HDFC ERGO Easy Health Insurance Family Floater Plan
When it comes to alleviating the unplanned financial burden arises due to an emergency hospitalisation, health insurance always comes in handy. In this regard, Easy Health Insurance by HDFC ERGO Health health insurance is one of the decent health insurance policies offered by the insurer. The policy outstands due to the widespread coverage offered.
Some of the features like pre and post-hospitalization expenses, domiciliary/home treatment, all day care procedures, daily cash for choosing shared accommodation, maternity expenses etc. have made the policy worth considering. The plan also extends its cover to major critical illnesses, treating which can be a costly affair. Let’s have a glance at how the plan works and its coverage.
Features of HDFC ERGO Health Easy Health Insurance
This plan can be availed in both Individual and Floater sum insured basis with three variants:
- Standard - Sum Insured ranging from Rs.2 lakh - Rs.15 lakh
- Exclusive - Sum Insured ranging from Rs.3 lakh - Rs.50 lakh
- Premium - Sum Insured ranging from Rs.4 lakh - Rs.50 lakh
- Additional coverage for Critical illness with comprehensive protection
- Comes with portability option where the insured can switch from one company to another or one plan to another within the insurer
- Premium is decided based on the location
- Tax benefit can be availed for the premium paid
- The policy comes with no capping on room rent or copayment
Benefits of HDFC ERGO Health Easy Health Family Plan
Scope of Cover Offered Under HDFC ERGO Health Easy Health Family Plan
- Pre-hospitalisation Expense- The insurer compensates the expenses for treatment, medications, consultation incurred up to 60 days pre-hospitalisation.
- Post-hospitalisation Cover- Compensates the expenses incurred in medicines, treatment, drugs availed post-discharge from the hospital for 90 days.
- Non-allopathic Treatment Cover- The expenses of Ayurvedic, Unani, Sidha or Homeopathic treatment are covered only if the same is availed from a recognised hospital.
- Daily Cash Allowance- Depending on the cover you have owned, you can enjoy daily cash value of Rs. 500 to a maximum of Rs. 6000 per day.
- Health Check-up- Complementary health check-up is offered on every 2 to 4 claim free year.
- Daily Cash for Accompanying Insured Child- depending on the plan you can enjoy a minimum of Rs. 800 to a maximum of Rs. 24000 daily cash allowance.
- Maternity & Child Birth- After serving a waiting period the insured can avail maternity benefit under Exclusive and Premium policy variants.
- New Born Cover- On payment of additional premium. However, the Standard plan doesn’t cover this.
- Outpatient Dental Cover- Only offered under Premium plan option up to 1% of sum insured.
- Emergency Air Ambulance- Covered up to Rs. 2.5 lakh/hospitalisation (plan basis)
- Critical Illness Rider- this optional benefit can be added where 50% or 100% of sum insured is paid subject to a minimum of Rs 1 lakh and Rs. 10 lakh.
- Out-patient Dental Cover: after a waiting period of 3 years up to Rs. 5,000
- Recovery Benefit: Recovery benefit of Rs. 10,000 is offered under Premium and Exclusive option for the hospitalisation of more than 10 days.
- Spectacles, Contact Lenses, Hearing Aid: Under Premium variants up to Rs. 10,000
Value-added Benefits of HDFC ERGO Health Easy Health Family Plan
The insurer also offers certain value-added services to promote the well-being of its customers as well as to make the entire process of hospitalisation a hassle-free experience. This includes:
- Health-line: Avail the instant services by providing your customer ID regarding health-related counselling, health information, nutrition and diet, individual referrals etc. These services are offered free of cost
- Cashless Hospitalization: Avail cashless services at over 4000 hospitals across India. The list of cashless hospitals can be found HDFC ERGO Health Family Floater brochure. A pre-authorisation is required to avail planned hospitalisation at least 48 hours before hospitalisation. Emergency hospitalisation should be informed within 24 hours of hospitalisation. The entire process is explained in the policy document.
- Health Risk Assessment: Every customer of HDFC ERGO Health is provided with access to a health risk assessment tool, which helps the insurer to profile each of their health statuses. This is done online where the members get personalised recommendations on diet, lifestyle and nutrition routine.
- Free-look Period: In case should you decide not to continue this plan, you can cancel this within 15 days from the date of policy initiation.
- Enhancement of Sum Insured: While renewing the policy, if you feel the sum insured can be increased or decreased. However, medical test or waiting period may be applied a fresh depending on up to the amount the SI has been increased.
