How is the newly launched Optima Secure plan by HDFC Ergo? - A Review

• Introduction
• Verdict
• Detailed review of the product
• PROS
• CONS
• What's on offer?
• Who is eligible?
• What is good?
• What could be better?
• How is the service and claims experience of HDFC Ergo health insurance company?
• What should you know before you buy?
• How expensive is Optima Secure?

HDFC Optima Secure is a health insurance plan provided by HDFC Ergo, one of the leading health insurance companies in India. This plan is essentially a hospitalization cover that promises to pay the exact costs incurred during hospitalization, and expenses leading to and following the hospitalization.

The product’s brochures and campaigns promise a 4X cover. The 4X cover basically comprises a 2X cover (Secure Benefit) from Day 1, the restoration benefit, and the No Claim Bonus put together.

Let’s understand more about this plan, whether it really makes sense to buy this plan in comparison to HDFC’s existing plan - Optima Restore plan as well as other competing plans in the market.

About the Insurer:  HDFC Ergo also known as HDFC Ergo General insurance company Ltd is a leading general insurance company in India. They offer general insurance products ranging across Motor, Health, Travel, Home, and Personal Accident insurance. They also offer products like Property, Marine, and liability insurance. Founded in 2002, HDFC Ergo is a joint venture between HDFC (Housing Development Finance Corporation) Limited and ERGO International AG. The company currently has 200+ branches across 170+ cities. 

In addition to this plan, HDFC Ergo also provides other health insurance products such as Optima Restore, Medisure Super Top-Up plan, Critical Illness Insurance, etc.

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HDFC Ergo’s Optima Secure plan offers the promise of a 4X cover. Unfortunately, this is mostly a promotional tactic. 

The 2X part of the cover is already factored in the pricing, and the remaining 2X is offered by several other plans in the form of NCB and Restoration Benefit. 

Here’s how the 4X coverage is arrived at.

1. 2X Secure Benefit - Instantly double the cover amount, from Day 1. However, the premium is higher than the 2X cover offered by other insurers. 
2. + 1X Plus Benefit - Is basically a No-claim Bonus benefit whether or not you make a claim, and is available with at least 3 other plans, Max Bupa Health Companion plan, Royal Sundaram Lifeline plan,  Magma HDI One Health plan (As no claim bonus which is not reversed when you make a claim)
3. + 1X Restore Benefit - Is available with Max Bupa and Aditya Birla amongst others (As Restore/ ReAssure/Reinstatement/Refill benefit)

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Optima Secure plan is a newly launched product from HDFC Ergo health insurance. It offers several top-end benefits, packed into one big package, marketing it as a 4X Cover. On face value, this might seem like a very enticing option. However, deeper analysis shows that the benefits aren’t very different or affordable - compared to other similar plans in the market. 

1- Of the 4X benefit, other competing plans from Max Bupa and Aditya Birla already offer 2X benefit through Restoration, No-claim bonus, etc. 

The only new benefit that Optima Secure exclusively offers is the 2X cover on Day 1 of the policy. This means you are getting a buy-one-get-one-free offer from this insurer. To know if this 2X BOGO cover is worth it - let’s compare the premiums.

2- On a premium comparison, we found that a 25 lakh cover of MaxBupa ReAssure is less expensive than a 10 lakh cover of HDFC Optima Secure (net cover of 20 lakhs). 

In fact, a 20 lakh cover of HDFC Optima Restore is only marginally more expensive than the 10 lakh cover of HDFC Optima Secure. 

So, we see that any cost advantage we expect from this plan is non-existent. 

3- Remember, this 2X benefit is a separate benefit, and not really your core coverage; the only benefit in a health insurance plan that cannot ever be reversed is the base sum insured. All other benefits including the 2X cover feature, No claim bonus, Restore feature, etc. - can be removed at a later date by withdrawing the policy and replacing it with another without the bells and whistles. So, in our opinion - you should invest in an adequate base cover, regardless of the additional feature / 2X promise. 

4- Taking this possibility into consideration, we compared premiums of 10lakh policies from HDFC Ergo and MaxBupa - and found that HDFC Ergo Optima Secure could be considerably more expensive. 

Premium of MaxBupa ReAssure - 10 Lakh base cover = 9111/-

Premium of HDFC Optima Secure - 10 Lakh base cover = 15135/-

5- Detailed analysis of the 4X promise of the Optima Secure plan

• 2X Secure Benefit - Premium is higher than 2X cover offered by other insurers. 
• + 1X Plus Benefit - Is available with at least 3 other plans, Max Bupa Health Companion plan, Royal Sundaram Lifeline plan,  Magma HDI One Health plan (As no claim bonus which is not reversed when you make a claim)
• + 1X Restore Benefit - Is available with Max Bupa and Aditya Birla amongst others (As Restore/ ReAssure/Reinstatement/Refill benefit

6- Another important point to remember is that this policy imposes room-rent limits on all covers below the sum insured of 50 lakhs. You can only choose a Single Private Room for any sum insured that is below 50 lakhs. In case you choose a room of a higher category, you will have to pay a part of your entire bill through proportionate deductions. This is a major letdown. 

