Prospectus

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

1 | P a g e

Optima Restore - Prospectus

Suitability:

a) This policy covers persons in the age group 91 days to 65 years. The maximum entry age is restricted

to 65 years. The Minimum entry age for adult dependent: is 18 years and maximum entry age is 65

years.

b) Children between 91 days and 5 years can be insured provided either parent is getting insured under

this policy.

c) There is no maximum cover ceasing age on renewals.

d) The policy will be issued for a period of 1/2/3 year(s) period, the sum insured & benefits will applicable

on policy year basis.

e) This policy can be issued to an individual and/or family. A maximum of 6 members can be added in a

single policy, whether on an individual or family floater basis.

f) The policy offers option of covering on individual sum insured basis and on family floater basis.

g) The family includes following relationships spouse, dependent children and dependent parents and

dependent in laws.

h) In a family floater policy, a maximum of 2 adults and a maximum of 5 children can be included in a single

policy. The 2 adults can be a combination of self, spouse, father, father in law, mother or mother in law

.

i) In a family floater the age of the eldest member will be considered while computing premium for the

family.

j) In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single

policy. The 4 adults can be a combination of self, spouse, father, father in law, mother or mother in law.

k) The Sum Insured of the dependent insured members should be equal to or less than the sum insured

of the primary insured member. In case where two or more children are covered, the sum insured for all

the children must be same. Sum insured of dependent parents must be the same.

Note:

I. Dependents means only the family members listed below:

i. Your legally married spouse as long as she continues to be married to you;

ii. Your children aged between 91 days and 25 years if they are unmarried

iii. Your natural parents or parents that have legally adopted you, provided that the parent

was below 65 years at his initial participation in the Optima Restore policy.

iv. You’re Parent -in-law as long as your spouse continues to be married to you and were

below 65 years at his initial participation in the Optima Restore policy.

v. All dependent parents must be financially dependent on you.

Dependent Child means a child (natural or legally adopted), who is unmarried, aged between 91 days

and 25 years, financially dependent on the primary Insured or Proposer and does not have his / her

independent sources of income.

Salient Features & Benefits:

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

2 | P a g e

We will cover the Medical Expenses for:

In addition to the waiting periods

(Section 5a) and general exclusions

(Section 5c), We will also not cover

expenses

a. In-patient Treatment.

This includes

• Hospital room rent or boarding;

• Nursing;

• Intensive Care Unit

• Medical Practitioners (Fees)

• Anaesthesia

• Blood

• Oxygen

• Operation theatre

• Surgical appliances;

• Medicines, drugs & consumables;

• Diagnostic procedures.

• Note pertaining specifically to AYUSH Treatments only:

•

• Medical expenses pertaining only to In-patient care

AYUSH treatment are also covered under 'In-patient

treatment' cover if undertaken in an AYUSH Hospital. Any

medical expense other than In-patient care AYUSH

treatment expenses are not covered under this policy

If as per any or all of the Medical references

herein below containing guidelines and

protocols for Evidence Based Medicines, the

Hospitalisation for treatment under claim is

not necessary or the stay at the hospital is

found unduly long:

▪ Medical text books,

▪ Standard treatment guidelines as

stated in clinical establishment act

of Government of India,

▪ World Health Organisation (WHO)

protocols,

▪ Published guidelines by healthcare

providers,

▪ Guidelines set by medical societies

like cardiological society of India,

neurological society of India etc.

b. Pre-Hospitalisation expenses for consultations,

investigations and medicines incurred upto 60 days

before the date of admission to the hospital (In-patient

OR Day Care OR Domiciliary treatment).

i) Claims which have NOT been admitted

under Inpatient treatment benefit and

day care procedure benefit.

ii) Expenses not related to the admission

and not incidental to the treatment for

which the admission has taken place.

c. Post-Hospitalisation expenses for consultations,

investigations and medicines incurred upto 180 days

after discharge from the Hospital (In-patient OR Day

Care OR Domiciliary treatment).

i. Claims which have NOT been

admitted under Inpatient treatment

benefit and day care procedure

benefit.

ii. Expenses not related to the

admission and not incidental to the

treatment for which the admission

has taken place

d. Day Care Procedures

Medical treatment or surgical procedure which is

undertaken under general or local anaesthesia, which

require admission in a Hospital/Day Care Centre for

stay less than 24 hours. Treatment normally taken on

out-patient basis is not included in the scope of this

definition.

i) Treatment that can be and is usually

taken on an out-patient basis is not

covered.

ii) Treatment NOT taken at a Hospital or

daycare centre.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

3 | P a g e

▪

e. Domiciliary Treatment

Medical treatment for an Illness/disease/injury which

in the normal course would require care and

treatment at a Hospital but is actually taken while

confined at home under any of the following

circumstances:

i. The condition of the patient is such that he/she is

not in a condition to be removed to a Hospital or,

ii. The patient takes treatment at home on account

of non-availability of room in a Hospital.

iii. Pre and Post Hospitalisation expenses for

consultations, investigations and medicines

incurred upto 60 days before hospitalisation and

180 days after hospitalization respectively will be

covered in case of domiciliary treatment.

1. Treatment of less than 3 days

(Coverage will be provided for expenses

incurred in first three days only if

treatment period is greater than three

days).

f. Organ Donor:

Medical and surgical Expenses of the organ donor for

harvesting the organ where an Insured Person is the

recipient.

IMPORTANT: Expenses incurred by an insured

person while donating an organ is NOT covered.

1. Claims which have NOT been admitted

under Inpatient treatment benefit for

insured member.

2. Admission not compliant under the

Transplantation of Human Organs Act,

1994 (as amended).

3. The organ donors Pre and Post-

Hospitalisation expenses.

g. Ambulance Cover

Expenses incurred on transportation of Insured

Person to a Hospital for treatment in case of an

Emergency, subject to Rs. 2000 per Hospitalisation.

1. Claims which have NOT been admitted

under Inpatient Treatment Benefit and

Daycare procedure benefit

2. Healthcare or ambulance service

provider not registered with road traffic

authority.

h. Daily Cash for choosing shared Accommodation

Daily cash amount will be payable per day as

mentioned in schedule of benefits if the Insured

Person is hospitalised in Shared Accommodation in a

Network Hospital for each continuous and completed

period of 24 hours if the Hospitalisation exceeds 48

hours.

1. Daily Cash Benefit for time spent by the

Insured Person in an intensive care unit

2. Claims which have NOT been admitted

under Inpatient Treatment benefit

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

4 | P a g e

i. E-Opinion in respect of a Critical Illness

We shall arrange and pay for a second opinion from

Our panel of medical Practitioners, if:

-The Insured Person suffers a Critical Illness during

the Policy Period; and

-He requests an E-opinion; and

The Insured Person can choose one of Our panel

Medical Practitioners. The opinion will be directly sent

to the Insured Person by the Medical Practitioner.

“Critical Illness” includes Cancer, Open Chest

CABG, First Heart Attack, Kidney Failure, Major

Organ/Bone Marrow Transplant, Multiple Sclerosis,

Permanent Paralysis of Limbs and Stroke.

1. More than one claim for this benefit in a

Policy Year.

2. Any other liability due to any errors or

omission or representation or

consequences of any action taken in

reliance of the E-opinion provided by the

Medical Practitioner

j. Emergency Air Ambulance Cover

We will pay for ambulance transportation in an

airplane or helicopter subject to maximum limit

prescribed in j (1) , for emergency life threatening

health conditions which require immediate and rapid

ambulance transportation to the hospital/medical

centre that ground transportation cannot provide

subject to:

• Necessary medical treatment not being available

at the location where the Insured Person is

situated at the time of Emergency;

• The Medical Evacuation been prescribed by a

Medical Practitioner and is Medically Necessary;

• The insured person is in India and the treatment

is required in India only and not overseas in any

condition whatsoever; and

• The air ambulance provider being registered in

India.

j(i) The amount payable in case of Air ambulance facility

shall be either the actual expenses or Rs. 2.5 Lacs per

hospitalisation, whichever is lower; upto basic sum

insured limit for a year.

1. Claims which have NOT been

admitted under 1 a) and 1d).

2. Expenses incurred in return

transportation to the insured’s home

by air ambulance is excluded.

Section II.

a. Restore Benefit

Instant addition of 100% Basic Sum Insured on

complete or partial utilization of Your existing

Policy Sum Insured and Multiplier Benefit (if

applicable) during the Policy Year. The Total

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

5 | P a g e

amount (Basic sum insured, Multiplier benefit and

Restore sum insured) will be available to all

Insured Persons for all claims under In-patient

Benefit during the current Policy Year and subject

to the condition that single claim in a Policy Year

cannot exceed the sum of Basic Sum Insured and

the Multiplier Benefit (if applicable).

Conditions for Restore benefit:

i. The Sum Insured will be restored only once in a

Policy Year.

ii. If the Restored Sum Insured is not utilized in a

Policy Year, it will expire.

In case of a Family Floater Policy, Restore Sum Insured

will be available on floater basis for all Insured Persons

in the Policy.

b. Unlimited Restore Benefit (Optional benefit)

This optional cover will be provide instant addition of

100% Basic Sum Insured on complete or partial

utilization of Your Restore benefit or Unlimited Restore

benefit (as applicable) during the Policy Year. This

optional cover will trigger unlimited times and is available

for all subsequent claims in a Policy Year.

Conditions for Unlimited Restore benefit:

i. The Sum Insured will be restored under this optional

cover for the subsequent claim in the Policy Year.

ii. A single claim in a Policy Year cannot exceed the sum

of Basic Sum Insured and the Multiplier Benefit (if

applicable).

In case of a Family Floater Policy, Unlimited Restore

Sum Insured will be available on floater basis for all

Insured Persons in the Policy.

c. Aggregate Deductible

The Insured Person shall bear an amount equal to the

Aggregate Deductible specified on Policy Schedule for

all admissible claims made by the Insured Person and

assessed by the Company in a Policy Year. The liability

of the Company to pay the admissible claim under that

Policy Year will commence only once the specified

Aggregate Deductible has been exhausted. This Cover

shall be subject to the following conditions:

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

6 | P a g e

I. This Cover is applicable on annual aggregate

basis and can be opted only at inception of the

Policy or at subsequent Renewals.

