HDFC ERGO Optima Senior: co-payment, waits and what it covers
Optima Senior (UIN HDHHLIP21379V022021) has no room-rent limit, but the room sets your co-payment: 15% of every claim in a shared room and 30% in a single room or higher. 14 listed illnesses and surgeries, including cataract, joint replacement and bypass surgery, carry a 30% co-payment. Pre-existing diseases wait 36 months. There is no cumulative bonus, only a 5% renewal premium discount after a claim-free year.
The co-payment rules
- Shared room or lower: 15% of each claim.
- Single room or higher: 30% of each claim. If you need urgent cardiac or accident care and no shared room is free, 15% applies.
- Day-care procedures: 15%.
- 30% on 14 listed illnesses and surgeries: cataract, hysterectomy, gall bladder removal, prostate surgery, hernia, angiography, arthroscopy, disc surgery, mastectomy, joint replacement, angioplasty, hydrocele, major organ transplant and bypass surgery.
What it covers
| Item | What the wording says |
|---|
| Room and ICU | No limit, but the room type sets the co-payment. |
|---|
| Before and after a hospital stay | 30 days and 60 days. |
|---|
| Road ambulance | ₹2,000 per hospitalisation. |
|---|
| Treatment at home | Covered for more than 3 days. |
|---|
| Bonus | None. A 5% renewal premium discount after a claim-free year. |
|---|
| Restore | None. |
|---|
Waiting periods
| Waiting period | What the wording says |
|---|
| Any illness after you first buy | 30 days. |
|---|
| Pre-existing diseases | 36 months. |
|---|
| Listed illnesses and surgeries | 24 months. |
|---|
Frequently asked questions
What is the co-payment in HDFC ERGO Optima Senior?
15% in a shared room and 30% in a single room or higher, plus 30% for 14 listed surgeries such as cataract and joint replacement.
Does Optima Senior give a no-claim bonus?
No cumulative bonus. You get a 5% discount on the renewal premium after a claim-free year.
What is the pre-existing disease waiting period in Optima Senior?
36 months of continuous cover.
Compare these plans clause by clause
Where this comes from
- HDFC ERGO Optima Senior policy wording, UIN HDHHLIP21379V022021. Clauses Section B, Co-Payment A and B, No Claim Discount, Excl01, Excl02.
Checked against the wording on 2026-10-09.
Terms on this page, explained
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