Optima Cash Prospectus
Optima Cash Prospectus
Optima Cash Prospectus
SUITABILITY 2) These benefits are effective only if noted as such in the Schedule of
• This policy covers persons in the age group 5 years onwards. The Benefits.
maximum entry age is 65 years. Children are covered from the age 3) Our maximum liability shall be restricted to the Sum Insured and
of 91 days onwards if either parent is covered under any Optima period mentioned in the Schedule of Benefits.
Cash policy. TAX BENEFIT – Avail tax benefit for the premium amount under Section
• There is no maximum cover ceasing age on renewals 80D of the Income Tax Act.
• The policy will be issued for 1 or 2 year(s) period DAILY CASH OPTIONS
• This policy can be issued to an individual and/or family
Sum Insured [All Figures in INR]
• The policy offers coverage on individual sum insured basis only.
Daily Cash Plan 500 1,000 2,000 3,000 4,000* 5,000*
• The family includes self, spouse and dependent children.
90 days 3 3 3 3 3 3
SALIENT FEATURES & BENEFITS 180 days 3 3 3 3 3 3
1. Sickness Hospital Cash - If an Insured Person suffers an Illness during * For Rs 4,000 and 5,000 Sum Insured entry age is restricted to 45 years.
the Policy Period that requires that Insured Person’s Hospitalisation
(including In-patient care AYUSH treatment in an AYUSH Hospital) as EXCLUSIONS
an inpatient, then The exclusions under this Policy are
i) We will pay Daily Cash amount for each continuous and Waiting Period: All Illnesses and treatments shall be covered subject to
completed period of 24 hours that the Insured Person is the waiting periods specified below:
Hospitalised, and
a) 30-day Waiting Period: Code – Excl03
ii) We will pay twice the Sickness Daily Cash amount for each
I. Expenses related to the treatment of any illness within 30 days from
continuous and completed period of 24 hours that the Insured
the first policy commencement date shall be excluded except claims
Person is admitted in an Intensive Care Unit, subject to maximum
arising due to an accident, provided the same are covered.
of 15 days per Policy Year. Whenever Intensive Care Unit benefit
is admissible under the policy, We will not pay for Daily Cash II. This exclusion shall not, however, apply if the insured person has
benefit in i. above for the period when the Insured Person is in continuous coverage for more than twelve months.
Intensive Care Unit. III. The within referred waiting period is made applicable to the
2. Accident Hospital Cash - If an Insured Person suffers an Accident enhanced sum insured in the event of granting higher sum insured
during the Policy Period that requires that Insured Person’s subsequently.
Hospitalisation (including In-patient care AYUSH treatment in an b) Specified disease/procedure waiting period: Code – Excl02
AYUSH Hospital) as an inpatient, then I. Expenses related to the treatment of the listed Conditions, surgeries/
i) We will pay Daily Cash amount for each continuous and treatments as mentioned in the table below shall be excluded until
completed period of 24 hours that the Insured Person is the expiry of 24 months of continuous coverage after the date
Hospitalised, and of inception of the first Policy with us. This exclusion shall not be
ii) We will pay twice the Accident Daily Cash amount for each applicable for claims arising due to an Accident.
continuous and completed period of 24 hours that the Insured II. In case of enhancement of sum insured the exclusion shall apply
Person is admitted in an Intensive Care Unit, subject to maximum afresh to the extent of Sum Insured increase.
of 15 days per Policy Year. Whenever Intensive Care Unit benefit III. If any of the specified disease/procedure falls under the waiting
is admissible under the policy, We will not pay for Daily Cash period specified for Pre-existing diseases, then the longer of the two
benefit in i. above for the period when the Insured Person is in waiting periods shall apply.
Intensive Care Unit.
IV. The waiting period for listed conditions shall apply even if contracted
3. Day-Care Procedure Cash - 50% of the Daily Cash amount if insured after the Policy or declared and accepted without a specific exclusion.
