Apollo Munich (now HDFC ERGO)
Optima Senior
HDFC ERGO’s Optima Senior is a specialized health insurance plan designed for senior citizens aged 61 and above. It includes benefits like organ donor expenses, domiciliary hospitalization, pre-post hospitalization [30-60 days respectively], daycare procedures, emergency ambulance [ subject to Rs. 2000 per hospitalization], and a second medical opinion for critical illnesses. The plan also provides lifelong renewability and a no-claim discount of 5% on renewal premiums after every claim-free policy year.
What's good here?
Pre & Post hospitalization expenses covered
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Full coverage even if you are forced to hospitalize at home
The insurer will bear the costs even if you are hospitalized at home due to a condition or the hospital running out of beds. In insurance lingo, they call this a policy with domiciliary cover.
Covers Alternative Medicine
Think of getting Ayurvedic, Homeopathic or other alternative treatments to cure an illness? Your insurer will cover you fully, up to the sum insured.
What's bad here?
You will have to pay a portion of the bill
The policy will only cover 100% of the final bill. The rest is on you. They call this a co-payment.
The policy will only cover 100% of the final bill. The rest is on you. They call this a co-payment.
You can only pick a shared room
Tough luck if you are thinking about opting for a single private room. Because the policy only lets you stay in a shared room. If you still want to pick a better room, then be ready to pay a lot more when the final bill shows up.
Reasonable waiting period for pre-existing diseases
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Doctor consultations are not covered
TODO
Your insurer won’t pay the full bill for certain diseases
Your insurer won’t bear the full costs if you are treated for Joint Replacement, Surgery of Hernia, Angiography, Cataract and a few other complications. In fact, you will have to bear 30% of the cost in the event you are hospitalized for these illnesses.
Maternity benefits not offered
TODO
What's okay here?
Day Care treatments covered up to a certain limit
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs up to 85% of the sum insured. Think dialysis, chemotherapy, or minor surgeries.
If you’re hospitalized for less than 24 hours in lieu of a minor procedure, then the insurer will cover these costs up to 85% of the sum insured. Think dialysis, chemotherapy, or minor surgeries.
What's lacking here?
No Restoration Benefit
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
Some policies will tell you - Even after you claim part of the cover on one occasion, you will have the full cover restored, if you are hospitalized another time during the same year. So if you have a family cover and multiple members of the family are hospitalized in the same year, this feature will come in handy. Unfortunately, this policy offers no such benefit.
No Bonus for being healthy and not claiming insurance
Some policies offer you extra cover if you go an entire year without claiming your insurance. This policy, however, offers no such benefit.
Your insurer doesn’t provide free health check-ups
If you want to get a full-body checkup just to make sure you’re in fine working condition, be ready to pay for it yourself.
Frequently Asked Questions
Talk to IRDAI-certified experts
Health is tricky, and insurance trickier. But we’ll simplify it for you - for FREE! Book a call now. Limited slots available.