HDFC ERGO
Optima Restore
- No cap - room covered at actual cost
- 36 months
- Refills 100% of your cover, once a year
The plan that doubles itself - the Multiplier adds 50% of your Sum Insured every year, claim or no claim, up to double the base; any hospital room is paid with no rent cap, and post-hospitalisation care runs 180 days.
PLAN SELECTION
1 plan available with 8 sum insured options
All plans
Optima Restore
What you should know first
At a glance
5 strong5 to watch
What's strong
- Room rent uncapped - any room is paid to your Sum Insured, with no proportionate deduction.
- Multiplier Benefit adds 50% a year to 100%, claim or not - a ₹10 lakh cover reaches ₹20 lakh in two years.
- Post-hospitalisation runs 180 days with no separate cap, against the 60 or 90 days most policies give.
- Domiciliary treatment paid to your Sum Insured with no disease shut out - it must run past three days.
- Restoration triggers on partial use of your Sum Insured, not only full exhaustion - 100% of the Basic Sum Insured comes back, once a policy year.
What to watch
- One bill is capped at Sum Insured plus Multiplier - a ₹7 lakh claim on ₹5 lakh cover leaves ₹2 lakh to you.
- IRDAI List I consumables are not paid without the Protector Rider - about ₹40,000 on a ₹4 lakh bill.
- A baby has no cover for its first 90 days - neonatal intensive care is paid from your own pocket.
- Road ambulance pays ₹2,000 per hospitalisation, the same cap on a ₹1 crore cover.
- No modern treatment clause - robotic surgery is paid as in-patient care, with no cap but no express promise.
The policy in one card
Sum Insured
Room rent
Non-payable items
Waiting periods
Co-pay and deductible
Restoration
Cumulative bonus
Not covered
One year through this plan
Two hospital bills in year one, on ₹10 Lakh of cover.
| Bill | Optima Restore |
|---|---|
| 1st bill₹7,00,000 | CoveredPaid from Sum Insured ₹7,00,000 |
| 2nd bill₹12,00,000 | ₹2,00,000not coveredPaid from |
01The ledger
Every feature, decoded
Tell us about your family and health - this list reorders around what matters to you.
Start the 90-second checkBig hospital bills3 of 15 are priority
There is no room rent cap. Hospital room and boarding sit inside the in-patient benefit and are paid up to your Sum Insured, with no room category and no daily rupee ceiling. Because there is no cap, the wording carries no proportionate deduction clause, so picking a costlier room does not cut what is paid on the rest of your bill.
Coverage detailstap any row to understand it
Room cost limitNo cap - room covered at actual cost
Room upgrade riderNot available
Minimum Hospitalisation Duration to Qualify (Hours)24 hours
Watch out
The stay has to be a hospital admission of at least 24 hours to count as hospitalisation, unless it is a day care procedure. Room rent is defined here to include associated medical expenses, so those charges are paid from the same Sum Insured.
The base plan does not pay the consumables list. Gloves, syringes, baby food, oxygen cylinders for home use and the rest of IRDAI List I are excluded outright, so those charges are settled by you at discharge. Cover for them is sold separately as the Protector Rider, whose limits and premium neither document states.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
IRDAI Non-payable Lists CoveredList I
The catch
Every item in IRDAI List I is paid by you at discharge unless you buy the Protector Rider. On a ₹4,00,000 hospital bill, a consumables share of ₹40,000 is money the base plan never pays.
Follow-up consultations, tests and medicines for 180 days after discharge are paid from your Sum Insured, with no separate rupee cap. 180 days is longer than the 60 or 90 days most Indian policies give, and that gap matters after heart surgery or a joint replacement, where the follow-ups run for months.
Coverage detailstap any row to understand it
Coverage Days After Discharge180 days
Expense limitCovered up to full Sum Insured
Day-Extension Rider AvailableNo
Claim Settlement TypeReimbursement Only
Watch out
The 180 days only cover the condition you were admitted for, and only if the in-patient or day care claim was admitted. A new illness that starts in those months is a fresh claim, not post-hospitalisation.
