the insured for the renewal of the policy. The insured can pay the renewal premium within the grace period to get the policy renewed.
  • There is nothing like maximum cover ceasing age under the policy. This means the policy has lifelong renewability.
  • For every continuous renewal, the waiting period mentioned in the policy decreases by 1 year.
  • The insured sum can be incremented at the time of renewal of the policy.
  • An insured can take the benefit of the port facility to change to another insurance entity only at the time of renewal of the policy. All the accumulated bonuses, waivers of the waiting period are restored when the insured ports the insurance company.

Discounts Under HDFC ERGO Health Optima Senior Plan (formerly known as Apollo Munich Health Insurance)

Below mentioned are the discounts that a buyer should be aware of:

  • In case the policy is renewed without a break then for every claim-free policy year the insured get a 5% discount on the renewal premiums.
  • A 5% discount is applicable in case both the husband and wife choose to buy the plan.
  • In case you opt for a two-year policy then you get an additional discount of 7.5% on the total premium.

Optima Senior Plan Review

HDFC Ergo Health optima senior plan is one of the best health plans for senior citizens to invest in. Human beings get more prone to illness as they grow in age. So, it is essential to have a health plan that provides you with several facilities relating to claim and renewal. Moreover, it provides a discount under certain cases. So, buy a policy today.

FAQs

No, the minimum age required to buy this policy is 61 years. All who are 61 years old and above can buy this policy at ease.

Yes, there is a special discount offered by the HDFC Ergo Health Optima Senior policy for those who buy the policy for the couple. An additional 5% discount is provided to the buyer.

A grace period of 30 days is provided for the renewal of the policy. One needs to renew the policy before or within the grace period.

The policy can be bought for a minimum of 1 year and a maximum of 2 years.

There are three coverage amount options under the plan: Rs.2 Lacs, Rs.3 Lacs, and Rs.5 Lakhs maximum.

Yes, the senior citizens planning to buy the Optima senior Plan have to go through a Pre insurance medical checkup. It is compulsory as per the rules of health insurance companies.

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Last updated on 05-02-2020