7- In Optima Secure, the restoration benefit will get triggered from the second claim in a policy year. However, in many other plans in the market, including Optima Restore, the restoration benefit gets triggered from the very first claim you make in a policy year. 

8-Using the Protect benefit - you can get the insurance plan to pay for a list of non-medical expenses such as baby food, gloves, thermometers, masks, PPE kits, mineral water, etc. as well.

9- Apart from the cost comparison, the insurance company HDFC Ergo does rank very high both in terms of their claims experience as well as service quality based on Beshak Ratings - meaning based on the data we have analyzed, you are more likely to get a smooth experience with them throughout your health insurance journey, compared to other insurers.

10- As a result, it's a call. The higher cost might be justified if getting a smooth experience is a top priority for you.

11- HDFC Optima Secure comes with most of the important features and benefits you’ll need in a good health insurance plan. Having said that, it comes at a considerably higher cost, compared to other similar products from the same insurer as well as other insurance companies, despite the promise of 2X coverage. 

12- You should go through all policy terms and conditions carefully before applying for the plan. When in doubt, ask your financial advisor, get clarity, and only then go ahead with your purchase.

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• Increase coverage through a variety of features. 
  • Secure Benefit: Increases sum insured to 2X from day one, for no additional cost.
  • Super Secure Benefit: (applicable to 3-year policy durations): Increases sum insured to 3X from day one, for no additional cost
  • Plus Benefit: Sum insured increases automatically by 50% per year (max limit 100%) regardless of claims made. 
• Restore benefit is available for related and unrelated conditions, and partial and full utilization of sum insured. 
• Non-medical expenses are covered. This has especially become super important post-pandemic when people saw 30-40% of their claim getting deducted due to non-medical expenses like masks, sanitation, etc. 
• Road ambulance charges, dental treatments (due to disease/ injury), and Plastic surgery (due to injury) form a part of InPatient and are covered without limits.
• Domiciliary treatments and home healthcare are covered separately
• Your family is eligible for Annual Health checkups regardless of making claims
• Inpatient hospitalization expenses of the organ donors are covered up to the Sum Insured, without any limits, like many other plans. 
• Surgeries such as cataracts, kidney stone removal, etc. are covered without any sub-limits. 

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• Comparatively costlier than similar products in the market, despite offering 2X coverage.
• Room rent limits are applicable up to 50 lakhs of Sum Insured.
• Restoration benefit will get triggered from the second claim you make in a policy year.
• Pre-approval is needed for home healthcare.
• Home healthcare is available only in metro cities
• All benefits are inbuilt, with no option to customize based on your needs.

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HDFC Ergo’s Optima Secure Plan is an indemnity-based hospitalization insurance plan. This means that the policy will pay for the exact costs incurred during your hospitalization (as per other terms and conditions), up to a maximum of your sum insured. The cover is applicable for all types of hospitalization including illness, disease, and accidents - and requires that you’re admitted for at least a 24 hour period to kick in. 

In addition to covering expenses incurred during hospitalization, the policy also pays for related expenses leading to and following the hospitalization under their pre and post-hospitalization expenses clauses. Pre-hospitalisation is covered for 60 days, while post-hospitalization is covered for 180 days. 

Further, this plan also covers expenses incurred by the organ donor when you’re the recipient of the organ, daycare treatments (complex medical treatments that can be completed in less than 24 hours due to advancements in medical science and technology), and also for Domiciliary treatment. (Domiciliary treatments are those treatments that you take at home because hospital beds are not available or it is too risky to move the patient to the hospital, because of their condition. This is not the same as home treatments.)

This plan allows you a variety of Sum Insured options ranging from a minimum of INR 5 lakhs to a maximum of INR 2 Crores.

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• Adults in the age bracket of 18 years  - 65 years can buy this policy. However, this policy is renewable for life. This means that as long as you buy the policy in the above age bracket you can renew it for as long as you’re alive. 
• Dependent children in the age bracket of 91 days to 25 years can be covered.
• Under multi-Individual plans, you can buy the plan for 6 Adults and 6 Children. 
• If you wish to buy this as a floater policy for multiple family members - you can cover up to 4 adults (amongst self, spouse, parents, in-laws) and up to 6 children under the same plan. 
• People with pre-existing conditions too can apply for this policy. However, there might be a premium loading applied. (additional loading requested to cover the risk of the disease). Also, a pre-existing disease waiting period of 2-4 years might be applied.