- Tax Benefits - With HDFC ERGO Health Easy Health Family Floater Plan, you can enjoy tax benefits for the premium paid toward the plan.
HDFC ERGO Health Easy Health Family Plan Applicable Waiting Period
- 30 Days: Initial waiting period for claiming the policy for any health issue. Only accidental injuries are an exception
- Covered after 2 years: specific illnesses
- Covered after 3 years: Pre-existing illnesses
- Covered after 3 years: Out-patient dental expenses
(Refer the policy document for the complete list of illnesses covered)
HDFC ERGO Health Easy Health Family Plan: Eligibility Criteria
Minimum Entry Age
91 days- 5 years (if any of the parents is covered)
Maximum Entry Age
Members to be Covered
4 adults and a maximum of 5 children to be covered
Based as per the age of the eldest member (floater cover)
1 & 2 years
Discount Available under HDFC ERGO Health Easy Health Family Plan
- Family discount: 5% if 2 family members are covered
- Family discount: 10% discount on premium if 3 or more family members are covered
- Cumulative Bonus: For not calming your insurance, you can avail a cumulative bonus of 10% up to a maximum of 100%.
Exclusions of HDFC ERGO Health Easy Health Family Plan
The policy doesn’t cover the following conditions:
- Any claim arises within the first 30 days from the date of policy initiation, except accidental claim
- No pre-existing illnesses will be covered before a waiting period of 3 years.
- Expenses incurred for the treatment of HIV or AIDS or other sexually transmitted diseases.
- Congenital illnesses, mental disorder, expenses incurred towards cosmetic surgery and weight management treatment etc.
- Any injury arising under the influence of alcohol or intoxicating drugs
- Hospitalisation owing to any war or war-like situation, nuclear weapon or radiation of any kind
- Except for the specific plan, maternity, dental treatment, external aids are not covered.
- Specific illnesses like Hernia, Cataract, joint replacement will be covered after serving 2 years of the waiting period.
- Items used for personal comfort and convenience
HDFC ERGO Health Easy Health Insurance Renewal
Renewal terms of this plan include:
- Easy Health Policy comes with lifelong renewability. That means there is no maximum age for cover ceasing.
- In case you miss the renewal due that, 30 days of Grace Period id offered to renew the policy.
- Waiting periods get reduced by 1 year at every year continuous renewal
- Renewal premium is subjected to changes as per the prior approval of IRDA. If the insurer makes any changes, the same will be initiated prior to 3 months at least.
Steps to Renew
To renew your existing plan visit the official website of HDFC ERGO Health
- Go to the ‘policy renewal’ button
- Login with the registered ID and Password or with the policy number
- Provide necessary information
- Calculate the premium and pay it online through credit/debit card or net banking
HDFC ERGO Health Easy Health Family Floater Claim Process
The Easy Health Policy can be claimed in two ways- cashless and reimbursement claim. In order to ensure a hassle-free claim, follow the below claim steps:
- Inform the insurer immediately about the vent leading to rising of a claim. To claim for a planned hospitalisation, approach the insurer seeking pre-authorisation for availing the cashless benefit 48 hours prior to the hospitalisation. You’ll require informing the insurer within 24 hours of hospitalisation in case of emergency like accident or severe condition of illness. Approach the TPA or insurance desk in the hospital and complete the formalities
- Once the insurer conveys its decision in your favour, avail the treatment free of cost. The incurred expenses will directly be settled by the insurer with the hospital authority.
- In case of any discrepancy in the documentation, the same will be intimated along with a discrepancy letter with 7 days from the receiving of the document.
- In case the insurer doesn’t approve the cashless request, avail the treatment and pay the expenses on own. Register a reimbursement claim after getting discharged from the hospital. Don’t forget to collect the original bills and receipts
- Make a claim by submitting a complte claim form along with the supporting documents. The insurer will verify the documents and settles the claim up to an admissible amount. The payment will be initiated in the name of policyholder only.
Documents Required to Claim HDFC ERGO Health Easy Health Family Insurance
You’ll require the following documents to claim your insurance in case of emergency:
- Duly filled and signed claim form
- Police FIR in case of accidental claim
- Discharge certificate
- A filled Pre0authoristaion signed by the treating doctor
- Medical report duly signed by the doctor stating about the nature of illness and treatment availed
- Original bills of medicines
- Original hospital bill and receipts
Written By: PolicyBazaar - Updated: 08 January 2021