Optima Restore in one table
| Insurer | HDFC ERGO General Insurance Company Limited |
|---|---|
| Sum insured | ₹3 lakh to ₹1 crore, in tiers of 3 / 5 / 10 / 15 / 20 / 25 / 50 / 100 lakh |
Claim settlement and complaint figures are IRDAI-published and held centrally by NYVO, not taken from the insurer's marketing.
What Optima Restore covers
These are the terms that decide what you are actually paid when you claim. Room rent, co-pay and restoration do more to shape a settlement than the sum insured does, and they are read from HDFC ERGO's own policy wording.
| Feature | This plan | What good looks like |
|---|---|---|
| Co-payment | None as standard; 10% or 20% only if you choose it for a lower premium | No Co-payment |
| Room Rent Limit | No room rent sub-limit in the plan's schedule of limits | No room rent capping |
| Disease sub-limit | No disease sub-limits | No sub-limit |
| Multiplier Benefit | 50% of base sum insured each renewal to a ceiling of 100%, added irrespective of claims | 50% each year (Minimum upto 100%) |
| Restore Benefit | 100% of base sum insured, once per policy year | 100% restoration once in a year |
| Pre-Hospitalization | 60 days | At least 60 days |
| Post-Hospitalization | 180 days | At least 120 days |
| Consumables | Not covered in the base plan – needs the Protector rider | Consumables covered |
| Day-Care Procedures | Covered up to the sum insured | Covered without a capped list |
| Road Ambulance | Up to ₹2,000 per hospitalisation | Covered up to the sum insured |
| Emergency Air Ambulance | Actual cost or ₹2.5 lakh per hospitalisation, whichever is lower, within the base sum insured | Included |
| AYUSH Treatment | Covered as part of in-patient treatment, in an AYUSH hospital | Included |
| Entry age | 18 to 65 years for adults · 91 days to 25 years for children | No maximum entry age |
Optima Restore add-ons you can buy with it
Each of these costs extra and each has its own conditions. Some are genuinely worth it; several exist to patch a gap in the base plan. Ask what each one adds before it goes on your quote.
Optima Restore discounts you can ask for
Published discounts on this plan. Most are applied at quote stage rather than offered, so it is worth naming the ones you qualify for. Every figure is a ceiling, not a promise - what you actually get depends on the case.
| Discount | Worth | When it applies |
|---|---|---|
| Family discount | Up to 10% | Two or more family members on the same policy under the individual option. |
| Long-term discount | Up to 7.5% or 10% | 7.5% on a 2-year policy and 10% on a 3-year policy, when the premium is paid up front as a single payment. |
| Loyalty discount | Up to 2.5% | If you already hold an HDFC ERGO retail policy with a premium above ₹2,000. |
| Aggregate deductible | Up to 25% to 50% | On a base cover up to ₹20 lakh: 25% for a ₹25,000 deductible, 40% for ₹50,000, 50% for ₹1 lakh. Above ₹20 lakh the same deductibles give 15%, 30% and 40%. |
| Voluntary co-payment | Up to 10% or 20% | Agree to pay 10% or 20% of every claim and the premium falls by the same percentage. Once opted it cannot be removed later. |
| Stay Active step count | Up to 8% | Accrued through the year on the insurer's app and applied to the renewal premium. Above a 10,000-step daily average earns the full 8%; 5,001 to 8,000 earns 2%. |
From the Optima Restore prospectus. Online, employee, loyalty and family discounts stack but are capped at 20% in total.
Optima Restore waiting periods: when each part of the cover starts
Waiting periods run from the day cover began, not from the day you fall ill, and they run in parallel rather than one after another.
| Initial Waiting Period | 30 days |
|---|---|
| Specific Illness | 24 months |
| Pre-Existing Disease | 36 months |
The named illnesses that wait 24 months
Payable once the policy has run 24 months without a break. An accident, and anything whose underlying cause is cancer, is covered from day one. This list is indicative – the policy wording carries the full set, grouped by organ system.
Optima Restore exclusions: what the plan will not pay for
Every policy carries exclusions, and they are the clauses people read for the first time at claim stage. These are the ones worth knowing before you buy.
Where Optima Restore falls short
No plan is right for everyone, and a page that only lists strengths is not much use to you. These are the gaps we would raise on a call before recommending it.
Optima Restore questions, answered
Is the Multiplier Benefit a no-claim bonus?
No. The prospectus is explicit that 50% of your base sum insured is added on renewal irrespective of any claims. A claim in the expiring year does not reduce or reset what you have already built up. The limit is a ceiling, not a claw-back: the accumulated Multiplier Benefit never exceeds 100% of your base cover.
How does the Restore Benefit differ from Unlimited Restore?
The base plan restores 100% of your base sum insured once in the policy year, and if that restored amount is not used it lapses at the year end. Unlimited Restore is a separate optional cover that triggers again every time the cover is exhausted. In both cases a single claim can never exceed your base sum insured plus any accrued Multiplier Benefit, so restoration helps across several claims, not on one very large one.
Are consumables covered under Optima Restore?
Not in the base plan. The general exclusions list the non-medical items in Annexure I, which is IRDAI's standard non-payable list. The Protector rider exists precisely to make those items payable. If you are comparing this plan with one that includes consumables as standard, that difference belongs in the comparison.
What happens when I turn 66?
Nothing, provided you were already insured. Entry is what closes at 65; there is no maximum cover-ceasing age on renewal, so an existing policy carries on for life as long as you renew without a break. The problem is only for someone shopping for a first policy after 65.
Can I lower the premium?
Three levers. An aggregate deductible of ₹25,000, ₹50,000 or ₹1 lakh cuts the premium by 25% to 50% on a base cover up to ₹20 lakh. A voluntary co-payment of 10% or 20% cuts it by the same percentage. And the Stay Active step-count discount gives up to 8% off the renewal premium if you average more than 10,000 steps a day on the insurer's app. Each of them moves risk back to you, so treat them as a budget decision, not a free saving.
Does the room I choose affect what gets paid?
The plan's own list of financial limits does not set a room rent sub-limit, so there is no proportionate deduction driven by room category as standard. What your policy schedule says still governs, so check the schedule you are issued – a co-payment or deductible you opted for will show there too.
Read it from the insurer
We summarise. The policy wording is the contract, and it is the only document that settles a dispute. These links go to the insurer's own pages.
Understand the terms before you commit
A plan page tells you what this policy does. These explain why each term matters and what it costs you when it is missing.
Other HDFC ERGO plans we have read
HDFC ERGO files these separately, and the terms differ between them. If you are choosing within the range, compare the waiting periods and the exclusions rather than the sum insured.