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This plan offers lots of options to retain and increase your cover amount such as -

• Secure Benefit: With this in-built benefit, your sum insured automatically increases to 2X the amount you choose without any additional cost or opt-in. 
• Super Secure Benefit: With this, an in-built feature is available if you purchase the plan for a 3-year period. With this, you can triple your cover amount from Day 1,  for no additional cost. The premium for the Super Secure plan might be higher than a Secure plan.
• Plus Benefit: With this in-built feature, your cover amount is automatically increased by 50% for every policy year up to a maximum of 100% Sum insured. The benefit is that this increase is not reversed when you make a claim.
• Restore benefit is very comprehensive. Sum Insured gets restored for both related and unrelated illnesses, as well as for partial and full utilization of the sum insured. 
• Protect benefit: With this in-built feature, this plan offers to pay for all listed non-medical expenses without any additional cost or opt-in. As a result, it is possible for you to get almost 100% of your hospital bill paid.
• There are no sub-limits imposed on road ambulance costs, dental treatments (due to disease/ injury). Plastic surgery (due to injury) under hospitalization expenses. 
• All Domiciliary (treatments taken at home due to specific compulsions) and all home healthcare treatments are covered.
• Health checkups can be utilized annually by adults and children in the policy regardless of whether you make a claim or not
• There are no sub-limits for treatment in the policy
• All inpatient costs for organ donors (when you are an organ recipient) are covered. 
• Surgeries such as cataracts, kidney stone removal, etc. are covered without any sub-limits imposed. 
• With this policy, you get an option to choose a yearly deductible when you buy the policy. You can get a premium discount by choosing a deductible. For example - for a 20 lakh Sum insured policy, you could choose deductibles of INR 25K, 50K, or 1L as a deductible and receive a premium discount of 25%, 40%, and 50% respectively. 

This can be beneficial for people who are willing to take some of the hospitalization cost burden (if and when it occurs), for a premium reduction - such as senior citizens, or even young individuals who want to buy a large cover for a smaller premium. 

Note that once the deductible is chosen at inception, it cannot be withdrawn at the time of renewal.

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• Comparatively costlier than similar products in the market
• Room rent limits are applicable up to 50 lakhs of SI. This might lead to you paying a part of the entire bill through proportionate deductions, in case you choose a room that is beyond the approved limit. 
• There are many plans where restoration benefit gets triggered from the very first claim you make in a policy year. In Optima Secure, however, the restoration benefit will get triggered from the second claim.
• If you want to get the cover for home healthcare, (not to be confused with Domiciliary treatment)  you will need to take pre-approval at least 48 hours before treatment begins. Also, this service is only applicable in metro cities
• There are no add-ons in this policy. All the benefits are in-built. No option to customize your plan as per your needs.

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According to research done by Beshak’s team, we found that the insurer - HDFC Ergo ranks very high in terms of the quality of their service and their claims experience. The Ratings are as follows -

Customer service rating: 4.9 / 5

Claims experience rating: 4.4/ 5

This makes this insurer one of the top-rated health insurance providers in the country if getting a smooth experience and good service is a priority for you. 

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• You should not get swayed by enticing offers such as getting a 4X cover -  2X cover from Day-1, a 50% no-claim bonus, etc. First, the pricing of the policy factors its 2X covers. Second, remember that these benefits can be withdrawn by the company at any time in the future, based on their performance and profitability. The only feature that your insurer cannot reduce is the Sum Insured. So, it is important for you to get an adequate cover - and take the cover received through Secure, Restore, Plus (no-claim bonus) benefits for what they are - a bonus.
• Depending upon your lifestyle and medical history, premium loading (additional premium requested by the insurer to cover the risks due to your previous or current illnesses, and lifestyle habits such as smoking or drinking) might be applicable. Every insurer analyses your profile with a different set of parameters and metrics - and charges an additional premium based on that. 
• The premium of every health insurance policy might get revised every year. So, it is important that you prepare to pay higher premiums, as you grow older. 

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Here’s a sample premium comparison of HDFC Optima Secure with some of the top health insurance products in the market. 

Comparison 1:

• Sum insured - 10 Lakh of all plans
• Age when the policy is bought: 30 Years
• Policy Term: 1 Year
• Date when the premiums were calculated: 8th October 2021.
• All premiums mentioned below are inclusive of taxes. 

• You’ll see from the above table that HDFC Optima Secure is indeed more expensive than other similar products in the market. 
• It is -
  • 31% costlier than the premium of HDFC Optima Restore (another health insurance product from the same insurer)
  • 66% higher than Max Bupa’s Reassure, and
  • 74% higher than Care Insurance’s Care policy.

Comparison 2:

• Sum insured - 10 Lakh Optima Secure | 20 Lakhs of all other plans
• Age when the policy is bought: 30 Years
• Policy Term: 1 Year
• Date when the premiums were calculated: 8th October 2021.
• All premiums mentioned below are inclusive of taxes. 

• You’ll see from the above table that HDFC Optima Secure is indeed more expensive than even 2X covers from other similar products in the market, with the exception of Optima Restore (which too is provided by HDFC Ergo itself)
• It is -
  • 6.93% cheaper than the premium for 2X cover of HDFC Optima Restore
  • 14% higher than Max Bupa’s Reassure, and
  • 21.68% higher than Care Insurance’s Care policy.

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