II. Once the Aggregate Deductible option is opted

by the Insured Person, it cannot be opted out or

reduced at any time during the Policy Year or at

subsequent Renewals. Deductible however can

be increased at the time of Renewal.

III. In case of Individual Policy, the entire amount of

Aggregate Deductible must first be exhausted

on per Insured Person basis, once in a Policy

Year, before the Company pays for claims of

that Insured Person in that Policy Year.

IV. In case of family floater Policy, the entire amount

of Aggregate Deductible must first be exhausted

by any one or more of the Insured Persons once

in a Policy Year before the Company pays for

claims of any Family Member covered under the

Policy in that Policy Year.

V. The Aggregate Deductible is not applicable to

section 3 (Preventive Health checkup), Section

1.i (E-Opinion in respect of a Critical Illness).

d. Co-Payment

I. If opted and mentioned on the Policy Schedule

that a Co-payment is effective, and an

admissible claim has been admitted, then the

insured person shall bear the percentage (%) of

Co-payment mentioned in the policy schedule

on all eligible claims payable under the Policy

and Our liability, if any, shall only be in excess of

that amount and would be subject to the Sum

Insured.

II. Co-payment is not applicable to Section 3

(Preventive Health checkup), Section 1.h (Daily

Cash for choosing shared Accommodation) and

Section 1.i (E-Opinion in respect of a Critical

Illness).

III. This benefit once opted, cannot be opted out at

any time during the Policy Year or at subsequent

Renewals.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

7 | P a g e

Illustration of Sum Insured utilization in a Policy Year

Basic Sum Insured : 5 Lacs

Multiplier Benefit: 2.5 Lacs

Number

of Claim

Claim

amount

Available Benefit Limit

Admissible

claim

amount

Utilization of Sum

Insured

Basic

Sum

Insured

Multiplier

Benefit

Restore

Benefit

Unlimited

Restore

Benefit

1

st

claim

7,00,000

5,00,000

2,50,000

0

7,00,000

Basic + Multiplier

(Partial)

2

nd

claim

3,50,000

-

50,000

5,00,000

0

3,50,000

Multiplier (balance)

+ Restore (partial)

3

rd

claim

3,00,000

-

2,00,000

5,00,000

3,00,000

Restore (balance) +

Unlimited Restore

4

th

claim

7,00,000

-

5,00,000

Unlimited Restore

5

th

claim

5,00,000

-

5,00,000

Unlimited Restore

Basic Sum Insured: Rs. 3Lacs; 5 Lacs; 10 Lacs; 15 Lacs; 20 Lacs; 25 Lacs; 50 Lacs; 100 Lacs on individual

as well as on family floater basis.

Policy Period

▪ The policy will be issued for 1/2/3 year period, the sum insured & benefits will be applicable on Policy

Year basis.

Payment Facility:

▪ Online

▪ Cheque/ / Credit Card Payment

▪ Electronic Clearing System

Renewal Incentives:

▪ Multiplier Benefit:

On Renewal of this Policy with the Company without a break, a sum equal to 50% of the Base Sum Insured of

the expiring Policy shall be provided as multiplier benefit irrespective of any claims and shall be available under

the Renewed Policy subject to the following conditions:

i. The maximum multiplier bonus will not exceed 100% of the Basic Sum Insured in any Policy

Year.

ii. In Family Floater policy, the Multiplier Benefit shall be available on Family Floater basis at policy

level

iii. In Family Floater policy, the accrued Multiplier Benefit is available to all Insured Persons under

the Policy.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

8 | P a g e

iv. The applicable Multiplier Benefit shall be applied annually only on completion of each Policy Year,

and once added, the accumulated amount will be carried forward to the subsequent Policy Year,

subject to there being no Break in Policy

v. If the Insured Persons in the expiring policy are covered on individual basis and thus have

accrued the multiplier bonus for each member in the expiring policy, and such expiring policy is

renewed with Us on a Family Floater basis, then the multiplier bonus to be carried forward for

credit in the Policy would be the lowest accrued multiplier bonus amongst all the Insured Persons

from the expiring Policy.

vi. Portability/migration benefit will be offered to the extent of sum of previous sum insured and

accrued multiplier bonus, portability/migration benefit shall not apply to any other additional

increased Sum Insured.

vii. In policies with a 2/3 year Policy Period, the application of above guidelines of Multiplier Benefit

shall be post completion of each policy year.

▪ Preventive Health checkup

This benefit is effective only if mentioned in the Schedule of Benefits.

If You have maintained an Optima Restore Policy with Us for the period of time mentioned in the schedule

of benefits without any break, then at the end of each block of continuous years (as mentioned in the

schedule of benefits) We will pay upto the amount mentioned in the Schedule of Benefits towards the

cost of a preventive health check-up for those Insured Persons who were insured for the number of

previous Policy Years mentioned in the Schedule.

Plan/SI

3 Lacs

5 Lacs

10 Lacs

15 Lacs

20/25/50/100

Lacs

Individual

(Per

Person)

Not

Applicable

Upto a maximum of

Rs.1,500 per insured

person, only once at the

end of a block of every

continuous

two policy years.

Upto a

maximum of

Rs.2,000 per

insured person

at the end of

each year at

renewal.

Upto a maximum

of Rs.4,000 per

insured person,

at the end of each

year at renewal

Upto a

maximum of

Rs. 5000 per

Insured

Person, at the

end of each

year at

renewal

Floater

(Per

Policy)

Not

Applicable

Upto a maximum of

Rs.2,500 per policy, only

once at the end of a

block of every continuous

two Policy Years.

Upto a

maximum of

Rs.5,000 per

policy at the end

of each year at

renewal

Upto a maximum

of Rs.8,000 per

policy, at the end

of each year at

renewal.

Upto a

maximum of

Rs. 10,000 per

policy,

at the end of

each year at

renewal.

Note: Preventive Health Check-up means a package of medical test(s) undertaken for general assessment of

health status, it does not include any diagnostic or investigative medical tests for evaluation of illness or a

disease.

Portability:

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

9 | P a g e

If you are insured continuously and without interruption under a health insurance plan issued by an Indian non-

life insurer and you want to shift to us on renewal, Optima Restore policy offers you transfer of accrued benefits

and make due allowances for waiting periods etc. If the Insured person transfers from any other insurer and

enhances coverage, then the portability benefits will be offered only in respect to the previous sum insured.

The application for portability should be received by us at least 45 days before the policy renewal date of the

existing policy.

Free Look Period:

You have a period of 30 days from the date of receipt of the Policy document to review the terms and conditions

of this Policy. If you have any objections to any of the terms and conditions, you have the option of canceling the

Policy stating the reasons for cancellation and you shall be refunded the premium paid by you after adjusting

the amounts spent on any medical check-up, stamp duty charges and proportionate risk premium. You can

cancel your Policy only if you have not made any claims under the Policy. All Your rights under this Policy shall

immediately stand extinguished on the free look cancellation of the Policy. Free look provision is not applicable

and available at the time of renewal of the Policy.

Exclusions:

A. Waiting Period

All Illnesses and treatments shall be covered subject to the waiting periods specified below:

i. 30-day waiting period – Code – Excl03

a) Expenses related to the treatment of any illness within 30 days from the first policy commencement

date shall be excluded except claims arising due to an accident, provided the same are covered.

b) This exclusion shall not, however, apply if the insured person has continuous coverage for more

than twelve months.

c) The within referred waiting period is made applicable to the enhanced sum insured in the event of

granting higher sum insured subsequently.

ii. Specified disease/procedure waiting period – Code – Excl02

a) Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded

until the expiry of 24 months of continuous coverage after the date of inception of the first policy with

us. This exclusion shall not be applicable for claims arising due to an accident or underlying cause

is cancer(s).

b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured

increase.

c) If any of the specified disease/procedure falls under the waiting period specified for pre-existing

diseases, then the longer of the two waiting periods shall apply.

d) The waiting period for listed conditions shall apply even if contracted after the policy or declared and

accepted without a specific exclusion.

e) If the Insured Person is continuously covered without any break as defined under the applicable

norms on portability/migration stipulated by IRDAI, then waiting period for the same would be

reduced to the extent of prior coverage.

f) List of specific diseases/procedures: -

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

10 | P a g e

Organ / Organ System

Illness / diagnoses (irrespective of

treatments medical or surgical)

Surgeries / procedure

(irrespective of any illness /

diagnosis other than cancers)

Ear, Nose & Throat

(ENT)

• Sinusitis

• Rhinitis

• Tonsillitis

• Adenoidectomy

• Mastoidectomy

• Tonsillectomy

• Tympanoplasty

• Surgery for Nasal septum

deviation

• Surgery for Turbinate

hypertrophy

• Nasal concha resection

• Nasal polypectomy

Gynaecological

• Cysts, polyps including breast

lumps

• Polycystic ovarian diseases

• Fibromyoma

• Adenomyosis

• Endometriosis

• Prolapsed Uterus

• Hysterectomy

Orthopaedic

• Non infective arthritis

• Gout and Rheumatism

Osteoporosis

• Ligament, Tendon and Meniscal

tear

• Prolapsed inter vertebral disk

• Joint replacement surgeries

Gastrointestinal

• Cholelithiasis

• Cholecystitis

• Pancreatitis

• Fissure/fistula in anus,

Hemorrhoids, Pilonidal sinus

• Gastro Esophageal Reflux Disorder

(GERD), Ulcer and erosion of

stomach and duodenum

• Cirrhosis (However Alcoholic

cirrhosis is permanently excluded)

• Perineal and Perianal Abscess

• Rectal Prolapse

• Cholecystectomy

• Surgery of hernia

Urogenital

• Calculus diseases of Urogenital

system including Kidney, ureter,

bladder stones

• Benign Hyperplasia of prostate

• Varicocele

• Surgery on prostate

• Surgery for Hydrocele/

Rectocele

Eye

• Cataract

• Retinal detachment

• Nil

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

11 | P a g e

• Glaucoma

Others

• NIL

• Surgery of varicose veins

and varicose ulcers

General

( Applicable to all organ

systems/organs

whether or not

described above)

• Benign tumors of Non-infectious

etiologye.eg. cysts, nodules,

polyps, lump, growth, etc.

