HDFC ERGO
Optima Secure - Optima-Secure
- No cap - room covered at actual cost
- 36 months
- Refills 100% of your cover, once a year
Comprehensive health insurance plan that instantly doubles your base cover from day one and features automatic restorations, no-cost coverage for non-medical expenses (consumables), and cumulative bonuses that can multiply your coverage.
PLAN SELECTION
8 plans available with 10 sum insured options
All plans
Optima Secure/Optima-Secure
What you should know first
At a glance
5 strong5 to watch
What's strong
- Road ambulance uncapped - most insurers cap this at ₹2,000–3,000.
- Automatic Restore - full base cover added back after any claim.
- Secure Benefit: an extra pool worth 100% of base cover from day 1.
- Non-payable items (gloves, consumables) covered inbuilt, no add-on needed.
- Free specialist second opinion on 51 critical illnesses - doesn't touch your SI.
What to watch
- Maternity excluded from base - needs the Parenthood add-on, 2-year wait.
- Pre-existing conditions wait 36 months; shorter wait must be set at purchase, can't add later.
- No newborn baby cover - a new baby has no dedicated benefit.
- No OPD in base - everyday doctor visits need the Wellbeing add-on.
- Dental limited to accidental hospitalisation only, not disease-driven cases.
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 Secure |
|---|---|
| 1st bill₹7,00,000 | CoveredPaid from Sum Insured ₹7,00,000 |
| 2nd bill₹12,00,000 | 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
Most plans pay your hospital room at actuals - no daily rupee cap and no room category limit. Optima Select caps you at a Single Private room and Optima Lite at 1% of base sum insured per day.
Coverage detailstap any row to understand it
Room cost limitNo cap - room covered at actual cost
Room upgrade riderAvailable - Downgrade
Minimum Hospitalisation Duration to Qualify (Hours)24 hours
Watch out
If you take a room above your plan's limit, the insurer cuts the same percentage from your room charge and from your associated medical expenses.
The Protect Benefit pays the non-medical items hospitals bill for - gloves, syringes, masks, nebuliser kits, admission charges - that insurers normally reject. It is built into most plans, optional on Optima Select and Optima Lite, and absent from Optima Suraksha.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
IRDAI Non-payable Lists CoveredList I, List II, List III, List IV
Reduces Main Sum InsuredYes
Expense limitCovered up to full Sum Insured
Watch out
These items commonly run to 10-20% of a hospital bill, so on a ₹4,00,000 stay that is ₹40,000 to ₹80,000. On plans where Protect Benefit is optional, it must be chosen at policy start or at a renewal, and it only pays if your Policy Schedule shows it in force.
Follow-up visits, medicines and physiotherapy for 180 days after discharge are paid, as long as they relate to a hospital stay the insurer has already admitted. Optima Lite is the exception at 60 days. There is no separate rupee cap - these bills come out of your sum insured.
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
180 days covers most recovery periods, including the long ones after bypass surgery or a joint replacement. The expenses must relate to the same treatment, so keep the discharge summary and every follow-up prescription together.
Cancer & serious illness4 of 10 are priority
Restore Benefit adds back 100% of your Base Sum Insured the moment an claim uses up your cover, partly or fully. Optima Select, Optima Lite and Optima Secure+ restore an unlimited number of times. The restored money pays only claims that come after it, not the bill that used up your cover.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
What the insurer calls itAutomatic Restore Benefit
RefillsRefills 100% of your cover, once a year
Illnesses eligible for refillCan be used for the same illness or a new one
Activates FromAfter First Paid Claim
Watch out
The refill cannot pay the bill that exhausted your cover - one single claim can never exceed your Base Sum Insured plus whatever Secure Benefit and bonus are left. If you take a ₹10 lakh aggregate deductible or higher, the Automatic Restore Benefit does not apply at all.
The Secure Benefit adds a second Sum Insured on top of your base from day one, before any claim. On the Optima Secure, Global, Global Plus and Secure+ plans it is 100% of your Base Sum Insured; on Optima Super Secure it is 200%. It is spent after the base cover runs out and it raises what one single bill can be paid - a ₹10,00,000 cover can pay ₹20,00,000 on one hospitalisation. Optima Suraksha, Select and Lite do not have it.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
What the insurer calls itSecure Benefit
Extra coverAdds 100% of your cover as an extra pool
Activates FromDay 1
Eligible Claim TypesBase Coverage Only
Watch out
The Secure Benefit applies only once in a policy year, though it can be spread across any number of claims in that year. Anything left over does not carry into the next year.
This policy sets no separate rule for modern treatments. There is no list of approved advanced procedures and no sub-limit on them, so robotic surgery, oral chemotherapy and similar treatments are paid under the main hospitalisation clause, up to your full sum insured.
