Health Insurance - HDFC Ergo

HDFC Ergo: my:Optima Secure

• Sum insured: 10lakh
• Initial Quote: 66428
• Premium revised : 77499

Exclusions:

1. Preexisting diseases(PED) are not covered for 36 months
2. Specified Disease/Procedure
3. Claims within 30days for any illness except accident
4. Investigation & Evaluation

Declared items:
Diabetes:

For Diabetes - Gemer P2 tablet.

Asthma

My mother was diagnosed with allergic reactions to dust(Wheezing problem) around 04.07.2022. I do not have any reports for that diagnosis. From that time, she has been taking these medicines regularly since then.

• Okacet 10mg
• TheoAsthalin tablets

Reference:

PED Declared and Accepted:

Questions from HDFC ergo:

1. PED:

• 36 months no coverage
• Coverage after 36months is subject to accepted conditions
• Under portablity norms, waiting period can be reduced
• Sum insured extension apply, exclusion applied afresh

2. Specified Disease/Procedure

• 24 months no coverage for the listed illness.

1. Internal Congenital: Diseases of gall bladder, Pancreatitis, Catarack, Osteroarthritis and Osteoporosis
2. Non Infective: Kidneystone and Urinary bladder stone, Ulcer and erosion of stomach, Reflux in Gastro Esophageal, Fissure/Fistula, Heamorrhoids
3. Pilonidal sinus: Cysts, modules, polyps including breast lumps, PCOD, Sinusitis, Rhinitis, Skin tumors, Tonsililitis

• 24 months no coverage for the listed surgical procedures
  1. Hernia, surgery for Vericose veins and vericose ulcers
  2. Joint relacement surgeries, polapsed Uterus, Glaucoma, Rectal prolapse, ENT surgery, Perianal abscesses.

3. 30 day waiting period
4. Investigation and Evaluation

Expenses primarily for diagnosis are excluded.
Rest cure, Rehab and respite care are exlused

• Obesity related
• Cosmetic and plastic surgery
• adventure sports related
• Breach of law with criminal intent
• Excluded providers
• Treatement for Alchoholism, drug
• Unproved treatment
• Surrogacy

For more details, please refer the below document:

• https://www.hdfcergo.com/docs/default-source/downloads/policy-wordings/health/optima-secure-revision-pw.pdf

• Customer INformation Sheet downloaded from application