The outbreak of the pandemic along with the rising incidence of lifestyle-related illness has not only highlighted the importance of having health insurance but also having sufficient cover (amount).

Additionally, a health policy should not only cover hospitalisation expenses but also offer other benefits including OPD, daily cash benefit in case of hospitalisation, restoration of sum insured (SI) in case of claim and no claim bonus (NCB).

HDFC Ergo has recently introduced one such product, Optima Secure. Here is a review of the product features.

What’s on offer

The SI under the Optima Secure policy starts from ₹5 lakh and goes up to ₹2 crore. It provides all basic covers like other health policies such as hospitalisation expenses including day care treatment expenses, AYUSH treatment, home healthcare (domiciliary hospitalisation), organ donor expenses, pre and post hospitalisation expenses, and cumulative bonus benefit.

The policy also covers the cost of preventive health check-up on each continuous renewal of the policy.

The highlight of Optima Secure is that it offers a cover of more than the base SI (cover amount) to all policyholders.

The ‘Secure’ benefit of the plan offers additional coverage amount equivalent to 100 per cent of the SI.It also offers a ‘Plus’ benefit, where on policy renewal, the policyholder receives 50 per cent of the base SI, irrespective of the number of claims made.

It also provides Cumulative Bonus benefit, where the base SI increases by 10 per cent for every claim-free year subject to a maximum of 100 per cent of the base SI.

Then there is an automatic Restore benefit. Under this, in the event of complete or partial utilisation of the base SI, the plan offers to restore it fully. This is irrespective of whether the secure or plus benefit or the cumulative bonus SI is utilised.

Let’s understand this with an example. Say Joe’s base SI is ₹10 lakh. As soon as he purchase the policy, he gets the Secure benefit. So his SI stands at ₹20 lakh (10 + 10). If the restore benefit is considered, then his total SI stands at ₹30 lakh during a policy year.

Additionally, Optima Secure also offers daily cash benefit for shared room (₹800 per day, maximum of ₹4,800), air ambulance service, and e-opinion for critical illness.

The policy also offers two add-on covers (riders) for additional premium - my: health critical illness cover up to ₹5 crore and my: health hospital cash benefit .

Our take

HDFC Ergo’s Optima Secure offers more than sufficient health cover for a policyholder and one can consider this plan only if you are looking for additional cover (amount) over and above the base SI.

The benefit of additional SI comes handy during medical emergencies and for those with existing medical conditions in the family.

Also, the plan doesn’t have any sub-limits or SI capping including for day care procedures, ICU or intensive cardiac care unit, road ambulance services and on modern treatments such as oral chemotherapy and stem cell therapy, unlike some health policies. For instance, HDFC Ergo’s Optima Restore plan has a sub-limit on road ambulance service of up to ₹2000 per hospitalisation.

But keep in mind a few points. One this Secure benefit is available only once in a policy year and does not carry forward to the next policy year. Even the automatic SI Restore feature is available only once during the policy year.

Two, though in most cases, the hospitalisation expense requirements are often met with the additional SI offered under Optima Secure, there are products in the market such as Max Bupa’s ReAssure plan and Care Plus plan from Care Health Insurance that offer restore benefit multiple times in a year.

Three, under Optima Secure, the NCB (cumulative bonus) benefit increases 10 per cent each claim-free year but there are products in the market which double the NCB or increase it 50 per cent for each claim-free year up to a maximum of 100 per cent of base SI.

The ReAssure plan from Max Bupa increases the same by 50 per cent for each claim-free year. Manipal Cigna’s Pro Health plan offers guaranteed increase in SI by 10 per cent up to 200 per cent (of base SI ) every year irrespective of the claims

And lastly, while Optima Secure offers comprehensive coverage, it may appear slightly expensive compared to other products in the market.

For instance, under Optima Secure, for a ₹10 lakh cover for a family (husband and wife; 30 years), the premium works out to ₹19,106 (including GST) per year.

Under Max Bupa’s ReAssure, the premium is around ₹11,321 (including GST) per year.