Cancer & serious illness4 of 10 are priority
If a claim uses up part or all of your cover, the policy adds back 100% of the Basic Sum Insured at once. That money pays your later hospital stays in the same year, and it refills once a year. One single bill is still never paid more than the Basic Sum Insured plus the Multiplier Benefit.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
What the insurer calls itRestore Benefit
RefillsRefills 100% of your cover, once a year
Illnesses eligible for refillCan be used for the same illness or a new one
Activates FromFrom Day 1 (no trigger needed)
The catch
One claim is never paid more than the Basic Sum Insured plus the Multiplier Benefit. In the insurer's own illustration on a ₹5 Lakh cover, a fourth claim of ₹7,00,000 is settled at ₹5,00,000 and you pay the remaining ₹2,00,000 from your own pocket.
This policy has no extra pool of cover sitting above your Sum Insured. A single claim is paid at most the Basic Sum Insured plus the accrued Multiplier Benefit, and the Restore Benefit only brings cover back for later claims. The paid Limitless add-on is the only route to a claim above that ceiling.
Coverage detailstap any row to understand it
How it's coveredNot covered
Watch out
The Multiplier Benefit does raise what one claim can be paid, but only by the amount you have actually accrued, and it is spent before the Restore Benefit is touched.
The wording carries no separate modern treatment clause and sets no sub-limit for one. Robotic surgery, oral chemotherapy, stem cell therapy for a bone marrow transplant and the other procedures on the standard IRDAI list are paid as ordinary in-patient treatment, up to your Sum Insured. Most policies cap this group at a share of the cover; here nothing caps it.
Coverage detailstap any row to understand it
Coverage ScopeListed Procedures (standard IRDAI list)
Expense limitCovered up to full Sum Insured
Watch out
Because no clause names these procedures, a claim is tested only as in-patient treatment: it must be medically necessary, charged at reasonable and customary rates and not an unproven treatment. An admission only to give intra-articular or intra-lesional injections, Zolendronic acid or IV immunoglobulin is excluded.
The base policy pays no lump sum for a critical illness. HDFC ERGO offers my:health Critical Illness, covering 50 critical illnesses, as a paid add-on alongside Optima Restore, and a Critical Advantage rider for planned treatment abroad for 8 listed major illnesses. Neither document carries the add-on's own terms.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
Number of Critical Illnesses Covered50 illnesses
Watch out
The add-on's waiting period, survival period, sum insured and payout terms live in a separate document, so read that before buying. Inside Optima Restore itself the only critical-illness benefit is a written second opinion.
When does my cover switch on?2 of 4 are priority
A condition you already have when the policy starts is not covered for the first 36 months of continuous cover. The clock runs from your first policy with this insurer, not from each renewal.
Coverage detailstap any row to understand it
Standard Waiting Period (Months)36 months
Coverage Condition After Waiting PeriodCovered if Declared at Policy Start
Portability / Migration Credit Reduces Waiting PeriodYes
Waiting period reductionNot reducible
Watch out
After 36 months, only a condition you declare when applying and the insurer accepts is paid. Nothing in either document sells an option to shorten this wait.
A named list of everyday conditions and operations - cataract, hernia, piles, kidney stones, gall bladder removal, hysterectomy and joint replacement among them - waits 24 months from the first policy. The wait does not apply to an accident claim, or where the underlying cause is cancer. If a listed condition is also pre-existing, the longer 36-month wait applies.
Coverage detailstap any row to understand it
Waiting Period (Months)24 months
Portability Credit Reduces Waiting PeriodYes
Pre-existing Disease Wait Applies if LongerYes
Accident Claims Exempt from Any Waiting PeriodYes
Waiting period reductionNot reducible
Watch out
The 24 months apply even to a listed condition that first appears after the policy starts, and even where it is declared at the start and accepted without a specific exclusion.
Planning a baby2 of 3 are priority
The base plan does not pay for childbirth: maternity is a permanent exclusion. The only cover is the optional Parenthood add-on, which pays maternity expenses after a 2-year waiting period. Ectopic pregnancy is paid under the base plan even without the add-on.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
Waiting Period for First Delivery (months)24 months
Delivery Types CoveredNormal + C-Section
Ectopic pregnancyCovered
Lawful Medical Termination of Pregnancy CoveredYes
Watch out
The 2-year wait runs before the add-on pays anything, so it only helps if you buy it well before you plan a family. Neither document gives the maternity limit, or says whether scans before delivery and check-ups after it are paid, so read the Parenthood wording first.
