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How does the HDFC ERGO Optima Restore policy handle the enhancement of the sum insured for pre-existing diseases? | In case of enhancement of the sum insured, the exclusion for pre-existing diseases shall apply afresh to the extent of the sum insured increase. |
Does the HDFC ERGO Optima Restore policy cover planned treatment abroad? | Yes, the Critical Advantage Rider in the HDFC ERGO Optima Restore policy covers planned treatment abroad for listed eight major illnesses. |
What is the discount percentage for an average step target of 5000 or below in a 3-year policy under the HDFC ERGO Optima Restore plan? | For an average step target of 5000 or below in a 3-year policy under the HDFC ERGO Optima Restore plan, the discount percentage is 0%. |
Is the cost of a shoe cover subsumed into room charges under the HDFC ERGO Optima Restore policy? | Yes, the cost of a shoe cover is subsumed into room charges under the HDFC ERGO Optima Restore policy as per List II. |
What are the surcharges covered under the HDFC ERGO Optima Restore policy? | The HDFC ERGO Optima Restore policy includes surcharges as part of the policy coverage. |
What happens if the insured person has multiple policies covering the same risk under the HDFC ERGO Optima Restore policy? | If the insured person has multiple policies covering the same risk on an indemnity basis, they shall only be indemnified for the treatment costs in accordance with the terms and conditions of the chosen policy under the HDFC ERGO Optima Restore policy. |
Who qualifies as a medical practitioner under the HDFC ERGO Optima Restore policy? | A medical practitioner is a person who holds a valid registration from the medical council of any state or medical council of India or council for Indian medicine or for homeopathy set up by the government of India or a state government and is thereby entitled to practice medicine within its jurisdiction, acting within... |
What is the maximum sum insured available under the HDFC ERGO Optima Restore Family policy? | The maximum sum insured available under the HDFC ERGO Optima Restore Family policy is Rs. 100 lakh. |
What does the HDFC ERGO Optima Restore policy state about vitamins and minerals? | Vitamins and minerals are not covered under the HDFC ERGO Optima Restore policy unless they are prescribed by a medical practitioner as part of a hospitalization claim or day care procedure. |
What does the term 'cashless facility' mean in the context of the HDFC ERGO Optima Restore policy? | A cashless facility means that the insured can avail medical services at a network provider without having to pay upfront, as the insurer settles the expenses directly with the provider. |
What is the consequence of non-payment of premium on the due date for the HDFC ERGO Optima Restore policy when using the ECS facility? | Non-payment of premium on the due date for the HDFC ERGO Optima Restore policy when using the ECS facility, subject to an additional 15 days of relaxation period, will lead to termination of the policy. |
Where is the office of the Insurance Ombudsman located in Bengaluru for the HDFC ERGO Optima Restore policy? | The office of the Insurance Ombudsman in Bengaluru for the HDFC ERGO Optima Restore policy is located at Jeevan Soudha Building, PID No. 57-27-N-19, Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078. The contact numbers are 080 - 26652048 / 26652049 and the email is bimalokpal.bengaluru@cioi... |
What is the IRDAI registration number for HDFC ERGO General Insurance Company Limited? | The IRDAI registration number for HDFC ERGO General Insurance Company Limited is 146. |
How much family discount is available under HDFC ERGO Optima Restore policy? | A 10% discount on the premium is available if two or more family members are covered under the same HDFC ERGO Optima Restore policy under the individual policy option. |
Are expenses for medical text books covered under the HDFC ERGO Optima Restore policy? | No, expenses for medical text books are not covered under the policy. |
Is organ donor treatment covered in the HDFC ERGO Optima Restore policy? | Yes, organ donor treatment is covered under the HDFC ERGO Optima Restore policy. |
What is the procedure for handling non-disclosure of pre-existing diseases in the HDFC ERGO Optima Restore policy? | In the HDFC ERGO Optima Restore policy, non-disclosure of pre-existing diseases can lead to the insurer permanently excluding the disease, incorporating an additional waiting period, or levying underwriting loading, depending on the situation. |
