Features of HDFC Ergo Health Insurance

  • No. of members- The plan covers maximum 4 members of your family with up to 2 children and 2 adults.
  • Lifelong Renewal – The plans offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
  • No Sub-Limits on Room Rent - As sub-limits on room rent practically eat into your sum insured, HDRC ERGO scores brownie points for their plans without any sub-limits on the room rent.
  • Wide Sum Insured Options – For every claim-free year you earn 5% bonus.
  • Pre & Post hospitalization cover- The plan covers medical expenses for 60 days prior to hospitalization and 90 days post hospitalization only for related medical expenses.
  • Health Check-ups – On successful completion of 4 claim-free years, the health check-up expenses are reimbursed.
  • Pre-existing diseases- Pre-existing diseases are covered after 4 years of waiting period.
  • Co-payment- The plan has no co-payment policy.

Benefits of Buying Health Insurance from HDFC ERGO Health Insurance

  • HDFC ERGO has an iAAA rating from the ICRA, indicating that HDFC ERGO insurance have a high ratio of claim settlement
  • Products are designed intuitively and are suited for everyone, whatever your needs be
  • Great customer service post sales

Products offered by HDFC ERGO

HDFC ERGO Health Suraksha Policy

Health Suraksha Policy offered by HDFC ERGO is a basic health insurance plan which covers most of the hospitalization expenses. The coverage under this plan is available as both individual and family floater.

Individual Coverage :

  • This policy offers basic coverage in the range of Rs. 3 lakh and Rs. 5 lakh for individuals of any age above 3 months.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, cashless benefit, hospital expense cover, ambulance cover, etc., are benefits provided in the plan.
  • Maternity benefit, critical illness cover (lump sum amount payment), co-payment, etc. can be additionally opted in the same policy. If you are under the age of 45, you need not go through a medical checkup. The policy also covers over 140 day care procedures.

Family Floater Coverage :

  • This is a basic family floater plan, which covers health costs of the entire family in the range of Rs. 3 lakh and Rs. 5 lakh.
  • A maximum of 2 adults and 2 children in the family of any age above 3 months can be covered under this policy.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, cashless benefit, hospital expense cover, ambulance cover, etc., are provided in the plan.
  • Maternity benefit, critical illness cover (lump sum amount payment), co-payment, etc. can be additionally opted in the same policy.

Health Suraksha Gold Policy

Health Suraksha Gold is advanced version of Health Suraksha Plan which has an option to opt for additional critical illness cover. The coverage under this plan is available as both individual and family floater.

Individual Coverage :

  • This policy offers basic coverage in the range of Rs. 2 lakh and Rs. 10 lakh for individuals of any age above 3 months.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, maternity benefit, cashless benefit, hospital expense cover, ambulance cover, etc., are benefits provided in the plan.

  • Critical illness, co-payment, etc. can be additionally opted in the same health insurance policy.

Family Floater Coverage :

  • This is a family floater plan, which covers health costs of the entire family in the range of Rs. 2 lakh and Rs. 10 lakh.
  • A maximum of 2 adults and 2 children in the family of any age above 3 months can be covered under this policy.
  • Pre and post hospitalization expenses, No sub-limits, No-claim bonus, maternity benefit, cashless benefit, hospital expense cover, ambulance cover, etc., are provided in the plan.
  • Critical illness, co-payment, etc. can be additionally opted in the same policy.

Health Suraksha Regain Policy

Health Suraksha Regain is the plan with restore benefit offered by HDFC ERGO. The coverage under this plan is available as both individual and family floater.

Individual Coverage :

  • This policy offers basic coverage in the range of Rs. 3 lakh and Rs. 10 lakh for individuals of any age above 3 months.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, hospital expense cover, ambulance cover, etc., are benefits provided in the plan.
  • In addition to the above mentioned benefits this plan also has a restore benefit facility (this benefit results in automatic restoration of coverage amount in case it is exhausted in a particular year).

Family Floater Coverage :

  • This is a family floater plan, which covers health costs of the entire family in the range of Rs. 2 lakh and Rs.10 lakh.
  • A maximum of 2 adults and 2 children in the family of any age above 3 months can be covered under this policy.
  • Pre and post hospitalization expenses, No sub-limits, No-claim bonus, hospital expense cover, ambulance cover, etc., are benefits provided in the plan.