• Nil

iii. Pre-Existing Diseases – Code – Excl01

a) Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall

be excluded until the expiry of 36 months of continuous coverage after the date of inception of the

first policy with insurer.

b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured

increase.

c) If the insured person is continuously covered without any break as defined under the

portability/migration norms of the extant IRDAI (Health Insurance) Regulations, then waiting period

for the same would be reduced to the extent of prior coverage.

d) Coverage under the policy after the expiry of 36 months for any pre-existing disease is subject to

the same being declared at the time of application and accepted by insurer.

B. General exclusions

We will not pay for any claim in respect of any Insured Person for, caused by, arising from or attributable

to:

Non-

Medical

Exclusions

1. War or similar situations:

Treatment arising from or consequent upon war or any act of war, invasion,

act of foreign enemy, (whether war be declared or not or caused during

service in the armed forces of any country), civil war, public defence,

rebellion, revolution, insurrection, military or usurped acts, nuclear

weapons/materials, chemical and biological weapons, radiation of any kind.

2. Intentional self-injury or attempted suicide.

3. Breach of law: Code – Excl10

Expenses for treatment directly arising from or consequent upon any Insured

Person committing or attempting to commit a breach of law with criminal

intent.

4. Hazardous or Adventure sports: Code – Excl09

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

12 | P a g e

Expenses related to any treatment necessitated due to participation as a

professional in hazardous or adventure sports, including but not limited to,

para-jumping, rock climbing, mountaineering, rafting, motor racing, horse

racing or scuba diving, hand gliding, sky diving, deep-sea diving.

5. Any Insured Person’s participation or involvement in naval, military or air force

operation.

Medical

Exclusions

6. Treatment for Alcoholism, drug or substance abuse or any addictive condition

and consequences thereof. Code – Excl12

7. Prosthetic and other devices which are self-detachable /removable without

surgery involving anaesthesia.

8. Treatment availed outside India

9. Treatment at a healthcare facility which is NOT a Hospital.

10. Obesity/ Weight Control: Code – Excl06

Expenses related to the surgical treatment of obesity that does not fulfil all

the below conditions:

i. Surgery to be conducted is upon the advice of the Doctor

ii. The surgery/Procedure conducted should be supported by clinical

protocols

iii. The member has to be 18 years of age or older and

iv. Body Mass Index (BMI);

a. greater than or equal to 40 or

b. 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:

i. Obesity-related cardiomyopathy

ii. Coronary heart disease

iii. Severe Sleep Apnoea

iv. Uncontrolled Type2 Diabetes

11.

Expenses related to the treatment for correction of eye sight due to

refractive error less than 7.5 dioptres. Code – Excl15

12. Cosmetic or plastic Surgery: Code – Excl08

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.

13. Circumcisions (unless necessitated by Illness or injury and forming part

of treatment)

14. Change-of-Gender treatments: Code – Excl07

Expenses related to any treatment, including surgical management, to

change characteristics of the body to those of the opposite sex.

15. Any non-allopathic treatment except to the extent of coverage provided

for under 'In-patient Hospitalization treatment' cover..

16. Conditions for which treatment could have been done on an outpatient

basis without any Hospitalisation.

17. Unproven Treatments:

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

13 | P a g e

Expenses related to any unproven treatment, services and supplies for or in

connection with any treatment. Unproven treatments are treatments,

procedures or supplies that lack significant medical documentation to support

their effectiveness. Code – Excl16

18. Investigation & Evaluation: Code – Excl04

a. Expenses related to any admission primarily for diagnostics and

evaluation purposes only are excluded.

b. Any diagnostic expenses which are not related or not incidental to the

current diagnosis and treatment are excluded.

19. Rest Cure, rehabilitation and respite care: Code – Excl05

a. Expenses related to any admission primarily for enforced bed rest and not

for receiving treatment. This also includes:

i.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.

ii.Any services for people who are terminally ill to address physical, social,

emotional and spiritual needs.

20. Preventive care, vaccination including inoculation and immunisations

(except in case of post-bite treatment);

21. Provision or fitting of hearing aids, spectacles or contact lenses

including optometric therapy, any treatment and associated expenses for

alopecia, baldness, wigs, or toupees, medical supplies including elastic

stockings, diabetic test strips, and similar products.

22. Treatments received in heath hydros, nature cure clinics, spas or similar

establishments or private beds registered as a nursing home attached to

such establishments or where admission is arranged wholly or partly for

domestic reasons. Code – Excl13

23. 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. Code – Excl14

24. Sleep-apnoea.

25. Congenital external diseases, defects or anomalies

26. Maternity: Code – Excl18

a. Medical treatment expenses traceable to childbirth (including complicated

deliveries and caesarean sections incurred during hospitalization) except

ectopic pregnancy;

b. Expenses towards miscarriage (unless due to an accident) and lawful

medical termination of pregnancy during the policy period.

27. Sterility and Infertility: Code – Excl17

Expenses related to sterility and infertility. This includes:

a. Any type of contraception, sterilization

b. Assisted Reproduction services including artificial insemination and

advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI

c. Gestational Surrogacy

d. Reversal of sterilization

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

14 | P a g e

28. The expense incurred by the insured on organ donation.

29. Treatment and supplies for analysis and adjustments of spinal

subluxation, diagnosis and treatment by manipulation of the skeletal

structure; muscle stimulation by any means except treatment of fractures

(excluding hairline fractures) and dislocations of the mandible and

extremities.

30. Any non-medical expenses mentioned in Annexure I.

31. Excluded Providers: Code – Excl11

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.

32. Treatment rendered by a Medical Practitioner which is outside his

discipline or the discipline for which he is licensed.

33. Treatments rendered by a Medical Practitioner who is a member of the

Insured Person’s family or stays with him, however proven material costs are

eligible for reimbursement in accordance with the applicable cover.

34. Any treatment or part of a treatment that is not of a reasonable charge

and not Medically Necessary.

35. Drugs or treatments which are not supported by a prescription.

36. Any specific time bound or lifetime exclusion(s) applied by us and

specified in the Schedule and accepted by the insured.

37. Admission for administration of Intra-articular or Intra-lesional

injections, Supplementary medications like Zolendronic acid (Trade name

Zometa, Reclast, etc) or IV immunoglobulin infusion

38. Dental treatment and surgery of any kind, unless requiring

Hospitalisation.

Claim Procedure:

HDFC ERGO General Insurance Company Limited will process all claims under this policy.

Intimation & Assistance - Please contact HDFC ERGO General Insurance Company at least 7 days prior

to an event which might give rise to a claim. For any emergency situations, kindly contact HDFC ERGO

General Insurance Company Limited within 24 hours of the event.

Procedure for Reimbursement of Medical Expenses –

• HDFC ERGO General Insurance Company Limited must be informed no later than 7 days of

completion of such treatment, consultation or procedure using the Claim Intimation Form.

• Please send the duly signed claim form and all the information/documents mentioned therein to

HDFC ERGO General Insurance Company Limited 15 days of the occurrence of the Incident.

The Company may accept claims where documents have been provided after a delayed interval

only in special circumstances and for the reasons beyond the control of the insured.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

15 | P a g e

* Please refer to claim form for complete documentation.

• If there is any deficiency in the documents/information submitted by you, HDFC ERGO General

Insurance Company Limited will send the deficiency letter within 7 days of receipt of the claim

documents.

• On receipt of the complete set of claim documents, HDFC ERGO General Insurance Company

Limited will send admissible amount, along with a settlement statement within 30 days.

• The payment will be made in the name of the Policyholder.

Note: Payment will only be made for items covered under your policy and upto the limits therein.

Procedure to avail Cashless facility -

• For any emergency Hospitalization, HDFC ERGO General Insurance Company Limited must

be informed no later than 24 hours after hospitalization.

• For any planned hospitalization, kindly seek cashless authorization from HDFC ERGO General

Insurance Company Limited at least 48 hours prior to the hospitalization.

• HDFC ERGO General Insurance Company Limited will check your coverage as per the eligibility

and send an authorization letter to the provider. In case there is any deficiency in the documents

sent, the same shall be communicated to the hospital within one hours of receipt of documents.

• Please pay the non-medical and expenses not covered to the hospital prior to the discharge.

• In case the ailment /treatment is not covered under the policy a rejection letter would be sent to

the provider within one hours.

Note:

▪ Insured person is entitled for cashless coverage only in our empanelled hospitals.

▪ Please refer to the list of empanelled hospitals on our website or the list provided along with

Policy kit or call us on our customer care number at 0226234 6234 / 0120 6234 6234.

▪ Rejection of cashless facility in no way indicates rejection of the claim.

Renewal of Policy:

A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure or

misrepresentation by the insured, provided the policy is not withdrawn and also subject to conditions stated

under Moratorium clause

i. Renewal of a health insurance policy shall not be denied on the ground that the insured had made

a claim or claims in the preceding policy years, except for benefit based policies where the policy

terminates following payment of the benefit covered under the policy like critical illness policies.

ii. The company shall condone a delay in renewal up to the grace period from the due date of renewal

without considering such condonation as a break in policy.

iii. No loading shall apply on renewals based on individual claims experience

iv. The Company shall not resort to fresh underwriting unless there is an increase in sum insured. In

case increase in sum insured is requested by the Policyholder, the Insurer may underwrite only to

the extent of increased sum insured.

v. Renewal premium due can be paid prior to the due date as per norms set out by the Company.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

16 | P a g e

▪ Basic Sum Insured Enhancement – Basic sum insured can be enhanced only at the time of renewal

subject to the underwriting norms and acceptability criteria of the policy. If the insured enhances the

basic sum insured one grid up, no fresh medicals shall be required. In cases where the basic sum

insured enhanced is more than one grid up, the case may be subject to medicals. In case of

enhancement in the basic sum insured waiting period will apply afresh in relation to the amount by

which the basic sum insured has been enhanced. However the quantum of increase shall be at the

discretion of the company.

Tax Benefit:

The premium amount paid under this policy qualifies for deduction under Section 80D of the Income Tax Act.

Requirement:

Completed proposal form

Pre- Policy Check-up:

Pre-Policy Check-up at our network may be required based upon the age and basic sum insured.

▪ We will reimburse 100% of the expenses incurred per Insured Person on the acceptance of the proposal.

▪ If Proposal is declined post PPC, 100% of Medical test charges will be borne by the customer for Rs.

3,00,000 & 500,000 sum insured, 50% for Rs. 10,00,000 Sum Insured and NIL for other Sum Insureds.