Can the Unlimited Restore Benefit be triggered for partial utilization of the Restore benefit in the HDFC ERGO Optima Restore policy? | Yes, the Unlimited Restore Benefit can be triggered for partial utilization of the Restore benefit during the Policy Year in the HDFC ERGO Optima Restore policy. |
Are expenses for medicines, drugs, and consumables covered under the HDFC ERGO Optima Restore policy? | Yes, expenses for medicines, drugs, and consumables are covered under the policy. |
What are Day Care Procedures in the HDFC ERGO Optima Restore policy? | Day Care Procedures in the HDFC ERGO Optima Restore policy refer to medical treatment or surgical procedure 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 an out-patient basis is not included in the scope of t... |
How does the HDFC ERGO Optima Restore policy define lawful medical termination of pregnancy? | The HDFC ERGO Optima Restore policy defines lawful medical termination of pregnancy as part of maternity expenses, covering the expenses incurred for the medical termination of pregnancy during the policy period, provided it is lawful. |
Does the HDFC ERGO Optima Restore policy cover photocopy charges? | Yes, photocopy charges are covered under the HDFC ERGO Optima Restore policy. |
Are elastic stockings covered under the HDFC ERGO Optima Restore policy? | No, elastic stockings are not covered under the HDFC ERGO Optima Restore policy. |
What is the importance of 'Reasonable & Customary Charges' in the HDFC ERGO Optima Restore policy? | 'Reasonable & Customary Charges' ensure that the charges for services or supplies are standard and consistent with prevailing charges in the geographical area for similar services. This helps in determining the admissibility and amount of claims under the policy. |
What does the Sum Insured for a Family Floater mean in the HDFC ERGO Optima Restore policy? | In the HDFC ERGO Optima Restore policy, the Sum Insured for a Family Floater means the sum shown in the Schedule, which represents the maximum liability for any and all claims made by you and/or all of your Dependents during the Policy Period. |
What is the significance of the Non-instalment Premium Payment in the HDFC ERGO Optima Restore policy? | The significance of the Non-instalment Premium Payment in the HDFC ERGO Optima Restore policy is that it requires the payment of the premium for the entire policy period to be made in advance as a single premium, ensuring continuous coverage without the need for periodic payments. |
Is an E-Opinion in respect of a Critical Illness covered under the HDFC ERGO Optima Restore policy? | Yes, an E-Opinion in respect of a Critical Illness is covered under the HDFC ERGO Optima Restore policy. |
What is the Stay Active discount for an average step count of 5000 or below in a 1-year policy under the HDFC ERGO Optima Restore policy? | For an average step count of 5000 or below in a 1-year policy, the Stay Active discount is 0% at each time interval, with a maximum of 0% at the end of the year. |
Where is the Insurance Ombudsman office located in Kochi for HDFC ERGO Optima Restore policy? | The Insurance Ombudsman office in Kochi is located at 10th Floor, Jeevan Prakash, LIC Building, Opp to Maharaja's College Ground, M.G.Road. It covers Kerala, Lakshadweep, and Mahe-a part of the Union Territory of Puducherry. |
How is 'Any one illness' defined in the HDFC ERGO Optima Restore policy? | 'Any one illness' in the HDFC ERGO Optima Restore policy refers to a continuous period of illness, including a relapse within 45 days from the date of the last consultation with the hospital or nursing home where treatment was taken. |
Is emergency air ambulance cover included in the HDFC ERGO Optima Restore policy? | Emergency air ambulance cover is not included for sum insured options up to Rs. 5.00 lakh, but it is covered for sum insured options of Rs. 10.00 lakh and above under the HDFC ERGO Optima Restore policy. |
What is the policy number for Optima Restore as per the document? | The policy number for Optima Restore as per the document is HDFHLIP205V12/08/425. |
What is the Aggregate Deductible in the HDFC ERGO Optima Restore policy? | The Aggregate Deductible in the HDFC ERGO Optima Restore policy is an optional benefit where the insured person shall bear an amount equal to the Aggregate Deductible specified on the policy schedule for all admissible claims made by the insured person and assessed by the company in a policy year. The liability of the ... |
