How Good Is The Secure Benefit Offered By HDFC Ergo Optima Secure? A Review

• Introduction
• Secure Benefit Under HDFC Ergo Optima Secure
• Conditions To Look Out For!
• What's The Catch?
• Wait Wait Wait…There's More!
• So, What Should You Do?

Health insurance is like a life jacket for your health, it helps protect you when you need it most and keeps you afloat even in the most turbulent waters. 

It is a contract between you and the insurance company where your insurer agrees to cover your medical expenses by providing you with a sum of money called the sum insured in exchange for a fee called a ‘premium’. It ensures that, no matter what happens, you will not have to bear the full brunt of healthcare costs at times of need.

And, to give you an extra layer of protection, health insurance has some amazing features -

• No Claim Bonus 
  You receive a No Claim Bonus if you do not make any claims during the policy year. It is like a reward - given either in the form of a premium discount or by increasing your sum insured up to a maximum limit set by the insurer. It is also known as a ‘cumulative bonus’. 
   
• Restoration Benefit 
  When you use your sum insured for any medical expenses in a policy year, the Restoration Benefit kicks in and replenishes your sum insured by a certain percentage - as per policy T&Cs.

Both of these options, however, will increase your sum insured only if certain conditions are met. What if we told you that there is something that doubles your sum insured as soon as you purchase the policy? It’s like a BOGO (Buy one get one free) offer - where you ‘buy’ one sum insured and get another muft, muft, muft!

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Presenting the Secure Benefit: unlike the No Claim Bonus, where your sum insured increases only if you don't file a claim, or the Restoration benefit, which kicks in only after you fully or partially use up your base sum insured and bonus (if any), within a policy year, this feature gives you a double coverage immediately. This provides you with the convenience of not having to wait or adhere to any specific criteria. It offers you coverage that is twice what you originally purchased without the need to activate it or make a claim.

Say you purchase the Optima Secure Health Insurance Plan with a sum insured of Rs 10 lakhs. In this case, your sum insured will instantly double to Rs 20 lakhs. You may use the additional amount for as many admissible claims as you like during a policy year - subject to policy T&CS.

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In quintessential Beshak style, let’s uncover if there are any conditions or fineprint associated with the Secure Benefit -

1️⃣ Applicable Only Once A Year
The Secure Benefit may only be applied once per policy year and any unused amount cannot be carried over to the next policy year. 
For example, Jayesh has a sum insured of Rs 10 lakhs under his health insurance plan. His plan has a Secure Benefit, because of which his sum insured gets doubled to Rs 20 lakhs. After a few months, he gets hospitalised for surgery that amounts to around Rs 15 lakhs. His insurer will cover the hospital bill. But, the remaining sum insured of Rs 5 lakhs will not be carried forward to the next year. 

2️⃣ Extent Of Coverage
You can use the Secure Benefit only to cover the following expenses -

👉 Hospitalisation Expenses, including - 

• Medical expenses for a minimum of 24 hours of hospitalisation.
• Room rent (per-day bed or room charges that you are required to pay when you get admitted to a hospital). 
• Road ambulance expenses.
• Inpatient care dental treatment, i.e., dental care expenses incurred due to disease or injury that necessitates hospitalisation.
• Plastic surgery due to an injury.
• Day Care Procedures (treatments administered under general or local anaesthesia in a hospital or a day care centre, which take less than 24 hours to complete).

👉 Home Health Care Treatments
Treatments that are undergone from the comfort of your home. 

👉Domiciliary Hospitalisation Expenses
Expenses you incur when undergoing medical treatment at home because you are unable to be moved to a hospital due to the severity of the illness or injury or because there are no beds available at the hospital. 

👉AYUSH Treatments
Treatments that don’t come under the scope of conventional Western medicine. These include Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy systems of medicine.

👉Pre-Hospitalisation Expenses
Medical expenses you incur before you get admitted to the hospital like X-rays, diagnostic tests, consultation fees, etc.

👉Post-Hospitalisation Expenses
Medical expenses you incur after you are discharged from the hospital like tests, rehabilitation, physiotherapy, etc.

👉Organ Donor Expenses
Medical expenses associated with the organ donor's hospitalisation for harvesting the donated organ - where the insured is the organ recipient.