person undergoes identified 10 Day care procedures which does not
require 24 hours hospitalisation due to technological advancement. V. If the Insured Person is continuously covered without any break
This benefit is payable maximum upto 6 Days. as defined under the applicable norms on portability stipulated by
IRDAI, then waiting period for the same would be reduced to the
4. Joint Hospitalisation due to an Accident- Twice the Daily Cash extent of prior coverage.
amount for the period where two or more Insured person(s) are
concurrently hospitalised due to an accident, in addition to Accident VI. List of specific diseases/procedure:
Hospital Cash above. This benefit is payable maximum upto 10 Days i) Illnesses: arthritis if non infective; calculus diseases of gall
per policy year. bladder and urogenital system; cataract; fissure/fistula in anus;
5. Convalescence - Lumpsum amount towards Convalescence if hemorrhoids; pilonidal sinus; gastric and duodenal ulcers; gout
insured person is hospitalised beyond 7 continuous days, in addition and rheumatism; internal tumors; cysts; nodules; polyps including
to Sickness/Accident Hospital Cash benefits above. This benefit can breast lumps (each of any kind unless malignant); osteoarthritis
be claimed only once in a policy year. and osteoporosis; polycystic ovarian diseases; sinusitis, Rhinitis,
Tonsillitis and skin tumors unless malignant.
6. Child Birth - Lumpsum amount equivalent to twice the Daily Cash
amount for maternity to female insured in event of child birth. There ii) Treatments: Surgeries for benign ear; adenoidectomy,
is a waiting period of 2 years for availing this benefit and this benefit mastoidectomy, tonsillectomy and tympanoplasty; dilatation and
will be paid maximum twice during the lifetime of the Insured Person. curettage (D&C); hysterectomy for menorrhagia or fibromyoma
or prolapse of uterus unless necessitated by malignancy; joint
7. Parent Accommodation - Daily Cash amount for parent’s replacement; myomectomy for fibroids; surgery of gallbladder
accommodation If the Insured child is aged 12 years or less and is and bile duct unless necessitated by malignancy; surgery of
hospitalised for more than 72 hours;in addition to Sickness/ Accident genito urinary system unless necessitated by malignancy;
Hospital Cash benefits above. This benefit is payable maximum upto surgery of benign prostatic hypertrophy; surgery of hernia;
30 Days per policy year. surgery of hydrocele; surgery for prolapsed inter vertebral disk;
Note – surgery of varicose veins and varicose ulcers; Nasal septum
1) A continuous and completed period of less than 24 hours of deviation; surgery on tonsils and sinuses.
Hospitalisation will be deemed to be a continuous and completed iii) If the Insured person renews with Us and increases the Sum
period of 24 hours if such period extends to at least 12 hours and Insured, then this exclusion shall only apply in relation to the
also includes the period 0200 to 0330 hours. amount by which the Sum Insured has been increased in the year.
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. Trade Logo 1
displayed above belongs to HDFC Bank Ltd and ERGO International AG and used by the Company under license. UIN: Optima Cash - HDHHLIP21339V022021.
HDFC ERGO General Insurance Company Limited
c) Pre- Existing Diseases: Code- Excl01 Expenses related to sterility and infertility. This includes:
I. Expenses related to the treatment of a pre-existing disease (PED) i. Any type of contraception, sterilization
and its direct complications shall be excluded until the expiry of 48 ii. Assisted Reproduction services including artificial insemination and
months of continuous coverage after the date of inception of the first advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI
policy with insurer.
iii. Gestational Surrogacy
II. In case of enhancement of Sum Insured the exclusion shall apply
afresh to the extent of sum of Sum Insured increase. iv. Reversal of sterilization
III. If the Insured Person is continuously covered without any break xii) Birth control, contraceptive supplies or services including
as defined under the portability norms of the extant IRDAI (Health complications arising out of same.
Insurance) Regulations, then waiting period for the same would be xiii) Dental treatment and surgery of any kind, unless requiring
reduced to the extent of prior coverage. Hospitalisation.
IV. Coverage under the Policy after the expiry of 48 months for any pre- xiv) Circumcisions (unless necessitated by Illness or injury and forming
existing disease is subject to the same being declared at the time of part of treatment)
application and accepted by Insurer. xv) Refractive error: Code – Excl15
d) We will not make any payment for any claim in respect of any Expenses related to the treatment for correction of eye sight due to
Insured Person caused by, arising from or in any way attributable refractive error less than 7.5 dioptres
to any of the following unless expressly stated to the contrary in
xvi) Change of gender treatments: Code – Excl07
this Policy:
Expenses related to any treatment, including surgical management,
i) Treatment arising from or consequent upon war or any act of war,
to change characteristics of the body to those of the opposite sex.
invasion, act of foreign enemy (whether war be declared or not or
caused during service in the armed forces of any country), civil war, xvii) Cosmetic or plastic surgery: Code – Excl08
public defence, rebellion, revolution, insurrection, military or usurped Expenses for cosmetic or plastic surgery or any treatment to change
acts, nuclear weapons/materials, chemical and biological weapons, appearance unless for reconstruction following an Accident, Burn(s)
radiation of any kind. or Cancer or as part of medically necessary treatment to remove
ii) Breach of the law: Code – Excl10 a direct and immediate health risk to the insured. For this to be
considered a medical necessity, it must be certified by the attending
Expenses for treatment directly arising from or consequent upon any
Medical Practitioner.