Optima Restore has no newborn cover. The policy defines a New Born Baby as a baby up to 90 days old but attaches no benefit to it, and a child can only be insured from 91 days. A baby's first 90 days, including any intensive care, are paid by you from your own pocket.
Coverage detailstap any row to understand it
How it's coveredNot covered
Watch out
A premature baby who needs intensive care in the first 90 days has no cover here. You pay the whole neonatal bill from your own pocket.
Everyday medical costs2 of 7 are priority
The base plan pays nothing for outpatient care. Anything that could have been treated without a hospital admission is excluded, so doctor visits, tests and medicines on their own are not payable. Outpatient cover exists only if you buy the Optima Wellbeing add-on, which both documents name in a single line and describe no further.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
Add-on NameOptima Wellbeing
Watch out
Neither the policy nor the prospectus gives the add-on's limit, the number of consultations, or what it pays for. Ask for the Optima Wellbeing wording and its premium before you count on outpatient cover.
Neither document uses the words mental illness. Treatment for a mental illness is handled like any other illness: if a doctor says hospitalisation is necessary, it is covered up to your Sum Insured, with no separate cap and no separate waiting period named. Consultations and therapy sessions attended without an admission are not paid.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
OPD and therapyIn-patient only, no OPD or therapy
In-patient expense limitCovered up to full Sum Insured
Mental health add-onNot available
Watch out
Outpatient counselling and psychiatric consultations are not payable, because the policy excludes conditions that could have been treated without hospitalisation. You pay for those sessions yourself.
Worth it if I never claim?2 of 4 are priority
Every year you renew without a break, the policy adds 50% of the Base Sum Insured as Multiplier Benefit, whether you claimed that year or not. It stops growing at 100% of the Basic Sum Insured, so a ₹10 Lakh cover reaches ₹20 Lakh in two years and stays there.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
What the insurer calls itMultiplier Benefit
Bonus growthGrows 50% of Sum Insured every year (even after claims), up to 100% of Sum Insured
Requires Renewal Without BreakYes
Eligible Claim TypesBase Coverage Only
Watch out
The accrued Multiplier Benefit carries forward only if there is no break in the policy. On a ₹10 Lakh cover that can mean losing up to ₹10 Lakh of extra cover, and you start again from the Basic Sum Insured.
You can choose an Aggregate Deductible of Rs. 25,000, Rs. 50,000 or Rs. 1 lakh and cut the premium by 15% to 50%. You then pay hospital bills yourself until that amount is used up in the policy year, and only after that does the insurer start paying. The deductible does not reduce your sum insured.
Coverage detailstap any row to understand it
AvailabilityOffered as an optional feature
Deductible waiverNo waiver option
Deductible Resets EveryPolicy Year
High Deductible Levels Restrict Other BenefitsNo
Deductible Can Only Be Increased at RenewalYes
Watch out
Once you opt in you cannot opt out or reduce the deductible, during the year or at any later renewal; you can only raise it.
0239 illnesses
39 named illnesses wait 24 months accidents from day 1 read by 9 body regions about 4 min
How long you wait, for what
Accidents
Day 1Covered from the first day, with no waiting at all.
Illness, in general
30 daysAfter the first month, ordinary illness is covered.
The listed conditions
24 monthsEach one is then covered, like any other illness.
What you already had
36 monthsConditions you declared when you bought the plan.
Nothing more to prove
60 monthsAfter this, only proven fraud can be held against a claim.
Already diagnosed with one of these? A different rule applies - conditions you already have follow the pre-existing waiting period.
Entire Body
39 ConditionsWaiting Period: 24 months
Eyes, ENT & Thyroid
Otitis Media and Mastoiditis
Middle ear infection
Head & Face
An infection inside or just behind the ear that causes pain.
The exact words
“Mastoidectomy”
Section C.1.ii(f) · pages 20–21
Tympanic Membrane Perforation
Ruptured Eardrum
Head & Face
A hole or tear in the eardrum that can cause hearing loss or infection.
The exact words
“Tympanoplasty”
Section C.1.ii(f) · pages 20–21
Deviated Nasal Septum
Bent nose bone problem
Head & Face
A bent bone inside the nose that makes breathing difficult.