Coverage detailstap any row to understand it
Coverage ScopeAll Modern Treatments
Expense limitCovered up to full Sum Insured
Sub-limit Modification AvailableNo
Watch out
The usual limits still apply: the treatment must be medically necessary and prescribed in writing, and anything the policy classes as unproven or experimental is excluded.
It is sold only as a paid add-on: my:health Critical Illness pays a lump sum on diagnosis of any of 51 listed critical illnesses, with a sum insured you choose from ₹1 lakh up to ₹5 Cr. A second add-on, Serious Illness Booster, pays actual medical expenses instead of a lump sum.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
Number of Critical Illnesses Covered51 illnesses
Payout TypeLump Sum on Diagnosis
Minimum Sum Insured Option (INR)₹1 Lakh
Maximum Sum Insured Option (INR)₹5 Cr
Watch out
The lump-sum add-on is a separate contract and its own terms, so the waiting period and survival period are set in that document, not in the Optima Secure wording. Ask for the add-on wording before you buy.
When does my cover switch on?2 of 4 are priority
Conditions you already had are not covered for the first 36 months of continuous cover. The wait can be cut to 24 or 12 months on any plan, but that option is sold at channel level only and only at inception - an individual buyer cannot ask for it.
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 reductionReducible to 12 months, 24 months - opt-in Policy Start Only, locked in once chosen, available to Channel
Watch out
After 36 months a pre-existing condition is covered only if you declared it when you applied and the insurer accepted it.
A named list of common conditions and operations - cataract, hernia, piles, kidney stones, gall bladder removal, hysterectomy, joint replacement and more - is not covered for the first 24 months of continuous cover. Accident claims are exempt.
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 condition you develop after buying the policy. If a listed condition is also pre-existing, the longer 36-month wait applies instead. This product sells no option to shorten either wait.
Planning a baby2 of 3 are priority
Maternity is available only if you buy the separate Parenthood add-on, and a claim is payable only after 2 years from the date you take it. One part survives without the add-on: ectopic pregnancy is carved out of the exclusion and is paid as an ordinary hospitalisation claim.
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
Add-on NameParenthood
Watch out
If you plan a baby within the next two years, this product will not pay for the delivery even with the Parenthood add-on. A normal delivery in a metro private hospital costs roughly ₹75,000 to ₹1,50,000, and you pay all of it from your own pocket during those 2 years.
This product has no newborn baby cover. There is no benefit that puts your baby on the policy from the day of birth, and no cover for NICU care in the first weeks. A child can be added as an Insured Person only from 91 days of age, which is enrolment, not day-one cover.
Coverage detailstap any row to understand it
How it's coveredNot covered
Everyday medical costs2 of 7 are priority
The base policy pays nothing for treatment taken as an outpatient - doctor visits, tests and medicines outside a hospital stay are excluded on every plan. OPD is available only if you buy the separate Optima Wellbeing add-on, whose limits and terms are set out in that add-on's own documents, not in this policy.
Coverage detailstap any row to understand it
How it's coveredOptional add-on
Add-on NameOptima Wellbeing
Watch out
Ask for the Optima Wellbeing schedule before you buy: the amount you get, the co-payment and what counts as an outpatient expense are all decided there, not here.
Hospitalisation for mental illness is paid the same way as any other illness - up to the Sum Insured, with no separate sub-limit anywhere in the wording and no exclusion for psychiatric treatment. Therapy and psychiatrist visits taken as an outpatient are not paid, because outpatient treatment is excluded on every plan.
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
Watch out
Most mental health care happens outside a hospital, and that side is excluded here.
Worth it if I never claim?2 of 4 are priority
Your cover grows every year whether or not you claim. Optima Suraksha and Optima Lite add 10% of Base Sum Insured a year and Optima Select 25%, both up to 100%. The Optima Secure family instead uses Plus Benefit at 50% a year up to 100%, and Optima Secure+ uses Infinite Benefit at 100% a year with no ceiling at all.
Coverage detailstap any row to understand it
How it's coveredIncluded in the base plan
What the insurer calls itPlus 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 bonus is credited only on renewal without a break, and only if the cover is shown in your Policy Schedule. Only one of these runs at a time. If you take Plus Benefit on a plan that had Cumulative Bonus, the accrued bonus carries over and the Cumulative Bonus stops. The same either-or rule applies between Plus Benefit and Infinite Benefit.
An optional feature on every plan: you agree to pay the first fixed amount of admissible expenses each policy year yourself, from ₹10,000 up to ₹25 lakh depending on the plan, and the insurer pays only above it. It resets every policy year. You can choose it at inception or at a renewal and raise it later, and once in the life of the policy you can reduce or waive it after 5 continuous years, subject to age limits.