Insured Person committing or attempting to commit a breach of law
with criminal intent. xviii) Unproven treatment: Code – Excl16
iii) Intentional self-injury or attempted suicide. Expenses related to any unproven treatment, services and supplies
for or in connection with any treatment. Unproven treatments are
iv) Hazardous or Adventure sports: Code – Excl09
treatments, procedures or supplies that lack significant medical
Expenses related to any treatment necessitated due to participation documentation to support their effectiveness
as a professional in hazardous or adventure sports, including but
xix) Investigation and evaluation: Code – Excl04
not limited to, para-jumping, rock climbing, mountaineering, rafting,
motor racing, horse racing or scuba diving, hand gliding, sky diving, a) Expenses related to any admission primarily for diagnostics and
deep-sea diving. evaluation purposes only are excluded.
v) Treatment for alcoholism, drug or substance abuse, or any addictive b) Any diagnostic expenses which are not related or not incidental to
condition and consequences thereof. Code – Excl12 the current diagnosis and treatment are excluded
vi) Obesity/Weight control: Code – Excl06 xx) Rest cure, rehabilitation, and respite care: Code – Excl05
Expenses related to the surgical treatment of obesity that does not Expenses related to any admission primarily for enforced bed rest
fulfil all the below conditions: and not for receiving treatment. This also includes:
A. Surgery to be conducted is upon the advice of the Doctor a) 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,
B. The surgery/Procedure conducted should be supported by clinical
moving around either by skilled nurses or assistant or non-skilled
protocols
persons.
C. The member has to be 18 years of age or older and
b) Any services for people who are terminally ill to address physical,
D. Body Mass Index (BMI); social, emotional and spiritual needs.
I. greater than or equal to 40 or xxi) Any non-allopathic treatment except to the extent of coverage
II. greater than or equal to 35 in conjunction with any of the following provided for under ‘Sickness Hospital Cash’ and ‘Accident Hospital
severe co-morbidities following failure of less invasive methods of Cash’ covers.
weight loss: xxii) Any treatment or part of a treatment that is not medically necessary.
a. Obesity-related cardiomyopathy xxiii) Any Insured Person committing or attempting to commit intentional
b. Coronary heart disease self-injury or attempted suicide or suicide while mentally sound or
c. Severe Sleep Apnoea unsound.
d. Uncontrolled Type2 Diabetes xxiv) Any Insured Person’s participation or involvement in naval, military
or air force operation.
vii) General debility or exhaustion (“run-down condition”)
xxv) Investigative treatment for Sleep-apnoea, General debility or
viii) External congenital diseases, defects or anomalies exhaustion (“run-down condition”).
ix) Growth hormone therapy. xxvi) Congenital external diseases, defects or anomalies,
x) Maternity: Code – Excl18 xxvii) Stem cell harvesting, or growth hormone therapy.
a) Medical treatment expenses traceable to childbirth (including xxviii) Investigative treatments for analysis and adjustments of spinal
complicated deliveries and caesarean sections incurred during subluxation, diagnosis and treatment by manipulation of the skeletal
hospitalization) except ectopic pregnancy; structure or for muscle stimulation by any means except treatment
b) Expenses towards miscarriage (unless due to an accident) and lawful of fractures (excluding hairline fractures) and dislocations of the
medical termination of pregnancy during the policy period. mandible and extremities).
xi) Sterility and infertility: Code – Excl17 xxix) Circumcisions (unless necessitated by Illness or Injury and forming
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No. 146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation,
2 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. Trade Logo
displayed above belongs to HDFC Bank Ltd and ERGO International AG and used by the Company under license. UIN: Optima Cash - HDHHLIP21339V022021.