The exact words
“Surgery for Nasal septum deviation”
Section C.1.ii(f) · pages 20–21
Sinusitis and Rhinitis
Sinus and nasal allergy
Head & Face
Swelling inside the nose and face bones causing blockage or pain.
The exact words
“Sinusitis”
“Rhinitis”
“Surgery for Turbinate hypertrophy”
“Nasal concha resection”
“Nasal polypectomy”
Section C.1.ii(f) · pages 20–21
Tonsillitis and Adenoiditis
Tonsil and throat swelling
Head & Face
Swollen throat glands that cause pain and trouble swallowing.
The exact words
“Tonsillitis”
“Adenoidectomy”
“Tonsillectomy”
Section C.1.ii(f) · pages 20–21
0343 listed
13 never paid 9 paid only if a condition is met 21 in every policy read from all 43 under a minute
Never paid
13 clausesNo waiting period reaches these - the plan does not cover them at all.
When the insurer accepts your proposal, it can apply an exclusion of its own for a named condition, either for a fixed number of years or for as long as you hold the policy. That exclusion is printed in your Policy Schedule and you accept it when you buy. Read the Schedule carefully, because if you are treated for a condition excluded there, you pay the full cost from your own pocket.
Any specific time bound or lifetime exclusion(s) applied by Us and specified in the Schedule and accepted by the insured.
PW p.25 C.3 item 21
If you are admitted only so that an infusion can be given, such as Zolendronic acid, sold as Zometa or Reclast, or an intravenous immunoglobulin infusion, the insurer does not pay for that admission. These infusions are expensive and are often repeated, so plan to pay for them from your own pocket.
Admission for administration of Intra-articular or Intra-lesional injections, Supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc) or IV immunoglobulin infusion
PW p.25 C.3 item 22
The insurer pays only what it treats as a reasonable charge, and only for treatment it treats as medically necessary. If it decides a charge is above the reasonable rate, or that part of the treatment was not necessary, it removes that amount from your claim and you pay it from your own pocket. This policy spells out the yardsticks it uses: medical textbooks, Government of India standard treatment guidelines, WHO protocols, and the guidelines of Indian medical societies. If those references say the admission was not needed or the stay ran too long, the insurer does not pay for it.
Any treatment or part of a treatment that is not of a reasonable charge and not Medically Necessary.
In addition to the waiting periods (Section C.1) and general exclusions (Section C.2 & C.3), We will also not cover expenses If as per any or all of the Medical references herein below containing guidelines and protocols for Evidence Based Medicines, the Hospitalisation for treatment under claim is not necessary or the stay at the hospital is found unduly long:
Medical text books, Standard treatment guidelines as stated in clinical establishment act of Government of India, World Health Organisation (WHO) protocols, Published guidelines by healthcare providers, Guidelines set by medical societies like cardiological society of India, neurological society of India etc.
PW p.25 C.3 item 19 · PW p.11 B (Evidence Based Medicine)
If a condition could have been treated without admission, the insurer does not pay for it, even when the hospital did admit you. This is one of the common reasons a hospitalisation claim gets cut, so the hospital record should state why admission was necessary.
Conditions for which treatment could have been done on an outpatient basis without any Hospitalisation.
PW p.24 C.3 item 9
The non-medical items listed in List I of Annexure I are not paid for. If any of them appear on your hospital bill, the insurer removes those amounts from the claim and you pay them from your own pocket. Medical supplies you buy to use yourself, such as elastic stockings and diabetic test strips, are not paid for either.
Any non-medical expenses mentioned in List - I of Annexure I.
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.
PW p.25 C.3 item 16; PW p.24 C.3 item 11 · cl. C.3 item 16, C.3 item 11
This policy does not pay for the treatment of sleep apnoea. If you are treated for sleep apnoea, you pay the full cost from your own pocket.
Sleep-apnoea
PW p.24 C.3 item 12
Insurance may not pay for general caretaking. Staying at a facility just to rest is not covered. Hiring helpers for daily tasks like walking or dressing may also be paid from your own pocket.
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.
PW p.23 C.2 item 10
If a prosthetic or other device can be taken off or removed without a surgery involving anaesthesia, the insurer does not pay for it. You pay for it from your own pocket. This exclusion does not apply to a device that has to be implanted during a surgery under anaesthesia.