  • In addition to the above mentioned plan this plan also has a restore benefit facility.

Health Suraksha Top-up Plus Policy

Health Suraksha Top-up as the name suggests is a top-up plan offered by HDFC ERGO. It offers coverage on individual and family floater basis.

Individual Coverage :

  • This is a top-up plan (these plans have an agreed upon deductible amount to be paid at the time of claim) for individuals from age 5 years up to 65 years.
  • The coverage amount for this plan is in the range of Rs. 2 lakh and Rs. 10 lakh and the deductible amount is in the range of Rs. 1 lakh and Rs. 5 lakh.
  • This plan offers basic coverage like pre and post hospitalization expenses, no sub-limits, no-claim bonus, hospital expense cover, ambulance cover, etc.

Family Coverage :

  • This is a family health insurance top up plan (these plans have an agreed upon deductible amount to be paid at the time of claim) which covers health costs of the entire family.
  • The coverage amount for this plan is in the range of Rs. 2 lakh and Rs.10 lakh and the deductible amount is in range of Rs.1 lakh and Rs.5 lakh.
  • A maximum of 2 adults and 2 children in the family between age 5 years up to 65 years can be covered under this policy. This plan offers basic coverage like pre and post hospitalization expenses, no sub-limits, no-claim bonus, hospital expense cover, ambulance cover, etc.

Critical Illness Silver Policy

  • One of the benefit plans offered by HDFC ERGO is the Critical illness plan which offers lump-sum benefit post diagnosis of critical illness. There are two variants available of this plan.
  • This plan specially offers individual cover for critical illness in the range of Rs.1 lakh and Rs.50 lakh for individuals between age 5 years and 65 years.
  • In this plan a lump sum amount equal to sum insured is offered to policyholder in case of critical illness or accident.
  • Critical Illness insurance offers coverage in case of heart attack, coronary bypass surgery, stroke, cancer, kidney failure, major organ transplants, multiple sclerosis and paralysis.

Critical Illness Gold Policy

  • This plan specially offers individual cover for critical illness in the range of Rs.1 lakh and Rs.50 lakh for individuals between age 5 years and 65 years.
  • In this plan a lump sum amount equal to the sum insured is offered to policyholder in case of 8 critical illnesses.
  • In addition to the silver plan this plan offers coverage in case of aorta graft surgery, primary pulmonary arterial hypertension, and heart valve replacement.
  • If you want to be completely sure that all your expenses in case of critical illness are getting covered, then know more about critical illness Gold Plan by HDFC ERGO which is advanced variant of critical illness silver plan.

Critical Illness Platinum Policy

  • This plan specially offers individual cover for critical illness in the range of Rs.1 lakh and Rs.50 lakh5 for individuals between age 5 years and 65 years.
  • In this plan a lump sum amount equal to sum insured is offered to policyholder in case of 15 critical illnesses.
  • In addition to the gold plan this plan offers coverage in case of benign tumor, Parkinson's disease, Alzheimer's disease and end stage liver disease.

Personal Accident Insurance Policy

  • Another benefit plan offered by HDFC ERGO which offers lump-sum benefit post death or disability resulting from an accident.
  • This plan offers coverage in case of accidents anywhere in the world in the range of Rs. 2.5 Lakh and Rs. 15 Lakh to individuals below age 65 years.
  • In this plan a lump sum amount in case of accidental death, daily cash in case of illness & accident, covers permanent or temporary total disability, injuries with broken bones or burns as well as ambulance costs.

Claims Process at HDFC ERGO Health Insurance

There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

HDFC Ergo Health Insurance has a well-defined claim processing system.

Cashless Service: Seeking Pre-Authorization

  • Complete the pre-authorization form available at the hospital's insurance/TPA Desk.
  • Send the completed form via email or fax.
  • Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
  • In case the authorization is rejected, initiate the treatment and file for reimbursement claim.

Reimbursement Claim: Claim Submission

  • Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
  • Necessary documents include discharge summary, prescriptions, bills etc.
  • Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
  • In case the claim is rejected, the reasons will be communicated by the team.

In case of any emergencies, you need to inform HDFC Ergo within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via HDFC Ergo's toll free number 1800-2000-700, or fax 1800-2000-600. The same could also be emailed to healthclaims@hdfcergo.com.

HDFC Ergo Health Insurance