▪ In case of any adverse medical declaration on the proposal form, we may request for additional medical

tests

Discounts:

▪ Online Discount: The Insured Person is eligible for 5% discount on premium in case he / she purchase the

Policy online from the Company’s website or the Company’s mobile app. The subsequent Renewal of the

same Policy will continue to enjoy the 5% discount, provided the Policy remains without the involvement of

any other insurance agent or insurance intermediary.

▪ Employee Discount: A discount of 5 % on the Premium is applicable if any Insured Person is a HDFC Group

employee (full time employee) / Munich Re Group employee (full time employee) at the time of enrolment,

or subsequent renewal; provided that such Policy is purchased through the Company’s website or the

Company’s mobile app and without the involvement of any insurance agent or insurance intermediary.

▪ Loyalty Discount: If any Insured Person has an active retail insurance Policy with premium above Rs. 2,000

with the Company, a discount of 2.5% on the Policy premium will be applicable at the time of enrolment as

well as subsequent renewals.

▪ Family Discount: The Insured Person will be entitled to receive 10% discount on the premium if two or more

family members are covered under the same Policy under the individual Policy option.

The above mentioned discounts are cumulative in nature and the total discount offered under Employee

discount, Online discount, Loyalty discount and Family discount shall not exceed 20%.

▪ Long Term Policy Discount: If the Policy Period is more than one year, the Insured Person will be entitled to

receive a discount of 7.5% and 10% will be offered in case a Policy is purchased for 2-year and 3-year tenure

respectively, provided he has paid the premium in advance as a single premium.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

17 | P a g e

▪ Aggregate Deductible Discount: If Aggregate Deductible is opted for all Insured Person, following discount

will be applicable on the Policy premium

Deductible (INR)

Discount % by Aggregate Deductible for All Ages

For Base Sum Insured < =

20,00,000

For Base Sum Insured >

20,00,000

25,000

25%

15%

50,000

40%

30%

1,00,000

50%

40%

▪ Co-payment Discount: A premium discount of 10% or 20% shall apply, if you choose to opt for a co-payment

of 10% or 20% respectively.

▪ Stay Active

We will offer a discount at each renewal if the insured member achieves the average step count target

on the mobile application provided by Us in the specified time interval ( calculated from the policy risk

start date) as per the grid below. In an individual policy, the average step count would be calculated per

adult member and in a floater policy it would be an average of all adult members covered. Dependent

children covered either in individual or floater plan will not be considered for calculation of average steps.

This discount will be accrued at defined time intervals as given in table below. The discount will be

cumulated and offered as discount on the renewal premium.

In individual policies the discount percentage (%) would be applied on premium applicable per insured

member (Dependent Children are not eligible for this stay active discount in an individual policy) and in

a floater policy it would be applied on premium applicable on policy.

The discount grid would be as per the table below:

1 Year Policy

Time Interval (calculated from policy risk start date)

Average Step

Target

Risk start date or

date of download of

mobile application -

90 days

91-180

days

181-270

days

271-300

days

Maximum

Discount at

the end of

the year

5000 or below

0%

5001 to 8000

0.5%

2%

8001 to 10000

1.25%

5%

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

18 | P a g e

Above 10000

2%

8%

2 Year Policy

Time Interval (calculated from policy risk start date)

Averag

e Step

target

Risk start

date or

date of

download

of mobile

applicatio

n -90

days

91-180

days

181-

270

days

271-

360

days

361-

450

days

451-

540

days

541-

630

days

631-

660

days

Maximu

m

Discount

at the

end of 2

years

5000 or

below

0%

5001 to

8000

0.25%

0.25

%

0.25%

2%

8001 to

10000

.625%

.625

%

.625%

5%

Above

10000

1%

8%

3 Year policy

Time Interval (calculated from policy risk start date)

Average

Step

target

Risk start

date or

date of

download

of mobile

application

-90 days

91-180

days

181-270

days

271-360

days

361-450

days

451-540

days

5000 or

below

0%

5001 to

8000

0.1667%

8001 to

10000

0.41667%

Above

10000

0.6667%

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

19 | P a g e

Time Interval (calculated from policy risk start date)

541-630

days

631-720

days

721-810

days

811-900

days

901-990

days

991-1020

days

Maximum

Discount

at the

end of 3

years

0%

0.1667%

2%

0.41667%

5%

0.6667%

8%

The mobile app must be downloaded within 30 days of the policy risk start date to avail this benefit. The

average step count completed by an Insured member would be tracked on this mobile application.

We reserve the right to remove or reduce any count of steps if found to be achieved in unfair manner by

manipulation.

Illustration

Policy start date

1st Jan 2016

Policy Tenure

1 year

Time Interval

Risk start date or date

of download of mobile

application -90 days

91 days-180

days

181 days-270

days

271- 300 days

average steps taken in

the defined time period

8500

10000

5001

7500

Discount %applicable

1.25%

0.5%

Total discount applicable on renewal premium = 3.5%

Loadings

▪ We may apply a risk loading on the premium payable (based upon the declarations made in the proposal

form and the health status of the persons proposed for insurance). The maximum risk loading applicable

for an individual shall not exceed above 100% per diagnosis / medical condition and an overall risk

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

20 | P a g e

loading of over 150% per person. These loadings are applied from Commencement Date of the policy

including subsequent renewal(s) with us or on the receipt of the request of enhancement in sum insured

(for the enhanced Sum Insured).

For Example: Consider a male aged 35 who is undergoing treatment for hypertension.

Age

Hypertension

Treatment

Systolic

Diastolic

loading

35

Yes

110-145

70-95

10%

35

Yes

146-160

70-95

20%

35

Yes

110-140

96-105

20%

35

Yes

>160

Any

Reject

35

Yes

Any

>105

Reject

Please note that this example is for enumerative purposes only, the decisions may vary based on age,

co morbidities etc.

▪ We will inform you about the applicable risk loading or exclusion or both as the case may be through a

counter offer letter. You need to revert to us with consent and additional premium (if any), within 7 days

of the receipt of such counter offer letter. In case, you neither accept the counter offer nor revert to us

within 7 days, we shall cancel your application and refund the premium paid within next 7 days.

▪ The application of loading does not mean that the illness/ condition, for which loading has been applied,

would be covered from inception. Any waiting period as mentioned in Section 5 A i), ii) & iii) of the policy

wordings or specifically mentioned on the Policy Schedule shall be applied on illness/condition, as

applicable.

▪ Please note that we will issue Policy only after getting your consent and additional premium, if any.

▪ We will not apply any additional loading on your policy premium at renewal based on claim experience.

▪ Please visit our nearest branch to refer our underwriting guidelines, if required.

Cancellation

i.

The Policyholder may cancel this policy by giving 7 days’ written notice and in such an event, the

Company shall refund to the Insured a pro-rata premium for the unexpired Policy Period.

ii.

Note : For Policies where premium is paid by instalment : In case of admissible claim under the Policy,

future instalment for the current Policy Year will be adjusted in the claim amount and no refund of any

premium will be applicable during the Policy Year.

iii.

The Company may cancel the policy at any time on grounds of misrepresentation non-disclosure of

material facts, fraud by the insured person by giving 15 days’ written notice. There would be no refund

of premium on cancellation on grounds of misrepresentation, non-disclosure of material facts or

fraud.

iv.

Refund of Policy premium in case of death of Insured Person/s: Policy premium shall be refunded

proportionately for the deceased Insured Person, for the unexpired Policy Period in case of death of

any Insured Person/s

v.

Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in

respect of Cancellation where any claim has been admitted or any benefit has been availed by the

Insured Person under the Policy.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

21 | P a g e

Renewability

▪ There shall be no cover ceasing age on renewal.

Free Look Period

The Free Look Period shall be applicable on new individual health insurance policies and not on

renewals or at the time of porting/migrating the Policy.

The Insured Person shall be allowed free look period of 30 days from date of receipt of the policy

document to review the terms and conditions of the policy, and to return the same if not acceptable.

If the Insured has not made any claim during the Free Look Period, the insured shall be entitled to

i. a refund of the premium paid less any expenses incurred by the Company on medical examination

of the Insured Person and the stamp duty charges or

ii. where the risk has already commenced and the option of return of the Policy is exercised by the

Insured Person, a deduction towards the proportionate risk premium for period of cover or

iii. Where only a part of the insurance coverage has commenced, such proportionate premium

commensurate with the insurance coverage during such period.

Disclosure of Information

The policy shall be void and all premium paid thereon shall be forfeited to the Company in the event of

misrepresentation, mis description or non-disclosure of any material fact by the policyholder.

Utilization of Sum Insured

The sequence of utilization of the Sum Insured in this Policy, subject to the optional covers in force under

the Policy, will be as follows;

i. Aggregate deductible (if applicable)

ii. Co-payment (if applicable)

iii. Basic Sum Insured / Benefit sub-limit

iv. Multiplier Benefit (if applicable and available)

v. Restore Benefit

vi. Unlimited Restore (if applicable)

Complete Discharge

Any payment to the Policyholder, Insured Person or his/ her nominees or his/ her legal representative

or assignee or to the Hospital, as the case may be, for any benefit under the Policy shall be a valid

discharge towards payment of claim by the Company to the extent of that amount for the particular

claim.

Moratorium Period

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

22 | P a g e

After completion of sixty continuous months of coverage (including portability and

migration) in health insurance policy, no policy and claim shall be contestable by the

insurer on grounds of non-disclosure, misrepresentation, except on grounds of

established fraud. This period of sixty continuous months is called as moratorium

period. The moratorium would be applicable for the sums insured of the first policy.

Wherever, the sum insured is enhanced, completion of sixty continuous months would

be applicable from the date of enhancement of sums insured only on the enhanced

limits

Portability

The Insured Person will have the option to port the Policy to other insurers by applying to such Insurer

to port the entire policy along with all the members of the family, if any, at least 45 days before, but not

earlier than 60 days from the policy renewal date as per IRDAI guidelines related to Portability. If such

person is presently covered and has been continuously covered without any lapses under any health

insurance policy with an Indian General/Health insurer, the proposed Insured Person will get the

accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.