👉Non-Medical Expenses
Costs associated with consumables such as gloves, nebulisation kits, etc.

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Despite how unique its proposition may seem, this health insurance plan comes with some disadvantages as well - 

1️⃣ The Plan is Expensive
The plan’s premiums are higher than those offered by other insurers for twice the coverage, making it apparent that it doesn’t necessarily provide a cost benefit if you look at it from all angles. Here’s a comparative table to understand this better - 

Note: The premiums are for a 30-year-old male and were taken on 24th May 2023.

2️⃣ You May End Up With Coverage More Than You Need
It is obvious that a sum insured of Rs 5 lakhs or Rs 10 lakhs will increase to Rs 10 lakhs or Rs 20 lakhs, respectively. This means a higher cover amount, such as Rs 25 lakhs or Rs 30 lakhs, will rise to Rs 50 lakhs or Rs 60 lakhs. Insurers are aware that even if you purchase such a large cover amount, not many claims will be made for that entire sum. This is similar to a restaurant offering an all-you-can-eat buffet: on the surface, it appears to be a great deal, but in reality, most people don’t actually need to eat that much. 

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Health insurance plans, by construct, can change. Here a few other things you should be aware of before you invest in one - 

1️⃣ Premium Hikes Happen At Every Renewal
Most health insurance products on the market usually determine premiums based on specific age bands or age slabs. For example, individuals who belong to age groups 25-30, 30-35, 35-40, etc. may have different premium rates for each age slab. Suppose you are 25 years old. You will need to pay a premium amount as set for the age group 25-30. This amount will remain the same until you reach the age of 30. So, you can enjoy the same premiums for these 5 years.

However, the premiums for the health insurance plans increase with every renewal. Furthermore, the insurer can increase the premium at any time - and there’s no upper cap to it. This is especially concerning as it can leave you vulnerable to dramatic and unexpected increases in premiums with no way to anticipate or plan for them.

2️⃣ Features Can Be Withdrawn Anytime
Imagine you’ve chosen a low sum insured, say 10 lakhs, hoping to get 20 lakhs. Sounds like a decent sum. Right? 

Wrong! What if we said you've taken a huge risk?

Opting for a low sum insured is like walking across a frozen lake: it may appear to be a safe bet but in reality, it carries a huge risk of disaster. 

Why?

According to IRDAI regulations, insurers can withdraw a product or its features at any time. This can be done per their internal product policies and approvals from internal product committees, just by notifying the regulator (IRDAI). Their only obligation is to prove they are experiencing losses based on current terms and pricing. Sometimes, you can even be moved to another product that doesn't have this feature.

You may also feel the need to upgrade your cover, having chosen a lower sum insured. However, as you age and develop lifestyle diseases or medical conditions, upgrading your insurance may become more challenging, as mentioned in the beginning. It is possible that the insurance company may reject your application or charge you a higher premium if you request an upgrade. You may also have to serve additional waiting periods from the year of the upgrade. 

You should, therefore, be prepared for the possibility of your benefits or features becoming obsolete in the future. Emphasising this, it is important to always stay informed of industry trends.

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Don't get swayed by a plan simply because of its attractive features or benefits - view them as extra rewards. 

Say you are looking to buy a car, you may be tempted to buy the one with all the flashy features like a fancy stereo set, plush interiors, etc. But, you need to pay close attention to the engine and core components under the hood to make sure it’s reliable and will last for a long time. 

Likewise, only your core coverage will remain a constant companion for the duration of your plan. So -

• Opt for an optimal sum insured at the time of policy purchase that can provide you with adequate coverage and keep up with ever-increasing medical costs throughout your lifetime. 
• Ensure that there are minimal or no financial limits on room rent, specific treatments, organ donations, modern treatments, etc.

Not to mention the fact that HDFC Ergo Optima Secure’s premiums are quite higher than the premiums charged by other insurance companies for 2x the cover amount. So, you don’t necessarily get a cost benefit as well. 

In all, focus on the core coverage of whichever health insurance plan you buy and ensure that it gives you the best value for your money. 

Having a hard time understanding health insurance plans? Want them simplified? Introducing - Beshak Health Decoder - a one-stop destination to understand the ins and outs of different health insurance plans!  

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