Plan Overview

HDFC Ergo Health Suraksha is a simple health insurance plan which provides coverage for hospitalization expenses, pre and post hospitalization expenses, expenses incurred on day care procedures, organ donor expenses, domiciliary treatments, etc. AYUSH coverage is also offered under the plan along with other additional benefits like free health check-ups, cumulative bonus for claim-free years, etc. So, it is a comprehensive plan at affordable premium rates.

Benefits included

Hospitalization means any impatient treatment (min. 24 hrs stay) as well as the named 144 day care procedures.

  • Other hospitalisations are covered after 30 days. Cover starts after 30 days, except accidents which are covered from day 1
  • Exceptions : Any pre-existing diseases (PED) which are covered after 4 years and some specified diseases which are covered after 2 years from the policy start date.

Other additional benefits :

  • Cover restoration
  • No claim bonus
  • Free Health Check-up
  • Ambulance charges
  • Daily cash allowance
  • 60 days pre-hospitalisation
  • 90 days post hospitalisation
  • Organ donor expenses
  • Maternity
  • New-born treatment
  • Home treatment
  • Outpatient
  • Ayush treatments
  • Recovery allowance

Out of pocket expenses

  • You will bear all the expenses not covered by the policy. Refer to the list of such expenses in the Policy Exclusions section below
  • Besides, you will have to pay more if you stay in a room category above N.A.

Policy Exculsion

  • Cosmetic surgery
  • Birth defects
  • Medical expenses due to drugs/alcohol abuse
  • Self-inflicted injury
  • Hazardous sports or war related injuries
  • HIV or AIDS
  • Sexually Transmitted Disease(STDs)
  • Consumables
  • Mental illness
  • Genetic disorders
  • Dental treatment / Surgery
  • Eye disorders & lasik laser treatment
  • Hospitalization for only diagnostic purpose
  • Diagnostic Charges
  • Hospital registration or admission fees
  • Administrative Charges
  • Non medical expenses

Claims settlement

  • If you go to a non-network hospital, you will have to get the claim settled on reimbursement basis by providing the original bills and documents to the insurer.
  • If you get admitted to a network hospital, you can get a cashless authorization from the insurer and then the insurer will settle the expenses directly with the hospital. See the list of the network hospitals near you below

Most frequently asked questions

Q. What are Day Care procedures?

A. Day care procedures are such procedures which require hospitalization for less than 24 hours due to the advancement of technology. Since hospitalization is for less than 24 hours, such treatments do not fall under the purview of in-patient hospitalization and are thus categorized as day care treatments. The plan provides coverage for 144 such treatments.

Q. What is the coverage duration for pre and post hospitalization expenses?

A. Pre hospitalization expenses are covered for a period of 60 days and post hospitalization expenses are covered for a period of 90 days.

Q. Can children be covered under the plan?

A. Yes, children aged 91 days and above can be included in the family floater variant of the plan.

Q. How is a claim made for AYUSH treatments?

A. Expenses incurred for in-patient AYUSH treatments are payable under the plan. However, cashless benefit is not allowed. The insured must bear the cost initially which would be later reimbursed by the company.

HDFC Ergo Health Insurance

Health Insurers