What happens if the step count is found to be manipulated in the HDFC ERGO Optima Restore policy? | If the step count is found to be manipulated in the HDFC ERGO Optima Restore policy, HDFC ERGO reserves the right to remove or reduce any count of steps achieved in an unfair manner. |
What is the email address for claim-related queries for the HDFC ERGO Optima Restore policy? | The email address for claim-related queries for the HDFC ERGO Optima Restore policy is care@hdfcergo.com. |
How is the third claim handled in terms of Sum Insured utilization in the HDFC ERGO Optima Restore policy? | In the third claim under the HDFC ERGO Optima Restore policy, with a claim amount of 3,00,000, the remaining Restore Benefit of 2,00,000 and the Unlimited Restore Benefit of 5,00,000 are utilized to cover the admissible claim amount of 3,00,000. |
What orthopedic conditions and surgeries are covered under the HDFC ERGO Optima Restore policy? | Under the HDFC ERGO Optima Restore policy, orthopedic conditions such as Non-infective arthritis, Gout and Rheumatism, Osteoporosis, Ligament, Tendon and Meniscal tear, and Prolapsed intervertebral disk are covered. The surgery listed is Joint replacement surgeries. |
How can I contact the Insurance Ombudsman office in Jaipur for HDFC ERGO Optima Restore policy? | You can contact the Insurance Ombudsman office in Jaipur at Jeevan Nidhi – Il Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005. Tel.: 0141- 2740363/2740798. Email: bimalokpal.jaipur@cioins.co.in. |
How is 'Congenital Anomaly' defined in the HDFC ERGO Optima Restore policy? | In the HDFC ERGO Optima Restore policy, 'Congenital Anomaly' refers to a condition present since birth that is abnormal in form, structure, or position. It is categorized into Internal Congenital Anomaly, which is not visible, and External Congenital Anomaly, which is visible. |
What is the policy on the renewal of policies with increased sum insured underwriting under the HDFC ERGO Optima Restore policy? | In case of an increase in sum insured requested by the policyholder, the insurer may underwrite only to the extent of the increased sum insured. |
What is the policy on renewal of the HDFC ERGO Optima Restore policy if the insured person has multiple policies covering the same risk? | If the insured person has multiple policies covering the same risk on an indemnity basis, they shall only be indemnified for the treatment costs in accordance with the terms and conditions of the chosen policy under the HDFC ERGO Optima Restore policy. |
What is the role of endorsements in the HDFC ERGO Optima Restore policy? | Endorsements in the HDFC ERGO Optima Restore policy serve as written evidence of any changes made to the policy. These changes can only be made by the insurer and will be signed and stamped by them. |
What is the CIN of HDFC ERGO General Insurance Company Limited? | The CIN of HDFC ERGO General Insurance Company Limited is U66030MH2007PLC177117. |
Are expenses for investigations covered under pre-hospitalisation under the HDFC ERGO Optima Restore policy? | Yes, expenses for investigations are covered under pre-hospitalisation up to 60 days before the date of admission. |
Is Domiciliary Treatment covered under the HDFC ERGO Optima Restore policy? | Yes, Domiciliary Treatment is covered under the HDFC ERGO Optima Restore policy. |
What are the conditions for the Unlimited Restore benefit in the HDFC ERGO Optima Restore policy? | The conditions for the Unlimited Restore benefit in the HDFC ERGO Optima Restore policy are: 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... |
What is the average step target for a 1.25% discount in a 1-year policy under the HDFC ERGO Optima Restore plan? | For a 1.25% discount in a 1-year policy under the HDFC ERGO Optima Restore plan, the average step target is between 8001 to 10000 steps. |
How is the discount grid structured for a 3-year policy in the HDFC ERGO Optima Restore plan? | For a 3-year policy in the HDFC ERGO Optima Restore plan, the discount grid is structured based on average step targets with specific discount percentages applied at various time intervals, culminating in a maximum discount at the end of 3 years. |
What is the maximum Stay Active discount for a 3-year policy under the HDFC ERGO Optima Restore policy? | The maximum Stay Active discount for a 3-year policy is 8% if the average step count is above 10,000. |
Are IM IV injection charges subsumed into room charges under the HDFC ERGO Optima Restore policy? | Yes, IM IV injection charges are subsumed into room charges under the HDFC ERGO Optima Restore policy as per List II. |
