HDFC ERGO General Insurance

HDFC ERGO Optima Restore

Plain-English breakdown of the plan — every field a shopper actually needs before clicking buy. Compiled from public HDFC ERGO brochures and policy wordings. Always confirm against the official PDF below.

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Trust at a glance

HDFC ERGO — IRDAI FY 2024-25

Verified

Claim Settlement Ratio: 97.37%
Incurred Claim Ratio: 84.85%
Complaints / 10,000 claims: 15
Network hospitals: 13,000

Source: IRDAI Annual Report FY 2024-25 · UIN 146PolicyPlain earns no commission · numbers shown verbatim

Plan details

Every field, in one place

Sum insured options: ₹3L · ₹5L · ₹10L · ₹15L · ₹20L · ₹25L · ₹50L · ₹1Cr
Pre-existing disease (PED) waiting: 36 months
Pre-existing covered: Covered after PED waiting period
Co-payment: No copay published
Room rent: Single private AC room
Restoration of sum insured: Unlimited (subject to clauses)
No Claim Bonus (NCB): 50% per claim-free year
Cashless network: 13,000 hospitals (insurer disclosure)
Free-look cancellation window: 15 days
Premium grace days: 30 days
IRDAI UIN: Not confirmed — verify on irdai.gov.in
Last verified: 2026-06 · third party aggregator

Honesty note: Optima Restore predates Optima Secure; many shoppers are moved off Restore at renewal — confirm variant before paying.

Indicative premium

Order-of-magnitude only — NOT a quote

Age	Sum insured	Approx annual premium
28	₹5L	~₹8,500/yr
35	₹10L	~₹14,000/yr

Indicative figures vary by city, family member count, medical loading and policy term. Always confirm on the insurer's premium calculator.

Known exclusions

What this plan typically does NOT cover

Cosmetic / aesthetic surgery
Maternity unless rider
Substance abuse, self-inflicted injury
Adventure / hazardous activities
Experimental treatments

Known traps

The fine print that decides claim outcomes

Restore benefit triggers AFTER base SI exhaustion AND only for unrelated illness in the same year on some variants.
Multiplier benefit (50% NCB step) caps at 100% — slower than competitor unlimited bonus mechanics.
Hospital must have 10+ beds (15 in metro) — many nursing homes don't qualify.
Single private room category cap — proportionate deduction beyond.
Modern treatments capped at 50% of SI.

How to claim

Cashless vs reimbursement — the steps

1Notify insurer. Within 24 hours of emergency admission or 48-72 hours for planned hospitalisation. Use HDFC ERGO's helpline or app — keep the reference number.
2Cashless: Pre-authorisation form filled by hospital, sent to HDFC ERGOvia the hospital's TPA desk. Approval typically 4-6 hours during business; longer overnight. If your hospital is OUT of network (or PPN-only), you'll be on reimbursement.
3Reimbursement:Pay hospital out-of-pocket, then submit claim form + original bills + discharge summary + investigation reports + KYC. Insurer's IRDAI-mandated turnaround is 30 working days from receipt of complete documents.
4Watch for deductions. Room rent above your eligible category triggers proportionate deduction across the WHOLE bill, not just room rent. Sub-limits on cataract / modern treatment apply even when total SI is far higher.
5If denied: Ask for a written denial citing the exact clause. Internal grievance redressal first, then IRDAI Bima Bharosa or the Insurance Ombudsman.

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