Prosthetic and other devices which are self-detachable /removable without surgery involving anaesthesia
PW p.24 C.3 item 4
Spectacles, contact lenses, hearing aids and optometric therapy are not paid for under this policy. You pay for them from your own pocket, even when a doctor prescribes them.
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.
PW p.24 C.3 item 11
If you are admitted so that an intra-articular or an intra-lesional injection can be given, for example a knee injection for arthritis, the insurer does not pay for that admission. You pay the cost from your own pocket.
Admission for administration of Intra-articular or Intra-lesional injections, Supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc) or IV immunoglobulin infusion
PW p.25 C.3 item 22
External congenital diseases, defects and anomalies are birth defects that can be seen from outside the body. This policy does not pay for their treatment. The exclusion applies only to external congenital conditions, and not to internal ones.
External congenital diseases, defects or anomalies
PW p.24 C.3 item 13
Medical costs for family planning are not covered. This means the policy may not pay for treatments to prevent pregnancy. It also may not pay for treatments to get pregnant.
Sterility and Infertility: Code - Excl17
Expenses related to sterility and infertility. This includes:
i. Any type of contraception, sterilization
ii. Assisted Reproduction services including artificial insemination and advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
iii. Gestational Surrogacy
iv. Reversal of sterilization
PW p.23 C.2 item 14
Standard health policies may not cover the costs of pregnancy or childbirth. Normal deliveries and C-sections are excluded. The usual exception is an ectopic pregnancy; where a policy pays maternity as a benefit, its own wording says so.
Maternity: Code - Excl18
i. Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;
ii. Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the policy period.
PW p.23 C.2 item 13
Paid, but only if…
9 clausesWritten as exclusions, but the policy states a way in. The condition is the whole point.
When it IS paid
In a life-threatening situation or following an accident, expenses up to the stage of stabilisation are paid, though not the complete claim.
Insurance companies have a list of banned hospitals and doctors. If you go to them, your claim may be rejected. The exceptions are a life-threatening emergency or an accident - and even then the policy pays only up to the point you are stabilised.
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.
PW pp.23-24 C.2 item 15
When it IS paid
Diagnostic expenses are paid when they are related or incidental to the diagnosis and the treatment for which you are admitted.
Health insurance pays for actual medical treatments. If you stay in a hospital purely for diagnostic tests or scans, the bill may not be covered. There must be an active treatment going on.
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.
PW pp.22-23 C.2 item 9
When it IS paid
Paid when a medical practitioner prescribes them as part of a hospitalisation claim or a day care procedure.
General vitamins and supplements are not covered. You may have to pay for them yourself. Insurance may only pay if a doctor strictly prescribes them during a hospital stay.
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
PW p.23 C.2 item 12
When it IS paid
Paid for reconstruction following an accident, burns or cancer, or as part of medically necessary treatment to remove a direct and immediate health risk, when the attending Medical Practitioner certifies the necessity.
Surgeries done just to look better are excluded. However, plastic surgery needed after a bad accident may be covered. Surgeries for burns or cancer reconstruction are also covered.
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.
PW p.22 C.2 item 6
When it IS paid
Paid when the dental treatment or surgery requires hospitalisation.
Dental treatment and dental surgery of any kind are not paid for when they are done without admission, so you pay for a filling, a root canal or a cleaning at the dentist's clinic from your own pocket. If the dental treatment requires you to be admitted to hospital, the insurer pays for it.
Dental treatment and surgery of any kind, unless requiring Hospitalisation.
PW p.25 C.3 item 23
When it IS paid
Correction of eye sight is paid when the refractive error is 7.5 dioptres or more.
Surgeries to remove your glasses are usually not covered. They are seen as a cosmetic choice. The policy pays only when your eyesight is very weak - 7.5 dioptres or worse.
Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. Code - Excl15
PW p.22 C.2 item 5
When it IS paid
Paid for treatment of fractures, other than hairline fractures, and for dislocations of the mandible and the extremities.
Analysis and adjustment of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure, and muscle stimulation by any means, are not paid for. The insurer does pay when the same treatment is given for a fracture, other than a hairline fracture, or for a dislocation of the jaw, the arms or the legs.