How does the HDFC ERGO Optima Restore policy define medically necessary treatment? | The HDFC ERGO Optima Restore policy defines medically necessary treatment as any treatment, test, medication, or stay in a hospital required for the medical management of the illness or injury suffered by the insured. It must not exceed the level of care necessary to provide safe, adequate, and appropriate medical care... |
What is the maximum amount payable for Air Ambulance under the HDFC ERGO Optima Restore policy? | The maximum amount payable for Air Ambulance under the HDFC ERGO Optima Restore policy is either the actual expenses or Rs. 2.5 Lacs per hospitalization, whichever is lower, up to the basic sum insured limit for a year. |
What is the cashless service procedure for planned treatments under the HDFC ERGO Optima Restore policy? | For planned treatments under the HDFC ERGO Optima Restore policy, you must notify the insurer at least 48 hours before the planned treatment or hospitalization to avail cashless service at a network hospital. |
What is the significance of clinical history documentation for Multiple Sclerosis coverage in the HDFC ERGO Optima Restore policy? | Clinical history documentation is significant as it provides evidence of exacerbations and remissions or neurological deficits, with at least two clinically documented episodes at least 1 month apart, meeting the policy's criteria for coverage. |
Is the restore benefit applicable if the policy sum insured is not fully utilized under the HDFC ERGO Optima Restore policy? | Yes, the restore benefit is applicable even if the policy sum insured is partially utilized under the HDFC ERGO Optima Restore policy. |
What is the procedure for grievance redressal if not satisfied with HDFC ERGO's methods under the Optima Restore policy? | If not satisfied with HDFC ERGO's methods, grievances can be lodged at the IRDAI Integrated Grievance Management System or approached to the office of Insurance Ombudsman as per Insurance Ombudsman Rules 2017 under the Optima Restore policy. |
Is the cost of a toothbrush subsumed into room charges under the HDFC ERGO Optima Restore policy? | Yes, the cost of a toothbrush is subsumed into room charges under the HDFC ERGO Optima Restore policy as per List II. |
What is the role of the Transplantation of Human Organs Act, 1994 in the HDFC ERGO Optima Restore policy? | The Transplantation of Human Organs Act, 1994 plays a role in the HDFC ERGO Optima Restore policy by ensuring that organ donor coverage is compliant with the act. Admissions not compliant under the act are excluded from coverage. |
What is the consequence of not complying with policy obligations under the HDFC ERGO Optima Restore policy? | The company will not be obligated to make any payment if the insured does not comply with policy obligations. |
What is the refund policy for installment payments under the HDFC ERGO Optima Restore policy if canceled within 6 months? | For installment payments under the HDFC ERGO Optima Restore policy, 50% of the current installment premium will be refunded when the current period elapsed is less than 6 months from the commencement of the policy year. |
What is the total discount applicable on renewal premium for the HDFC ERGO Optima Restore policy? | The total discount applicable on renewal premium for the HDFC ERGO Optima Restore policy is 3.5%. |
What does room rent include according to the HDFC ERGO Optima Restore policy? | Room rent, according to the HDFC ERGO Optima Restore policy, includes the amount charged by a hospital towards room and boarding expenses and shall include associated medical expenses. |
What are the specific organs mentioned for Major Organ Transplant coverage in the HDFC ERGO Optima Restore policy? | The specific organs mentioned for Major Organ Transplant coverage include the heart, lung, liver, pancreas, and kidney. |
Are crepe bandages covered under the HDFC ERGO Optima Restore policy? | No, crepe bandages are not covered under the HDFC ERGO Optima Restore policy. |
Can the company cancel the HDFC ERGO Optima Restore policy on grounds of fraud? | Yes, the company may cancel the HDFC ERGO Optima Restore policy at any time on grounds of established fraud, non-disclosure, or misrepresentation by the insured person by giving 15 days’ written notice. There would be no refund of premium on cancellation on these grounds. |
What is the coverage duration for post-hospitalization expenses for a sum insured of Rs. 10 lakh under the HDFC ERGO Optima Restore policy? | The coverage duration for post-hospitalization expenses for a sum insured of Rs. 10 lakh under the HDFC ERGO Optima Restore policy is up to 180 days. |