Coverage detailstap any row to understand it
AvailabilityOffered as an optional feature
Deductible waiverAvailable after 5 years - eldest insured up to 50 years at purchase, up to 61 years at waiver time
Deductible Resets EveryPolicy Year
High Deductible Levels Restrict Other BenefitsYes
Deductible Can Only Be Increased at RenewalYes
0248 illnesses
48 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
48 ConditionsWaiting Period: 24 months
Spine & Back
Ankylosing Spondylitis
Inflammatory Spine Disease
Back & Spine
A painful joint disease that causes the bones in the spine to fuse together.
The exact words
“Non infective Arthritis”
Section C.1.b · pages 31–32
Prolapse of Intervertebral Disc
Slip Disc (Back problem)
Back & Spine
A back problem where a spinal disc slips and presses on nerves.
The exact words
“Surgery for prolapsed inter vertebral disc”
Section C.1.b · pages 31–32
Digestive & Abdominal
Gastritis, Peptic Ulcers and GERD
Acid reflux and stomach ulcers
Upper Abdomen
Acid damage causing burning or sores in the food pipe, stomach, or the first part of the intestine.
The exact words
“Ulcer and erosion of stomach and duodenum”
Section C.1.b · pages 31–32
Cholelithiasis and Cholecystitis
Gallstones
Upper Abdomen
Hard stone-like pieces in the gallbladder that cause stomach pain.
The exact words
“Diseases of gall bladder including cholecystitis”
“Cholecystectomy”
Section C.1.b · pages 31–32
Pancreatitis
Pancreas swelling
Upper Abdomen
Swelling in the stomach organ that helps with digestion.
The exact words
“Pancreatitis”
Section C.1.b · pages 31–32
0335 listed
8 never paid 11 paid only if a condition is met 16 in every policy read from all 35 under a minute
Never paid
8 clausesNo waiting period reaches these - the plan does not cover them at all.
The insurer can name a condition on your own policy schedule and exclude it permanently, in a case where it would otherwise have refused you cover altogether. You accept that exclusion when you buy the policy. Read your schedule, because this exclusion is personal to you and appears nowhere else in the policy.
Any permanent exclusion applied on any medical or physical condition or treatment of an Insured Person as specifically mentioned in the Policy Schedule and as specifically accepted by Policyholder/Insured Person. Such exclusions shall be applied for the condition(s) or treatment(s) that otherwise would have resulted in rejection of insurance coverage under this Policy to such Insured Person as per Company’s Underwriting Policy.
PW p.35 §3.q
If you chose a deductible, this plan treats every claim below that amount as an exclusion, not as a reduction. Such a claim is refused completely, so you pay the whole of it from your own pocket.
Claims/claim amount falling within Aggregate Deductible limit if opted and in force, as specified in the Policy Schedule.
PW p.34 §3.b
Investigative treatment for sleep apnoea, general debility or a run-down condition is excluded. If you need a sleep study to find out whether you have apnoea, you pay for it yourself.
Investigative treatment for sleep-apnoea, general debility or exhaustion (“run-down condition”).
PW p.34 §3.e
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.
Expenses related to any admission primarily for enforced bed rest and not for receiving treatment. This also includes:
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.
Any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
PW p.32 §2.b
Stem cell harvesting - collecting and storing stem cells, for example from bone marrow or cord blood, so they can be used in a later treatment - is not paid for. The collection and storage cost stays with you.
Stem cell harvesting.
PW p.34 §3.g
Birth defects visible on the outside of the body are not paid, and no waiting period turns them into cover. There is no exception for a newborn. Internal ones are covered.
Congenital external diseases, defects or anomalies
PW p.34 §3.f
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.
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.34 §2.n; Parenthood add-on PW p.69
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.
Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy
PW p.34 §2.o; Parenthood add-on PW p.69
Paid, but only if…
11 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 after an accident, expenses up to the stage of stabilisation are payable - but 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.
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 p.33 §2.h
When it IS paid
Disapplied entirely wherever the Protect Benefit is in force.
The non-medical items listed in Annexure B are cut from the hospital bill, and you pay for them from your own pocket. If the Protect Benefit is in force, this exclusion does not apply at all.
Non-Medical expenses such as food charges (other than patient’s diet provided by hospital), laundry charges, attendant charges, ambulance collar, ambulance equipment, baby food, baby utility charges and other such items. Full list of Non-Medical Expenses is attached as ANNEXURE B and also available at www.hdfcergo.com.
PW p.35 §3.k; disapplied at PW p.16 §2.3
When it IS paid
Diagnostics related or incidental to the treatment you were admitted for stay covered.
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.
Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded.
Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
PW p.32 §2.a
When it IS paid
Paid when prescribed by a doctor as part of a hospitalisation claim or 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.
