HDFC ERGO Health Insurance (formerly Apollo Munich Health Insurance) posted a 100% claim settlement ratio in FY 2023-24, the highest in the health insurance segment. This means it paid every single claim it received that year, according to the IRDAI Annual Report.
Optima Secure — the flagship plan
The Optima Secure plan is HDFC ERGO's top seller. Key features:
No room rent cap: you can choose any room in a network hospital without paying the difference from your pocket.
Secure benefit: the sum insured doubles automatically at the second policy renewal if no claim is made.
Co-pay: zero co-payment at all ages at network hospitals.
Restoration: 100% automatic restoration of sum insured after a claim.
Premium estimates
For a 30-year-old individual, Rs 10 lakh sum insured costs roughly Rs 8,000-11,000 per year. For a family of 3 (self, spouse, one child), expect Rs 18,000-25,000 per year for Rs 10 lakh cover.
Premiums are at the higher end of the market, but the no-room-rent-cap and in-house claim settlement (no TPA) justify the cost for buyers who want clean, fast claims.
Who should pick HDFC ERGO Health
Tier 1 city residents who hospitalise at private hospitals with expensive room rates. If you stay in a room above the room rent limit, many insurers make you pay the entire proportionate difference. HDFC ERGO does not have this problem.
People who have had claim troubles with other insurers. The 100% CSR and in-house processing make it a reliable choice.
Not ideal for: buyers primarily focused on premium cost, or those in tier 3 cities where HDFC ERGO's network is thinner.
How to file a claim
Cashless: Inform the hospital's insurance desk at the time of admission. They contact HDFC ERGO directly. Pre-authorisation is typically given within 2 hours.
Reimbursement: Submit bills and documents within 30 days of discharge. HDFC ERGO targets a 7-working-day settlement for complete documentation, without routing through a third-party administrator.