What is the discount percentage for an average step target of 5001 to 8000 in a 1-year policy under the HDFC ERGO Optima Restore plan? | For an average step target of 5001 to 8000 in a 1-year policy under the HDFC ERGO Optima Restore plan, the discount percentage is 2%. |
What is the role of investigation reports in the HDFC ERGO Optima Restore policy claim process? | Investigation reports play a role in the HDFC ERGO Optima Restore policy claim process by providing evidence of the medical condition and treatment received, supporting the claim. |
What is the refund percentage for cancellation of the HDFC ERGO Optima Restore policy up to 12 months? | For cancellation of the HDFC ERGO Optima Restore policy up to 12 months, the refund percentage is 0.0%. |
Is the unlimited restore benefit an optional feature in the HDFC ERGO Optima Restore policy? | Yes, the unlimited restore benefit is an optional feature in the HDFC ERGO Optima Restore policy and is applicable if opted. |
What is the Basic Sum Insured utilized for the 2nd claim in the HDFC ERGO Optima Restore policy? | For the 2nd claim in the HDFC ERGO Optima Restore policy, the Basic Sum Insured is not utilized. |
What is the significance of 'Portability' in the HDFC ERGO Optima Restore policy? | 'Portability' in the HDFC ERGO Optima Restore policy allows policyholders to transfer credits gained for pre-existing diseases and specific waiting periods from one insurer to another. This ensures continuity of benefits and coverage when switching insurers. |
Which areas are covered by the Insurance Ombudsman in Pune for HDFC ERGO Optima Restore policy? | The areas covered by the Insurance Ombudsman in Pune for HDFC ERGO Optima Restore policy include Maharashtra, and areas of Navi Mumbai and Thane (excluding Mumbai Metropolitan Region). |
Can a family member who is a medical practitioner provide treatment under the HDFC ERGO Optima Restore policy? | Treatments rendered by a medical practitioner who is a member of the insured person’s family or stays with them are not covered, except for proven material costs eligible for reimbursement. |
What is the significance of the policy schedule in the Restore Benefit and Unlimited Restore Benefit under the HDFC ERGO Optima Restore policy? | The policy schedule is not directly related to the Restore Benefit and Unlimited Restore Benefit under the HDFC ERGO Optima Restore policy. These benefits provide an instant addition of 100% Basic Sum Insured on complete or partial utilization of your existing policy sum insured and multiplier benefit (if applicable) d... |
Does the HDFC ERGO Optima Restore policy cover housekeeping charges? | Yes, housekeeping charges are covered under the HDFC ERGO Optima Restore policy. |
What happens if the insured person has multiple policies and the sum insured is not exhausted under the HDFC ERGO Optima Restore policy? | If the insured person has multiple policies and the sum insured is not exhausted, they have the right to prefer claims under the HDFC ERGO Optima Restore policy for the amounts disallowed under any other policy/policies. The insurer shall independently settle the claim subject to the terms and conditions of the HDFC ER... |
Does the HDFC ERGO Optima Restore policy cover treatment for injuries sustained during hazardous or adventure sports? | No, expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports are excluded. |
Is there a refund of policy premium in case of death of an insured person under the HDFC ERGO Optima Restore policy? | Yes, in case of death of an insured person, the policy premium shall be refunded proportionately for the deceased insured person for the unexpired policy period under the HDFC ERGO Optima Restore policy. |
What is the role of the insurer's liability in the HDFC ERGO Optima Restore policy cashless service? | The insurer's liability in the HDFC ERGO Optima Restore policy cashless service determines the extent of payment made directly to the network hospital for planned or emergency treatments. |
What is the process for submitting prescriptions for claims under the HDFC ERGO Optima Restore policy? | For claims under the HDFC ERGO Optima Restore policy, prescriptions must be submitted with the corresponding doctor's invoice, naming the insured person, listing the drugs prescribed, their price, and including a receipt for payment. |
Are expenses for medicines covered under post-hospitalisation under the HDFC ERGO Optima Restore policy? | Yes, expenses for medicines are covered under post-hospitalisation up to 180 days after discharge from the hospital. |