For Detailed Guidelines on Portability, kindly refer the link

https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page=PageNo3987

Migration

The Insured Person will have the option to migrate the Policy to other health insurance products/plans

offered by the Company by applying for Migration of the policyatleast30 days before the policy renewal

date as per IRDAI guidelines on Migration. If such person is presently covered and has been

continuously covered without any lapses under any health insurance product/plan offered by the

Company, the Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI

guidelines on Migration.

For Detailed Guidelines on Migration, kindly refer the link

https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.aspx?page=PageNo3987

Possibility of Revision of terms of the Policy including the Premium Rates

The Company, with prior approval of IRDAI, may revise or modify the terms of the Policy including the

premium rates. The Insured Person shall be notified three months before the changes are effected.

Withdrawal of Policy

i. In the likelihood of this product being withdrawn in future, the Company will intimate the Insured

Person about the same 90 days prior to expiry of the policy.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

23 | P a g e

ii. Insured Person will have the option to migrate to similar health insurance product available with the

Company at the time of renewal with all the accrued continuity benefits such as Cumulative Bonus,

waiver of waiting period as per IRDAI guidelines, provided the policy has been maintained without a

break.

Nomination:

The Policyholder is required at the inception of the Policy to make a nomination for the purpose of

payment of claims under the Policy in the event of death of the Policyholder. Any change of nomination

shall be communicated to the Company in writing and such change shall be effective only when an

endorsement on the Policy is made. In the event of death of the Policyholder, the Company will pay the

nominee {as named in the Policy Schedule/Policy Certificate/Endorsement (if any)} and in case

Condition Precedent to admission of Liability

The terms and conditions of the Policy must be fulfilled by the Insured Person for the Company to make

any payment for claim(s) arising under the Policy.

Fraud

If any claim made by the Insured Person, is in any respect fraudulent, or if any false statement, or

declaration is made or used in support thereof, or if any fraudulent means or devices are used by the

Insured Person or anyone acting on his/her behalf to obtain any benefit under this Policy, all benefits

under this policy and the premium paid shall be forfeited.

Any amount already paid against claims made under this Policy but which are found fraudulent later

shall be repaid by all recipient(s)/policyholder(s), who have made that particular claim, who shall be

jointly and severally liable for such repayment to the Insurer.

For the purpose of this clause, the expression "fraud" means any of the following acts committed by the

Insured Person or by his agent or the hospital/doctor/any other party acting on behalf of the Insured

Person, with intent to deceive the insurer or to induce the insurer to issue an insurance policy:

a) the suggestion, as a fact of that which is not true and which the Insured Person does not

believe to be true;

b) the active concealment of a fact by the Insured Person having knowledge or belief of the fact;

c) any other act fitted to deceive; and

d) any such act or omission as the law specially declares to be fraudulent

The Company shall not repudiate the claim and / or forfeit the Policy benefits on the ground of Fraud, if

the Insured Person / beneficiary can prove that the misstatement was true to the best of his knowledge

and there was no deliberate intention to suppress the fact or that such misstatement of or suppression

of material fact are within the knowledge of the Insurer.

Premium Payment in Instalments

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

24 | P a g e

If the Insured Person has opted for payment of Premium on an installment basis i.e. Half Yearly, Quarterly or

Monthly, as mentioned in the Policy Schedule, the following Conditions shall apply (notwithstanding any terms

contrary elsewhere in the Policy):

a. Grace Period as mentioned in the table below would be given to pay the installment premium due for the

Policy

Options

Instalment Premium Option

Grace Period applicable

Option 1

Multi-Year / Yearly

30 days

Option 2

Half Yearly

30 days

Option 3

Quarterly

30 days

Option 4

Monthly

15 Days

b. If premium is paid in instalments then coverage will be available during the grace period

also. (Note: In case of non-instalment premium payment, coverage shall not be available for the period for

which no premium is received).

c. The Insured Person will get the accrued continuity benefit in respect of the “Waiting Periods”, “Specific

Waiting Periods” in the event of payment of premium within the stipulated Grace Period

d. No interest will be charged If the installment premium is not paid on due date

e. In case of installment premium due not received within the Grace Period, the Policy will get cancelled

f. In the event of a claim, all subsequent premium installments shall immediately become due and payable

g. The Company has the right to recover and deduct all the pending installments from the claim amount due

under the Policy.

Instalment premium payment through Auto Debit/ECS Facility

a. If Option of Premium payment by instalment is opted through auto Debit/ECS facility, Electronic Clearing

Service (ECS) Mandate form needs to be completely filled & signed by the Insured Person.

b. The Premium amount which would be auto debited & frequency of instalment should be duly filled in the

ECS Mandate form.

c. New ECS Mandate Form is required to be filled in case of any change in the Premium due to change of

Sum Insured / age / plan /coverages/revision in premium.

d. The Company should be informed at least 15 days prior to the due date of instalment premium if the

Insured Person wishes to discontinue the ECS facility.

Non-payment of premium on due date as opted by the Insured Person in the mandate form subject to an

additional 15 days of relaxation period will lead to termination of the Policy.

Multiple Policies

i. In case of multiple policies taken by an Insured Person during a period from one or more insurers

to indemnify treatment costs, the Insured Person shall have the right to require a settlement of

his/her claim in terms of any of his/her policies. In all such cases the Insurer chosen by the Insured

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

25 | P a g e

Person shall be obliged to settle the claim as long as the claim is within the limits of and according

to the terms of the chosen Policy.

ii. Insured Person having multiple policies shall also have the right to prefer claims under this Policy

for the amounts disallowed under any other policy / policies even if the Sum Insured is not exhausted.

Then the insurer shall independently settle the claim subject to the terms and conditions of this

Policy.

iii. If the amount to be claimed exceeds the Sum Insured under a single Policy, the Insured Person

shall have the right to choose Insurer from whom he/she wants to claim the balance amount.

iv. Where an Insured Person has policies from more than one Insurer to cover the same risk on

indemnity basis, the Insured Person shall only be indemnified the treatment costs in accordance

with the terms and conditions of the chosen Policy.

Redressal of Grievance

In case of any grievance the insured person may contact the Company through:

• Website: www.hdfcergo.com

• Toll free: 022 6234 6234 / 0120 6234 6234

• E-mail: grievance@hdfcergo.com

• Contact Details for Senior Citizen: 022 – 6242 – 6226

• E-mail specific for Senior citizens : seniorcitizen@hdfcergo.com

Insured Person may also approach the grievance cell at any of the Company’s branches with the

details of grievance.

If Insured Person is not satisfied with the redressal of grievance through one of the above methods,

Insured Person may contact the grievance officer at cgo@hdfcergo.com

For updated details of grievance officer, kindly refer the link: https://www.hdfcergo.com/customer-

voice/grievances

Schedule of Benefits

Optima Restore Individual

Basic Sum

Insured per

Insured Person

per Policy Year

(Rs. in Lakh)

3.00

5.00

10.00

15.00

20.00,

25.00,

50.00,

100.00

1a) In-patient

Treatment

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

1b) Pre-

Hospitalization

Covered, upto

60 Days

Covered, upto

60 Days

Covered, upto

60 Days

Covered, upto

60 Days

Covered, upto

60 Days

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

26 | P a g e

1c) Post-

Hospitalization

Covered, upto

180 Days

Covered, upto

180 Days

Covered, upto

180 Days

Covered, upto

180 Days

Covered, upto

180 Days

1d) Day Care

Procedures

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

1e) Domiciliary

Treatment

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

1f) Organ

Donor

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

1g) Emergency

Ambulance

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000

per

Hospitalization

1h) Daily Cash

for choosing

Shared

Accommodation

Rs.800 per

day,

Maximum

Rs.4,800

Rs.800 per

day,

Maximum

Rs.4,800

Rs.800 per

day,

Maximum

Rs.4,800

Rs.800 per

day,

Maximum

Rs.4,800

Rs.1000 per

day,

Maximum

Rs.6,000

1i) E-Opinion in

respect of a

Critical Illness

Covered

1j) Emergency

Air Ambulance

Cover

Not Covered

Covered upto

rs. 2.5 Lacs per

hospitalization

and maximum

upto sum

insured in an

year

Covered upto

rs. 2.5 Lacs per

hospitalization

and maximum

upto sum

insured in an

year

Covered upto

rs. 2.5 Lacs per

hospitalization

and maximum

upto sum

insured in an

year

2) Restore

Benefit

Equal to 100%

of Basic Sum

Insured

Equal to 100%

of Basic Sum

Insured

Equal to 100%

of Basic Sum

Insured

Equal to 100%

of Basic Sum

Insured

Equal to 100%

of Basic Sum

Insured

2b. Unlimited

Restore Benefit

(Optional

Benefit)

Applicable if

opted

Applicable if

opted

Applicable if

opted

Applicable if

opted

Applicable if

opted

2c) Aggregate

Deductible

(Optional

Benefit)

25K/50K/1L

2d) Co-

Payment

(Optional

Benefit)

10% / 20%

3)Preventive

Health Checkup

(per person)

Not Applicable

Upto Rs. 1500

Upto Rs. 2000

Upto Rs. 4000

Upto Rs. 5000

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

27 | P a g e

4) Multiplier

Benefit

50% of the

Basic Sum

Insured

maximum upto

100% post

completion of

each policy

year

irrespective of

claims

50% of the

Basic Sum

Insured

maximum upto

100% post

completion of

each policy

year

irrespective of

claims

50% of the

Basic Sum

Insured

maximum upto

100% post

completion of

each policy

year

irrespective of

claims

50% of the

Basic Sum

Insured

maximum upto

100% post

completion of

each policy

year

irrespective of

claims

50% of the

Basic Sum

Insured

maximum upto

100% post

completion of

each policy

year

irrespective of

claims

Optima Restore Family

Basic Sum Insured

per Insured Person

per Policy Year

(Rs. in Lakh)

3.00

5.00

10.00

15.00

20.00,

25.00,

50.00,

100.00

1a) In-patient

Treatment

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto sum

insured

1b) Pre-

Hospitalization

Covered, upto

60 Days

Covered, upto

60 Days

Covered, upto

60 Days

Covered, upto

60 Days

Covered, upto 60

Days

1c) Post-

Hospitalization

Covered, upto

180 Days

Covered, upto

180 Days

Covered, upto

180 Days

Covered, upto

180 Days

Covered, upto 180

Days

1d) Day Care

Procedures

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Coveredupto

sum insured

Covered upto sum

insured

1e) Domiciliary

Treatment

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto sum

insured

1f) Organ Donor

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto

sum insured

Covered upto sum

insured

1g) Emergency

Ambulance

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000

per

Hospitalization

Upto Rs.2,000 per

Hospitalization

1h) Daily Cash for

choosing Shared

Accommodation

Rs.800 per

day,

Maximum

Rs.4,800

Rs.800 per

day,

Maximum

Rs.4,800

Rs.800 per

day,

Maximum

Rs.4,800

Rs.800 per

day,

Maximum

Rs.4,800

Rs.1000 per day,

Maximum

Rs.6,000

1i) E-Opinion in

respect of a Critical

Illness

Covered

1j) Emergency Air

Ambulance Cover

Not Covered

Covered upto

rs. 2.5 Lacs

per

hospitalization

and maximum

Covered upto

rs. 2.5 Lacs

per

hospitalization

and maximum

Covered upto rs.