PW p.34 §2.k
When it IS paid
Paid for reconstruction following an accident, burns or cancer, or to remove a direct and immediate health risk. Plastic surgery needed because of an injury is separately covered up to the full Sum Insured on all 8 plans.
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.
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.33 §2.e; positive grant at PW p.11 §1.1.1.iii
When it IS paid
In-patient dental treatment made necessary by disease or injury is covered up to the full Sum Insured on all 8 plans.
Dental treatment taken as an out-patient is not paid, so you pay for it yourself. Dental work that needs hospital admission is covered up to the full Sum Insured.
Treatment taken on outpatient basis.
PW p.35 §3.l; in-patient grant PW p.11 §1.1.1.ii
When it IS paid
Paid when used during surgery itself.
Artificial limbs, wheelchairs, crutches, corrective devices and oxygen concentrators are paid only when they are used during the surgery itself. If you use an oxygen concentrator at home, you pay for it yourself.
Expenses for Artificial limbs and/or device used for diagnosis or treatment (except when used intra-operatively), prosthesis, corrective devices external durable medical equipment of any kind, wheelchairs, crutches, and oxygen concentrator for bronchial asthma/ COPD conditions, cost of cochlear implant(s) unless necessitated by an Accident.
PW p.35 §3.o
When it IS paid
A cochlear implant IS paid when an accident made it necessary.
Glasses, contact lenses and hearing aids are not paid for. A cochlear implant is paid only when an accident made it necessary.
The provision or fitting of hearing aids, spectacles or contact lenses.
PW p.35 §3.m and §3.o · cl. §3.m, §3.o
When it IS paid
At 7.5 dioptres or worse the correction is paid as an ordinary hospitalisation claim.
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.
PW p.34 §2.l
When it IS paid
Treatment of fractures (but not hairline fractures) and dislocations of the jaw and limbs is still paid.
Skeletal manipulation and muscle stimulation for chronic back pain are not paid. The insurer still pays for setting a broken jaw or limb.
Investigative treatments for analysis and adjustments of spinal sub luxation, diagnosis and treatment by manipulation of the skeletal structure or for muscle stimulation by any means except treatment of fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
PW p.34 §3.h
When it IS paid
Paid on your doctor's advice, at 18 or older, with BMI 40 or more - or 35 or more with obesity-related cardiomyopathy, coronary heart disease, severe sleep apnoea or uncontrolled Type 2 diabetes. Meet all four and bariatric surgery is paid up to the full Sum Insured with no sub-limit.
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.
Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions:
Surgery to be conducted is upon the advice of the Doctor
The surgery/Procedure conducted should be supported by clinical protocols
The member has to be 18 years of age or older and
Body Mass Index (BMI)
greater than or equal to 40 or
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:
Obesity-related cardiomyopathy
Coronary heart disease
Severe sleep apnoea
Uncontrolled type2 diabetes
PW pp.32–33 §2.c
0410 discounts
9 just for qualifying 1 cost you a deductible capped at 20% about 3 min
Just for qualifying9
When it appliesPurchase & renewal
Stacks withCapped at 20% combined with the Employee, Loyalty and Family discounts.
Printed atProspectus p.29 · §8
Watch out
Renewal keeps it only if no agent or intermediary is involved
When it appliesPurchase & renewal
Stacks withWithin the 20% combined cap.
Printed atProspectus p.29 · §8
When it appliesPurchase & renewal
Stacks withWithin the 20% combined cap.
Printed atProspectus p.29 · §8
When it appliesPurchase & renewal
Stacks withWithin the 20% combined cap.
Printed atProspectus p.29 · §8
When it appliesTiming not stated
Stacks withOutside the 20% cap.
Printed atProspectus p.29 · §8
When it appliesPurchase & renewal
Stacks withOutside the 20% cap.
Printed atProspectus pp.29–30 · §8
Watch out
Re-declared each year; claims while visiting India need the differential premium paid
When it appliesTiming not stated
Printed atProspectus p.30 · §8
When it appliesPurchase only
Stacks withOutside the 20% cap.
Printed atProspectus p.30 · §8
Watch out
Earned only at first purchase - then continues for life at every renewal
When it appliesPurchase & renewal
Stacks withOutside the 20% cap.
Printed atProspectus pp.50–53 · §15
In exchange for something1
When it appliesPurchase & renewal
Printed atProspectus pp.30–31 · §8
In return
Each policy year you pay claims up to your chosen deductible yourself before the policy pays anything.
Watch out
Can be increased at any renewal, but reduced or removed only once in the policy's lifetime
Not offered: a voluntary co-payment discount - no voluntary co-payment option exists · Wellness Discount.
05
97.94% claims settled 13,000 cashless hospitals 1.68 solvency under a minute
HDFC ERGO
Filed plan · UIN HDFHLIP26058V082526
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: HDFHLIP26058V082526
3 documents we read this from under a minute