HDFC Ergo Optima Secure Health Insurance Review 2026
Health-conscious individuals wanting future-proof coverage with modern treatments
Claim Settlement Ratio
91.82% (FY 2023-24)
Good claim settlement record
Key Features
Coverage Details
Plan Details
| Min Coverage | ₹5 Lakh |
| Max Coverage | ₹5 Crore |
| Coverage Unit | sum insured in Rs |
| Claim Settlement Ratio | 91.82% (FY 2023-24) |
| Premium Starts From | Rs 6,200/year (for 25-year-old, Rs 5 lakh cover) |
| Network Hospitals | 13,000+ |
| Initial Waiting Period | 30 days initial waiting period |
| Pre-existing Wait | 48 months |
| Entry Age | 18 to 65 years |
| Renewal | Lifetime renewability |
Plan Options
Rating Breakdown
Pros & Cons
✓Pros
- ✔Sum insured multiplied up to 3X at no extra cost
- ✔No room rent restriction
- ✔Covers modern treatments (robotic surgery, gene therapy, etc.)
- ✔Reset benefit — resets sum insured on exhaustion
- ✔Good claim settlement ratio
✗Cons
- ✘Premium is slightly higher than competitors
- ✘Waiting period of 48 months for pre-existing diseases
- ✘Limited network hospitals compared to Star Health
What Is Covered (Inclusions)
- ✔In-patient hospitalization
- ✔Pre and post hospitalization (30 and 60 days)
- ✔Day care procedures
- ✔Modern treatments (stem cell, gene therapy, robotic surgery)
- ✔Ambulance charges (up to Rs 5,000)
- ✔AYUSH treatment
- ✔Mental illness coverage
What Is Not Covered (Exclusions)
- ✘Cosmetic treatments
- ✘Pre-existing diseases (first 48 months)
- ✘Dental treatments
- ✘Congenital diseases
- ✘Self-inflicted injuries
How to File a Claim
Inform the Insurer
Contact HDFC Ergo helpline or use the mobile app to intimate the claim within 24 to 48 hours of hospitalization.
Cashless or Reimbursement
For cashless, show your health card at a network hospital. For reimbursement, pay the hospital and collect all original bills and reports.
Submit Documents
Submit the claim form along with discharge summary, hospital bills, diagnostic reports, pharmacy bills, and your health card copy.
Claim Processing
HDFC Ergo reviews the documents and processes the claim. Cashless claims are usually settled at discharge. Reimbursement claims take 15 to 30 days.
Settlement
Approved claims are settled directly with the hospital (cashless) or transferred to your bank account (reimbursement). Any queries are communicated via email or phone.