2.5 Lacs per

hospitalization and

maximum upto

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

28 | P a g e

upto sum

insured in an

year

upto sum

insured in an

year

sum insured in an

year

2a) Restore Benefit

Equal to 100%

of Basic Sum

Insured

Equal to 100%

of Basic Sum

Insured

Equal to 100%

of Basic Sum

Insured

Equal to 100%

of Basic Sum

Insured

Equal to 100% of

Basic Sum

Insured

2b) Unlimited

Restore Benefit

(Optional Benefit)

Applicable if

opted

Applicable if

opted

Applicable if

opted

Applicable if

opted

Applicable if opted

2c) Aggregate

Deductible

(Optional Benefit)

25K/50K/1L

2d) Co-Payment

(Optional Benefit)

10% / 20%

3) Preventive

Health Checkup

(per policy)

Not Applicable

Upto Rs 2500

Upto Rs.5000

Upto Rs. 8000

Upto Rs. 10,000

4) Multiplier Benefit

50% of the

Basic Sum

Insured

maximum

upto 100%

post

completion of

each policy

year

irrespective of

claims

50% of the

Basic Sum

Insured

maximum

upto 100%

post

completion of

each policy

year

irrespective of

claims

50% of the

Basic Sum

Insured

maximum upto

100% post

completion of

each policy

year

irrespective of

claims

50% of the

Basic Sum

Insured

maximum

upto 100%

post

completion of

each policy

year

irrespective of

claims

50% of the Basic

Sum Insured

maximum upto

100% post

completion of

each policy year

irrespective of

claims

Premium rates:

▪ The premium under individual coverage will be charged on the completed age of the individual insured

member.

▪ In case of Family Floater policies Floater discount of 55% will be applied on all the members except

the oldest member.

▪ The premium for the policy will remain the same for the Policy Period mentioned in the policy schedule.

▪ Please note that your premium at renewal may change due to a change in your age or changes in the

applicable tax rate.

▪ Premium rates are subject to change with prior approval from IRDA.

▪ The Sum Insured of the dependent insured members should be equal to or less than the Sum Insured

of the Primary Insured member. In case where two or more children are covered, the Sum Insured for

all the children must be same. Sum insured of all Dependent Parents and Dependent Parent in law must

be same.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

29 | P a g e

▪ The premium will be computed basis the city of residence provided by the insured person in the

application form. The premium that would be applicable zone wise and the cities defined in each zone

are as under:

o Tier 1 : Delhi, NCR, Mumbai, Thane, Mumbai Suburban and Navi Mumbai, Surat, Ahmedabad

& Vadodara

o Tier 2 : Rest of India- All other cities

Pl Note. Premium rates and policy terms and conditions are for standard healthy individuals. These may

change post underwriting of proposal based on medical tests (where applicable) and information provided

on the proposal form.

Add – On Covers:

‘Optima Restore’ offers following Add on Covers:

• Optima Wellbeing (Add on) : Covers expenses for various outpatient benefits

• lndividual Personal Accident Rider: Provides Lumpsum pay out in case of Accidental Death,

Permanent Total Disablement and Permanent Partial Disablement. Sum Insured shall be 5 (five) times

the Sum Insured of Base Plan up to a maximum of Rs. 1 Crore

• Protector Rider: Covers expenses which are not payable under the Base Plan as per the List of

Excluded items released by IRDA along with benefits such as Sum Insured protector

• Hospital daily cash rider: Daily cash benefit upto 1K/2K/3K

• Critical Advantage rider: covers planned treatment abroad for listed 8 major illness

• my:health Critical Illness: Comprehensive policy with coverage for 50 Critical Illnesses

(For in depth details on terms and conditions applicable to add-ons, Kindly refer to the Prospectus & Policy

wording documents of the respective add-on available under downloads section on our website).

Gross Premium Tables (Exclusive of Taxes)

Optima Restore - Risk Premium (Excl. GST) - Tier 1 (Delhi, NCR, Mumbai, Thane, Mumbai Suburban and

Navi Mumbai, Surat, Ahmedabad & Vadodara)