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.
PW p.25 C.3 item 15
When it IS paid
Paid to the extent of the cover given under In-patient Hospitalization treatment, which is where AYUSH in-patient treatment sits.
Non-allopathic treatment is paid only to the extent of the In-patient Hospitalization treatment cover, which is where this policy places its AYUSH benefit. If you take Ayurveda, Yoga, Unani, Siddha or Homeopathy treatment without being admitted, or you take any other non-allopathic therapy, you pay the full cost from your own pocket.
Any non-allopathic treatment except to the extent of coverage provided for under 'In-patient Hospitalization treatment' cover.
PW p.24 C.3 item 8
When it IS paid
Obesity surgery is paid when all four conditions are met: the doctor advises the surgery, clinical protocols support it, the insured person is 18 or older, and the Body Mass Index is 40 or more, or 35 or more together with obesity-related cardiomyopathy, coronary heart disease, severe sleep apnoea or uncontrolled Type 2 Diabetes after less invasive weight-loss methods have failed.
The policy pays for weight-loss surgery only when your doctor advises it, you are 18 or older, and your BMI is 40 or more - or 35 or more together with a condition like heart disease, severe sleep apnoea or uncontrolled diabetes. Surgery to change how you look is not covered.
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
PW p.22 C.2 item 4
049 discounts
7 just for qualifying 2 cost you a co-pay or a deductible capped at 20% about 4 min
Just for qualifying7
When it appliesPurchase & renewal
Stacks withCounts inside the 20% combined cap with Employee, Loyalty and Family.
Printed atPolicy wording p.33 · D.2.c; Prospectus p.18
Watch out
Kept at renewal only while no agent or intermediary is involved
When it appliesPurchase & renewal
Stacks withCounts inside the 20% combined cap with Online, Loyalty and Family.
Printed atPolicy wording p.33 · D.2.c; Prospectus p.18
When it appliesPurchase & renewal
Stacks withCounts inside the 20% combined cap with Online, Employee and Family.
Printed atPolicy wording p.33 · D.2.c; Prospectus p.18
When it appliesPurchase & renewal
Stacks withCounts inside the 20% combined cap with Online, Employee and Loyalty.
Printed atPolicy wording p.34 · D.2.c; Prospectus p.18
When it appliesPurchase only
Stacks withSits outside the 20% combined cap, and is applied after the Favourable Claims Experience Discount.
Printed atPolicy wording p.34 · D.2.c; Prospectus pp.18-19
Watch out
Only if the whole multi-year premium is paid up front as a single premium
When it appliesPurchase & renewal
Stacks withSits outside the 20% combined cap, and is applied before the Long Term Policy Discount.
Printed atPolicy wording pp.40-43 · D.2.m; Prospectus pp.28-29
In exchange for something2
When it appliesPurchase & renewal
Stacks withSits outside the 20% combined cap; no clause bars combining it with the Co-payment Discount.
Printed atProspectus p.19; mechanics Policy wording p.15 · B.2.c
In return
You pay the first ₹25,000, ₹50,000 or ₹1,00,000 of your claims in a policy year yourself, and the policy pays only above that line.
Watch out
Permanent once opted - the deductible can only be increased at renewal, never dropped
When it appliesPurchase & renewal
Stacks withSits outside the 20% combined cap; no clause bars combining it with the Aggregate Deductible Discount.
Printed atProspectus p.19; mechanics Policy wording p.16 · B.2.d
In return
You pay 10% or 20% of every admissible claim out of your own pocket, for as long as the policy runs.
Watch out
Permanent once opted - the co-payment cannot be dropped during the year or at renewal
Not offered: a discount for renewing early, and no referral, alumni, affinity or senior-citizen special pricing.
05
97.94% claims settled 13,000 cashless hospitals 1.68 solvency under a minute
HDFC ERGO
Filed plan · UIN HDFHLIP26055V102526
0610 comparisons
10 comparisons, every clause that differs under a minute
Sources
Everything on this page is read from the insurer’s own filings. It is an educational summary - not advice, not a recommendation to buy, and we sell nothing.
Plan facts last updated 9 Sept 2026.
IRDAI UIN: HDFHLIP26055V102526
2 documents we read this from under a minute