HDFC ERGO General Insurance Company Limited
xxxiv) Any treatment and associated expenses for alopecia, baldness • As per the enclosed tariff sheet.
including corticosteroids and topical immunotherapy wigs, toupees, LOADINGS
hair pieces, any non-surgical hair replacement methods, Optometric We may apply a risk loading on the premium payable (based upon the
therapy. declarations made in the proposal form and the health status of the
xxxv) Dental treatment and surgery of any kind, unless requiring persons proposed for insurance). The maximum risk loading applicable
Hospitalisation for an individual shall not exceed above 100% per diagnosis / medical
condition and an overall risk loading of over 150% per person. These
DISCOUNT loadings are applied from Commencement Date of the policy including
• Family discount of 10 % if 2 or more members are included under the subsequent renewal(s) with us or on the receipt of the request of increase
same policy. in sum insured (for the increased Sum Insured).
• Discount of 5% on published tariff, if customer is already insured with We will inform you about the applicable risk loading through a counter
Us in any other policy and buys Optima Cash Policy through online/ offer letter. You need to revert to us with consent and additional premium
Tele sales channel. (if any), within 15 days of the issuance of such counter offer letter. In case,
• Discount of 5% on published tariff, if customer buys Optima Cash you neither accept the counter offer nor revert to us within 15 days, we
policy through Our Online, Tele Sales or Bancassurance channel. shall cancel your application and refund the premium paid within next 7
days.
RENEWABILITY Please note that we will issue policy only after getting your consent.
• We offer renewal unless the Insured Person or any one acting on
behalf of an Insured Person has acted in a improper, dishonest or MORATORIUM PERIOD
fraudulent manner or any misrepresentation under or in relation to After completion of eight continuous years under this Policy no look
this policy or the Policy poses a moral hazard. back would be applied. This period of eight years is called as Moratorium
• Grace Period - Grace Period of 15 days for renewing the Policy is Period. The moratorium would be applicable for the Sums Insured of the
provided under this Policy. first Policy and subsequently completion of eight continuous years would
be applicable from date of enhancement of Sums Insured only on the
• Maximum Age - There is no maximum cover ceasing age on enhanced limits. After the expiry of Moratorium Period no claim under
renewals this Policy shall be contestable except for proven fraud & permanent
• Waiting Period - The Waiting Periods mentioned in the policy exclusions specified in the policy contract. Co-payment and Deductible
wording will get reduced by 1 year on every continuous renewal of specified in the Policy. The Policy would however be subject to all limits,
your Optima Cash policy. sub limits, co-payments, Deductibles as per the policy contract.
• Renewal Premium - Renewal premium are subject to change with PORTABILITY
prior approval from IRDA.
The insured person will have the option to port the policy to other
• Sum Insured Enhancement - Sum Insured can be enhanced only insurers by applying to such insurer to port the entire policy along with
at the time of renewal subject to no claim have been lodged/ paid all the members of the family, if any, at least 45 days before, but not
under the policy. If the Insured increases the Sum Insured, the case earlier than 60 days from the policy renewal date as per IRDAI guidelines
will be subject to medical underwriting. In case of increase in the Sum related to portability. If such person is presently covered and has been
Insured waiting period will apply afresh in relation to the amount by continuously covered without any lapses under any health insurance
which the Sum Insured has been enhanced. However the quantum policy with an Indian General/Health insurer, the proposed insured
of increase shall be at the discretion of the company. person will get the accrued continuity benefits in waiting periods as per
Possibility of Revision of Terms of the Policy Including the Premium IRDAI guidelines on portability.
Rates Detailed Guidelines on Portability are available at
The Company, with prior approval of IRDAI, may revise or modify the https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_Layout.
terms of the policy including the premium rates. The insured person aspx?page=PageNo3987
shall be notified three months before the changes are effected.
REQUIREMENT
Completed proposal form
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. Trade Logo 3
displayed above belongs to HDFC Bank Ltd and ERGO International AG and used by the Company under license. UIN: Optima Cash - HDHHLIP21339V022021.
HDFC ERGO General Insurance Company Limited
Cancellation
i. The policyholder may cancel this policy by giving 15days’ written notice and in such an event, the Company shall refund premium for the unexpired
policy period as detailed below.
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No. 146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation,
4 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. Trade Logo
displayed above belongs to HDFC Bank Ltd and ERGO International AG and used by the Company under license. UIN: Optima Cash - HDHHLIP21339V022021.
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. Trade Logo 5
displayed above belongs to HDFC Bank Ltd and ERGO International AG and used by the Company under license. UIN: Optima Cash - HDHHLIP21339V022021.