Age/

Sum

Insured

3,00,000

5,00,000

10,00,000

15,00,000

20,00,000

25,00,000

50,00,000

1,00,00,000

0

6,300

7,350

7,950

8,900

9,700

10,350

12,550

15,550

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

30 | P a g e

1

6,400

7,450

8,050

9,000

9,800

10,500

12,700

15,800

2

6,500

7,550

8,150

9,100

9,900

10,650

12,850

16,050

3

6,600

7,650

8,250

9,200

10,000

10,800

13,000

16,300

4

6,700

7,750

8,350

9,300

10,100

10,950

13,150

16,550

5

6,800

7,850

8,450

9,400

10,200

11,100

13,300

16,800

6

6,900

7,950

8,550

9,500

10,300

11,250

13,450

17,050

7

7,000

8,050

8,650

9,600

10,400

11,400

13,600

17,300

8

7,100

8,150

8,750

9,700

10,500

11,550

13,750

17,550

9

7,200

8,250

8,850

9,800

10,600

11,700

13,900

17,800

10

7,300

8,350

8,950

9,900

10,700

11,850

14,050

18,050

11

7,400

8,450

9,050

10,000

10,800

12,000

14,200

18,300

12

7,500

8,550

9,150

10,100

10,900

12,150

14,350

18,550

13

7,600

8,650

9,250

10,200

11,000

12,300

14,500

18,800

14

7,700

8,750

9,350

10,300

11,100

12,450

14,650

19,050

15

7,800

8,850

9,450

10,400

11,200

12,600

14,800

19,300

16

7,900

8,950

9,550

10,500

11,300

12,750

14,950

19,550

17

8,000

9,050

9,650

10,600

11,400

12,900

15,100

19,800

18

9,550

10,850

11,900

12,300

13,100

14,050

16,250

20,900

19

9,650

10,950

12,050

12,500

13,300

14,250

16,500

21,200

20

9,750

11,050

12,200

12,700

13,500

14,450

16,750

21,500

21

9,850

11,150

12,350

12,900

13,700

14,650

17,000

21,800

22

9,950

11,250

12,500

13,100

13,900

14,850

17,250

22,100

23

10,050

11,350

12,650

13,300

14,100

15,050

17,500

22,400

24

10,150

11,450

12,800

13,500

14,300

15,250

17,750

22,700

25

10,250

11,550

12,950

13,700

14,500

15,450

18,000

23,000

26

10,350

11,650

13,100

13,900

14,700

15,650

18,250

23,300

27

10,450

11,750

13,250

14,100

14,900

15,850

18,500

23,600

28

10,550

11,850

13,400

14,300

15,100

16,050

18,750

23,900

29

10,650

11,950

13,550

14,500

15,300

16,250

19,000

24,200

30

10,750

12,050

13,700

14,700

15,500

16,450

19,250

24,500

31

10,850

12,150

13,850

14,900

15,700

16,650

19,500

24,800

32

10,950

12,250

14,000

15,100

15,900

16,850

19,750

25,100

33

11,050

12,350

14,150

15,300

16,100

17,050

20,000

25,400

34

11,150

12,450

14,300

15,500

16,300

17,250

20,250

25,700

35

11,250

12,550

14,450

15,700

16,500

17,450

20,500

26,000

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

31 | P a g e

36

11,450

13,150

14,850

16,000

16,800

17,950

20,900

26,450

37

11,650

13,350

15,100

16,250

17,100

18,250

21,250

26,850

38

11,850

13,550

15,350

16,500

17,400

18,550

21,600

27,250

39

12,050

13,750

15,600

16,750

17,700

18,850

21,950

27,650

40

12,250

13,950

15,850

17,000

18,000

19,150

22,300

28,050

41

12,450

14,150

16,100

17,250

18,300

19,450

22,650

28,450

42

12,650

14,350

16,350

17,500

18,600

19,750

23,000

28,850

43

12,850

14,550

16,600

17,750

18,900

20,050

23,350

29,250

44

13,050

14,750

16,850

18,000

19,200

20,350

23,700

29,650

45

13,250

14,950

17,100

18,250

19,500

20,650

24,050

30,050

46

16,250

17,400

20,700

22,350

23,500

24,900

29,400

36,050

47

17,100

18,300

21,800

23,550

24,950

26,250

31,200

38,450

48

17,950

19,200

22,900

24,750

26,400

27,600

33,000

40,850

49

18,800

20,100

24,000

25,950

27,850

28,950

34,800

43,250

50

19,650

21,000

25,100

27,150

29,300

30,300

36,600

45,650

51

20,600

22,250

26,300

29,950

30,950

31,950

38,500

48,300

52

21,250

23,300

27,500

31,400

32,400

33,500

40,400

50,350

53

21,900

24,350

28,700

32,850

33,850

35,050

42,300

52,400

54

22,550

25,400

29,900

34,300

35,300

36,600

44,200

54,450

55

23,200

26,450

31,100

35,750

36,750

38,150

46,100

56,500

56

26,300

28,850

34,850

38,300

39,350

40,950

49,400

61,250

57

27,250

30,100

36,250

40,500

41,900

43,450

52,400

65,000

58

28,200

31,350

37,650

42,700

44,450

45,950

55,400

68,750

59

29,150

32,600

39,050

44,900

47,000

48,450

58,400

72,500

60

30,100

33,850

40,450

47,100

49,550

50,950

61,400

76,250

61

31,100

35,200

46,400

49,600

53,600

56,050

67,300

83,450

62

31,950

36,550

47,850

52,100

57,400

60,750

72,750

90,200

63

32,800

37,900

49,300

54,600

61,200

65,450

78,200

96,950

64

33,650

39,250

50,750

57,100

65,000

70,150

83,650

1,03,700

65

34,500

40,600

52,200

59,600

68,800

74,850

89,100

1,10,450

66

41,950

47,700

64,500

69,900

78,300

81,650

1,01,150

1,22,750

67

43,150

49,450

66,500

72,900

81,650

85,650

1,04,950

1,28,800

68

44,350

51,200

68,500

75,900

85,000

89,650

1,08,750

1,34,850

69

45,550

52,950

70,500

78,900

88,350

93,650

1,12,550

1,40,900

70

46,750

54,700

72,500

81,900

91,700

97,650

1,16,350

1,46,950

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

32 | P a g e

71

49,150

56,500

74,950

85,200

95,650

1,01,900

1,22,100

1,53,050

72

50,150

57,800

77,350

88,450

98,700

1,05,100

1,27,350

1,58,750

73

51,150

59,100

79,750

91,700

1,01,750

1,08,300

1,32,600

1,64,450

74

52,150

60,400

82,150

94,950

1,04,800

1,11,500

1,37,850

1,70,150

75

53,150

61,700

84,550

98,200

1,07,850

1,14,700

1,43,100

1,75,850

76

56,300

64,750

88,450

1,03,350

1,13,600

1,20,300

1,49,750

1,84,700

77

58,250

67,250

92,350

1,07,300

1,18,500

1,25,850

1,55,350

1,92,150

78

60,200

69,750

96,250

1,11,250

1,23,400

1,31,400

1,60,950

1,99,600

79

62,150

72,250

1,00,150

1,15,200

1,28,300

1,36,950

1,66,550

2,07,050

80

64,100

74,750

1,04,050

1,19,150

1,33,200

1,42,500

1,72,150

2,14,500

81

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

82

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

83

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

84

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

85

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

86

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

87

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

88

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

89

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

90

68,574

79,256

1,10,832

1,29,379

1,44,879

1,54,292

1,88,931

2,34,274

*Only for Renewal Purposes

Optima Restore Risk Premium (Excl. GST) - Tier 2 (Rest of India)

Age/

Sum

Insured

3,00,000

5,00,000

10,00,000

15,00,000

20,00,000

25,00,000

50,00,000

1,00,00,000

0

5,300

6,400

7,100

8,450

9,500

10,100

12,300

15,150

1

5,400

6,500

7,200

8,550

9,600

10,250

12,450

15,350

2

5,500

6,600

7,300

8,650

9,700

10,400

12,600

15,550

3

5,600

6,700

7,400

8,750

9,800

10,550

12,750

15,750

4

5,700

6,800

7,500

8,850

9,900

10,700

12,900

15,950

5

5,800

6,900

7,600

8,950

10,000

10,850

13,050

16,150

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

33 | P a g e

6

5,900

7,000

7,700

9,050

10,100

11,000

13,200

16,350

7

6,000

7,100

7,800

9,150

10,200

11,150

13,350

16,550

8

6,100

7,200

7,900

9,250

10,300

11,300

13,500

16,750

9

6,200

7,300

8,000

9,350

10,400

11,450

13,650

16,950

10

6,300

7,400

8,100

9,450

10,500

11,600

13,800

17,150

11

6,400

7,500

8,200

9,550

10,600

11,750

13,950

17,350

12

6,500

7,600

8,300

9,650

10,700

11,900

14,100

17,550

13

6,600

7,700

8,400

9,750

10,800

12,050

14,250

17,750

14

6,700

7,800

8,500

9,850

10,900

12,200

14,400

17,950

15

6,800

7,900

8,600

9,950

11,000

12,350

14,550

18,150

16

6,900

8,000

8,700

10,050

11,100

12,500

14,700

18,350

17

7,000

8,100

8,800

10,150

11,200

12,650

14,850

18,550

18

7,150

8,250

9,500

10,800

11,800

13,100

15,900

20,400

19

7,250

8,350

9,650

11,000

12,000

13,300

16,100

20,600

20

7,350

8,450

9,800

11,200

12,200

13,500

16,300

20,800

21

7,450

8,550

9,950

11,400

12,400

13,700

16,500

21,000

22

7,550

8,650

10,100

11,600

12,600

13,900

16,700

21,200

23

7,650

8,750

10,250

11,800

12,800

14,100

16,900

21,400

24

7,750

8,850

10,400

12,000

13,000

14,300

17,100

21,600

25

7,850

8,950

10,550

12,200

13,200

14,500

17,300

21,800

26

7,950

9,050

10,700

12,400

13,400

14,700

17,500

22,000

27

8,050

9,150

10,850

12,600

13,600

14,900

17,700

22,200

28

8,150

9,250

11,000

12,800

13,800

15,100

17,900

22,400

29

8,250

9,350

11,150

13,000

14,000

15,300

18,100

22,600

30

8,350

9,450

11,300

13,200

14,200

15,500

18,300

22,800

31

8,450

9,550

11,450

13,400

14,400

15,700

18,500

23,000

32

8,550

9,650

11,600

13,600

14,600

15,900

18,700

23,200

33

8,650

9,750

11,750

13,800

14,800

16,100

18,900

23,400

34

8,750

9,850

11,900

14,000

15,000

16,300

19,100

23,600

35

8,850

9,950

12,050

14,200

15,200

16,500

19,300

23,800

36

9,000

10,100

12,450

14,500

15,500

16,950

19,850

24,750

37

9,150

10,250

12,650

14,700

15,800

17,250

20,150

25,050

38

9,300

10,400

12,850

14,900

16,100

17,550

20,450

25,350

39

9,450

10,550

13,050

15,100

16,400

17,850

20,750

25,650

40

9,600

10,700

13,250

15,300

16,700

18,150

21,050

25,950

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

34 | P a g e

41

9,750

10,850

13,450

15,500

17,000

18,450

21,350

26,250

42

9,900

11,000

13,650

15,700

17,300

18,750

21,650

26,550

43

10,050

11,150

13,850

15,900

17,600

19,050

21,950

26,850

44

10,200

11,300

14,050

16,100

17,900

19,350

22,250

27,150

45

10,350

11,450

14,250

16,300

18,200

19,650

22,550

27,450

46

13,500

13,900

18,000

20,250

22,650

23,900

28,250

34,250

47

14,100

14,650

18,950

21,350

23,850

25,200

29,800

36,550

48

14,700

15,400

19,900

22,450

25,050

26,500

31,350

38,850

49

15,300

16,150

20,850

23,550

26,250

27,800

32,900

41,150

50

15,900

16,900

21,800

24,650

27,450

29,100

34,450

43,450

51

16,600

18,000

23,250

26,400

29,050

30,750

36,400

45,850

52

17,250

18,750

24,100

28,000

30,550

32,400

38,250

47,800

53

17,900

19,500

24,950

29,600

32,050

34,050

40,100

49,750

54

18,550

20,250

25,800

31,200

33,550

35,700

41,950

51,700

55

19,200

21,000

26,650

32,800

35,050

37,350

43,800

53,650

56

21,950

23,400

30,150

35,300

37,700

39,850

46,950

57,550

57

22,600

24,400

31,450

37,450

40,350

42,300

49,800

61,450

58

23,250

25,400

32,750

39,600

43,000

44,750

52,650

65,350

59

23,900

26,400

34,050

41,750

45,650

47,200

55,500

69,250

60

24,550

27,400

35,350

43,900

48,300

49,650

58,350

73,150

61

25,200

28,650

38,000

46,700

51,950

54,050

63,950

80,200

62

25,700

29,350

40,300

48,700

55,450

58,400

69,100

86,150

63

26,200

30,050

42,600

50,700

58,950

62,750

74,250

92,100

64

26,700

30,750

44,900

52,700

62,450

67,100

79,400

98,050

65

27,200

31,450

47,200

54,700

65,950

71,450

84,550

1,04,000

66

33,650

37,900

55,200

64,900

75,450

79,650

95,050

1,16,600

67

34,900

39,700

57,250

67,500

78,700

82,600

99,150

1,22,350

68

36,150

41,500

59,300

70,100

81,950

85,550

1,03,250

1,28,100

69

37,400

43,300

61,350

72,700

85,200

88,500

1,07,350

1,33,850

70

38,650

45,100

63,400

75,300

88,450

91,450

1,11,450

1,39,600

71

40,100

47,500

65,700

78,900

91,750

95,750

1,16,350

1,45,400

72

41,350

48,350

68,000

81,400

94,900

99,300

1,21,200

1,50,850

73

42,600

49,200

70,300

83,900

98,050

1,02,850

1,26,050

1,56,300

74

43,850

50,050

72,600

86,400

1,01,200

1,06,400

1,30,900

1,61,750

75

45,100

50,900

74,900

88,900

1,04,350

1,09,950

1,35,750

1,67,200

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

35 | P a g e

76

47,150

53,900

77,950

92,800

1,08,750

1,14,950

1,41,650

1,75,450

77

49,000

56,200

81,000

96,550

1,13,000

1,19,900

1,47,250

1,82,500

78

50,850

58,500

84,050

1,00,300

1,17,250

1,24,850

1,52,850

1,89,550

79

52,700

60,800

87,100

1,04,050

1,21,500

1,29,800

1,58,450

1,96,600

80

54,550

63,100

90,150

1,07,800

1,25,750

1,34,750

1,64,050

2,03,650

81

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

82

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

83

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

84

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

85

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

86

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

87

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

88

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

89

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

90

58,573

67,368

98,641

1,17,735

1,37,635

1,46,578

1,79,484

2,22,561

*Only for Renewal Purposes

Premium for Unlimited Restore Benefit (Optional benefit) : 0.50% will be applied on the Final Policy Premium in

respect of all the base/in-built coverages under this product

▪ Premium Computation Illustration

Illustration 1

• Plan Name – Optima Restore

• Tenure – 1 Year

• Location – Delhi - Tier 1

Age of the

members

insured (in

Years)

Coverage opted on individual basis

covering each member of the family

separately (at a single point in time)

Coverage opted on individual basis covering multiple members

of the family under a single policy (Sum Insured is available for

each member of the family)

Premium (INR)

Sum Insured in

Lakhs (INR)

Premium

(INR)

Family

Discount of

10% (if any)

Premium

after discount

(INR)

Sum Insured

in Lakhs

(INR)

5

8450

10

8450

845

7605

10

25

12,950

10

12,950

1295

11655

10

37

15100

10

15100

1510

13590

10

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

36 | P a g e

47

21800

10

21800

2180

19620

10

57

36250

10

36250

3625

32625

10

63

49,300

10

49300

4930

44370

10

1,43,850

Total Premium (exclusive of

taxes)

1,29465

Total premium (exclusive of taxes) for

all members of the family is INR

1,43,850, when each member is

covered separately (at a single point in

time).

