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HDFC ERGO General Insurance

HDFC ERGO Optima Senior

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.

seniorindividual
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Trust at a glance

HDFC ERGO — IRDAI FY 2024-25

Verified
Claim Settlement Ratio
97.37%

FY 2024-25

Incurred Claim Ratio
84.85%

% of premium paid as claims

Complaints / 10,000 claims
15

Lower is better

Network hospitals
13,000

Insurer locator ↗

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
₹5L · ₹10L
Pre-existing disease (PED) waiting
12 months
Pre-existing covered
Covered after PED waiting period
Co-payment
20% from entry age 61+
Room rent
Single private AC room
Restoration of sum insured
Once per policy year
No Claim Bonus (NCB)
10% 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: Field values inferred from HDFC ERGO Optima Senior brochure; entry age caps vary by sales channel — confirm in writing before paying.

Indicative premium

Order-of-magnitude only — NOT a quote

AgeSum insuredApprox annual premium
65₹5L~₹30,000/yr
70₹5L~₹42,000/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
  • Substance abuse, self-inflicted injury
  • Adventure / hazardous activities
  • Experimental treatments
  • Treatment outside India

Known traps

The fine print that decides claim outcomes

  • Entry age cap of 65 on some variants — re-confirm at point of purchase.
  • 20% copay on all claims at entry age 61+.
  • PED waiting is 12 months — among the shortest in the senior bucket — but copay offsets.
  • Modern treatments capped at 50% of SI.
  • Pre-policy medical check costs may not be fully reimbursed even if policy is issued.

How to claim

Cashless vs reimbursement — the steps

  1. 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.
  2. 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.
  3. 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.
  4. 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.
  5. 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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