Are diabetic footwear charges covered under the HDFC ERGO Optima Restore policy? | No, diabetic footwear charges are not covered under the HDFC ERGO Optima Restore policy as per List I of items for which coverage is not available. |
What is the policy number for HDFC ERGO Optima Restore? | The policy number for HDFC ERGO Optima Restore is HDFHLIP20521V042425. |
What is the jurisdiction of the Insurance Ombudsman office in Guwahati for HDFC ERGO Optima Restore policy? | The jurisdiction of the Insurance Ombudsman office in Guwahati includes Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland, and Tripura. |
What is the daily cash benefit provided by the Hospital Daily Cash Rider in the HDFC ERGO Optima Restore policy? | The Hospital Daily Cash Rider provides a daily cash benefit of up to Rs. 1,000, Rs. 2,000, or Rs. 3,000. |
How many days of pre-hospitalization expenses are covered under the HDFC ERGO Optima Restore policy? | Pre-hospitalization expenses are covered for up to 60 days under the HDFC ERGO Optima Restore policy for all the basic sum insured options. |
What is the CIN of HDFC ERGO General Insurance Company Limited? | The CIN of HDFC ERGO General Insurance Company Limited is U66030MH2007PLC177117. |
What is the significance of MLC records and FIR in the HDFC ERGO Optima Restore policy? | MLC records and FIR are significant in the HDFC ERGO Optima Restore policy for claims arising out of an accident, as they provide legal documentation of the incident. |
Are external congenital diseases covered by the HDFC ERGO Optima Restore policy? | No, external congenital diseases, defects, or anomalies are not covered by the HDFC ERGO Optima Restore policy. |
Are admission or registration charges covered under the HDFC ERGO Optima Restore policy? | Yes, admission or registration charges are subsumed into costs of treatment under the HDFC ERGO Optima Restore policy. |
Are surgical blades, harmonic scalpel, and shaver charges included in the HDFC ERGO Optima Restore policy? | Yes, surgical blades, harmonic scalpel, and shaver charges are subsumed into procedure charges under the HDFC ERGO Optima Restore policy. |
What is the role of the IRDAI registration number in the HDFC ERGO Optima Restore policy? | The role of the IRDAI registration number in the HDFC ERGO Optima Restore policy is to indicate that HDFC ERGO General Insurance Company Limited is authorized and regulated by the Insurance Regulatory and Development Authority of India, ensuring compliance with industry standards and regulations. |
What constitutes a complete discharge of payment under the HDFC ERGO Optima Restore policy? | A complete discharge of payment under the HDFC ERGO Optima Restore policy occurs when any payment is made to the policyholder, insured person, their nominees, legal representative, assignee, or the hospital for any benefit under the policy. This payment is considered a valid discharge towards the claim by the company t... |
Is the cost of a comb subsumed into room charges under the HDFC ERGO Optima Restore policy? | Yes, the cost of a comb is subsumed into room charges under the HDFC ERGO Optima Restore policy as per List II. |
Which states are covered by the Insurance Ombudsman in Patna for HDFC ERGO Optima Restore policy? | The states covered by the Insurance Ombudsman in Patna for HDFC ERGO Optima Restore policy are Bihar and Jharkhand. |
Is the Co-Payment applicable to Preventive Health Check-up in the HDFC ERGO Optima Restore policy? | No, the Co-Payment is not applicable to Section 3 (Preventive Health Checkup) in the HDFC ERGO Optima Restore policy. |
Does the 30-day waiting period apply if the insured person has continuous coverage for more than twelve months in the HDFC ERGO Optima Restore policy? | No, the 30-day waiting period does not apply if the insured person has continuous coverage for more than twelve months in the HDFC ERGO Optima Restore policy. |
What happens if an insured person dies under the HDFC ERGO Optima Restore policy? | If an insured person dies, they will cease to be an insured person upon HDFC ERGO receiving all relevant particulars. A rateable part of the premium received for such person will be returned if there are no claims in respect of that insured person under the policy. |
What is the procedure for handling non-disclosure of information in the HDFC ERGO Optima Restore policy? | In the HDFC ERGO Optima Restore policy, non-disclosure of information can lead to policy cancellation or modification. The insurer may also exclude the disease, add a waiting period, or levy underwriting loading, depending on the situation. |
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