Sum Insured available for each

individual is INR 10 Lakhs.

Total premium (exclusive of taxes) for all members of the

family is INR 129465, when they are covered under a single

policy (Sum Insured is available for each member of the

family).

Sum Insured available for each individual is INR 10 Lakhs.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

37 | P a g e

Illustration 2

• Plan Name – Optima Restore

• Tenure – 1 Year

• Location – Lucknow - Tier 2

Age of

the

members

insured

(in

Years)

Coverage opted on family floater basis with overall Sum Insured (only one Sum Insured is available for the

entire family)

Premium or consolidated

premium for all family

members of the family (Rs.)

Floater discount of 55% applied on all

the members except the oldest

member

Premium after

discount (Rs.)

Sum Insured

in Lakhs (Rs.)

8

7900

4345

3,555

10

19

9650

5307

4343

10

37

12650

6958

5692

10

42

13650

0

13650

10

Total Premium

(exclusive of taxes)

27240

Total premium (exclusive of taxes) when policy is opted on floater basis is INR 27240.

Sum Insured of Rs. 10 Lakhs is available for the entire family.

▪ 2 year & 3year Premium Calculation

7.5% Discount on premium if Insured Person is paying premium of 2 years in advance & 10% Discount on

premium if Insured Person is paying premium of 3 years in advance

Example

1) Proposed Insured Age 32 years from Delhi opting for Optima Restore Individual 2 year policy with

Sum Insured of 5 Lac

Calculation – 9753 x 2 x 92.5% = Rs. 18043.05/- plus taxes.

2) Proposed Insured Age 45 years from Lucknow opting for Optima Restore Individual 3 year policy

with Sum Insured of 15 Lac

Calculation – (14818+21496+21496) x 90% = Rs. 52029/- plus taxes.

Section 41 of Insurance Act 1938 as amended by Insurance Laws Amendment Act, 2015 (Prohibition of

Rebates):

1. No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to

take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in

India, any rebate of the whole or part of the commission payable or any rebate of the premium shown

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

38 | P a g e

on the policy, nor shall any person taking out or renewing or continuing a Policy accept any rebate,

except such rebate as may be allowed in accordance with the published prospectuses or tables of the

insurers.

2. Any person making default in complying with the provision of this section shall be liable for a penalty

which may extend to ten lakh rupees.

Note: Policy Term and Conditions & Premium rates are subject to change with prior approval from IRDA.

Disclaimer

This is only a summary of the product features. The actual benefits available are as described in the policy, and

will be subject to the policy terms, conditions and exclusions. Please seek the advice of your insurance advisor

if you require any further information or clarification.

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

39 | P a g e

Annexure I

List I – Items for which coverage is not available in the policy

S.

No.

Item

S.

No.

Item

1

BABY FOOD

35

OXYGEN CYLINDER (FOR USAGE

OUTSIDE THE HOSPITAL)

2

BABY UTILITIES CHARGES

36

SPACER

3

BEAUTY SERVICES

37

SPIROMETRE

4

BELTS/ BRACES

38

NEBULIZER KIT

5

BUDS

39

STEAM INHALER

6

COLD PACK/HOT PACK

40

ARMSLING

7

CARRY BAGS

41

THERMOMETER

8

EMAIL / INTERNET CHARGES

42

CERVICAL COLLAR

9

FOOD CHARGES (OTHER THAN

PATIENT'S DIET PROVIDED BY

HOSPITAL)

43

SPLINT

10

LEGGINGS

44

DIABETIC FOOT WEAR

11

LAUNDRY CHARGES

45

KNEE BRACES (LONG/ SHORT/ HINGED)

12

MINERAL WATER

46

KNEE IMMOBILIZER/SHOULDER

IMMOBILIZER

13

SANITARY PAD

47

LUMBO SACRAL BELT

14

TELEPHONE CHARGES

48

NIMBUS BED OR WATER OR AIR BED

CHARGES

15

GUEST SERVICES

49

AMBULANCE COLLAR

16

CREPE BANDAGE

50

AMBULANCE EQUIPMENT

17

DIAPER OF ANY TYPE

51

ABDOMINAL BINDER

18

EYELET COLLAR

52

PRIVATE NURSES CHARGES- SPECIAL

NURSING CHARGES

19

SLINGS

53

SUGAR FREE TABLETS

20

BLOOD GROUPING AND CROSS

MATCHING OF DONORS SAMPLES

54

CREAMS POWDERS LOTIONS

(TOILETRIES ARE NOT PAYABLE, ONLY

PRESCRIBED MEDICAL

PHARMACEUTICALS PAYABLE)

21

SERVICE CHARGES WHERE

NURSING CHARGE ALSO CHARGED

55

ECG ELECTRODES

22

TELEVISION CHARGES

56

GLOVES

23

SURCHARGES

57

NEBULISATION KIT

24

ATTENDANT CHARGES

58

ANY KIT WITH NO DETAILS MENTIONED

[DELIVERY KIT, ORTHOKIT, RECOVERY

KIT, ETC]

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

40 | P a g e

List II – Items that are to be subsumed into Room Charges

25

EXTRA DIET OF PATIENT (OTHER

THAN THAT WHICH FORMS PART OF

BED CHARGE)

59

KIDNEY TRAY

26

BIRTH CERTIFICATE

60

MASK

27

CERTIFICATE CHARGES

61

OUNCE GLASS

28

COURIER CHARGES

62

OXYGEN MASK

29

CONVEYANCE CHARGES

63

PELVIC TRACTION BELT

30

MEDICAL CERTIFICATE

64

PAN CAN

31

MEDICAL RECORDS

65

TROLLY COVER

32

PHOTOCOPIES CHARGES

66

UROMETER, URINE JUG

33

MORTUARY CHARGES

67

AMBULANCE

34

WALKING AIDS CHARGES

68

VASOFIX SAFETY

Sl

No

Item

1

BABY CHARGES (UNLESS SPECIFIED/INDICATED)

2

HAND WASH

3

SHOE COVER

4

CAPS

5

CRADLE CHARGES

6

COMB

7

EAU-DE-COLOGNE / ROOM FRESHNERS

8

FOOT COVER

9

GOWN

10

SLIPPERS

11

TISSUE PAPER

12

TOOTH PASTE

13

TOOTH BRUSH

14

BED PAN

15

FACE MASK

16

FLEXI MASK

17

HAND HOLDER

18

SPUTUM CUP

19

DISINFECTANT LOTIONS

20

LUXURY TAX

21

HVAC

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

41 | P a g e

List III – Items that are to be subsumed into Procedure Charges

22

HOUSE KEEPING CHARGES

23

AIR CONDITIONER CHARGES

24

IM IV INJECTION CHARGES

25

CLEAN SHEET

26

BLANKET/WARMER BLANKET

27

ADMISSION KIT

28

DIABETIC CHART CHARGES

29

DOCUMENTATION CHARGES / ADMINISTRATIVE EXPENSES

30

DISCHARGE PROCEDURE CHARGES

31

DAILY CHART CHARGES

32

ENTRANCE PASS / VISITORS PASS CHARGES

33

EXPENSES RELATED TO PRESCRIPTION ON DISCHARGE

34

FILE OPENING CHARGES

35

INCIDENTAL EXPENSES / MISC. CHARGES (NOT EXPLAINED)

36

PATIENT IDENTIFICATION BAND / NAME TAG

37

PULSEOXYMETER CHARGES

Sl

No.

Item

1

HAIR REMOVAL CREAM

2

DISPOSABLES RAZORS CHARGES (for site preparations)

3

EYE PAD

4

EYE SHEILD

5

CAMERA COVER

6

DVD, CD CHARGES

7

GAUSE SOFT

8

GAUZE

9

WARD AND THEATRE BOOKING CHARGES

10

ARTHROSCOPY AND ENDOSCOPY INSTRUMENTS

11

MICROSCOPE COVER

12

SURGICAL BLADES, HARMONICSCALPEL,SHAVER

13

SURGICAL DRILL

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

42 | P a g e

List IV – Items that are to be subsumed into costs of treatment

14

EYE KIT

15

EYE DRAPE

16

X-RAY FILM

17

BOYLES APPARATUS CHARGES

18

COTTON

19

COTTON BANDAGE

20

SURGICAL TAPE

21

APRON

22

TORNIQUET

23

ORTHOBUNDLE, GYNAEC BUNDLE

Sl

No.

Item

1

ADMISSION/REGISTRATION CHARGES

2

HOSPITALISATION FOR EVALUATION/ DIAGNOSTIC PURPOSE

3

URINE CONTAINER

4

BLOOD RESERVATION CHARGES AND ANTE NATAL BOOKING CHARGES

5

BIPAP MACHINE

6

CPAP/ CAPD EQUIPMENTS

7

INFUSION PUMP– COST

8

HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS ETC

9

NUTRITION PLANNING CHARGES - DIETICIAN CHARGES- DIET CHARGES

10

HIV KIT

11

ANTISEPTIC MOUTHWASH

12

LOZENGES

13

MOUTH PAINT

14

VACCINATION CHARGES

15

ALCOHOL SWABES

Optima Restore – Prospectus

HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor,

HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and conditions,

please read the policy document carefully before concluding a sale. . Optima Restore: HDFHLIP25012V082425 | Protector Rider - HDHHLIP21335V022021 |

Individual Personal Accident Rider - APOPAIP19004V011920 | Hospital Daily Cash Rider - HDHHLIP21344V022021 | Critical Advantage Rider HDHHLIP21342V022021

| my:health Critical Illness - HDFHLIA22141V032122 | Optima Wellbeing (Add-on) - HDFHLIA24099V012324

43 | P a g e

16

SCRUB SOLUTION/STERILLIUM

17

Glucometer& Strips

18

URINE BAG