HDFC ERGO Health Wallet Plan

HDFC ERGO Health Wallet (formerly known as Apollo Munich Health Wallet) is first of its kind health plan offered by the insurer, which comes with unique features and benefits. The Reserve Benefit under this plan can be utilised in paying of the additional expenses to be incurred during OPD or any non-payable items. You can also pay up to 50% of your health insurance renewal premiums using this benefit. Let’s know a little more about this policy and how does it function.

Key Features of HDFC ERGO Health Wallet Plan (formerly known as Apollo Munich Health Wallet Plan)

The salient features HDFC ERGO Health Wallet plan (formerly known as Apollo Munich Health Wallet plan) that make the policy worth buying are:

  • The reserve benefit under this policy keeps increasing every passing year
  • 6% of the bonus is offered for non-utilization of balance under this policy
  • This policy can be converted to a full-fledged policy without much hassle
  • The policy comes with restore benefit where the basic sum insured gets restored automatically in case it’s exhausted.
  • The multiplier benefit of this plan enables you to earn rewards for not claiming the insurance.
  • Experience fast and smooth claim settlement
  • Cashless claim services at 5000+ network hospitals across India
  • 100% lifelong renewability
  • Tax benefit to be availed under Section 80D of Income Tax Act.

Key Benefits under HDFC ERGO Health Wallet (formerly known as Apollo Munich Health Wallet)

There are four main benefits apart from the basic coverage offered under HDFC ERGO Health Wallet (formerly known as Apollo Munich Health Wallet) policy. These are:

  • Reserve Benefit - This benefit keeps increasing every policy year if not utilised and can be used to cushion the impact of spiralling medical costs even in the retirement age. A 6& bonus is offered for not claiming the policy, which can be further utilised to pay the premiums up to 50%, post 5 claim-free renewals.
  • Restore Benefit - With this benefit, the basic sum insured of the policy is restored by 100% in case you claim the policy or even exhaust it partially. Let’s say if you have Rs. 5 lakh cover and you claim Rs. 2 lakh. In this case, you SI would be restored up to Rs. 5 lakh. Now you’ll have Rs. 5 lakh (basic cover) minus Rs. 2 lakh(claimed amount) i. e Rs 3 lakh (remaining cover) +Rs 5 lakh (restored cover)= Rs. 8 lakh.
  • Multiplier Benefit - This policy comes with an amazing benefit in which sum insured increases for every claim-free year. The basic sum insured gets increased up to 50% at the time of renewal. So, if you don’t claim your policy even in the second year, the policy sum insured gets doubled.
  • Recovery Benefit - Under this benefit a lump sum of Rs. 10,000 is offered in case of accidental hospitalisation and is the duration of stay exceeds 10 days.
  • Deductible Benefit (optional) - Usually deductible is shared by the insured person, anything beyond that is covered by the insurance company. If this cover has opted, the deductible will be applied to all insured person(s).

Eligibility Criteria

Minimum entry age

Children: 91 days to 5 years

Adult 18 years

Maximum entry age

65 years

Policy ceasing age

No

Policy Tenure

1 year

Member covered

6 members

Waiting Period Clause

  • All claims related to illnesses will be entertained after a waiting period of 30 days
  • Pre-existing health conditions will be entertained only after a waiting period of 36 months
  • Specific illnesses such as Cataract, Hernia, specific surgeries are to be covered after 2-years waiting period.

Scope of Cover under HDFC ERGO Health Wallet Policy (formerly known as Apollo Munich Health Wallet Policy)

  • In-Patient Hospitalisation - Hospitalisation expenses including room rent, nursing expenses, ICU cost, OT cost, doctor’s consultation, medicine, oxygen, X-ray, laboratory etc.
  • Pre-Hospitalisation - Expenses of treating an illness 60 days prior to the hospitalisation.
  • Post-Hospitalisation - The medical expenses incurred in 90 days immediately after discharge from the hospital.
  • Day-Care Procedures - Selected day-care procedures that don’t require 24 hours hospitalisation due to the advancement in medical science and technology.
  • Organ Donor - Treatment expenses for the organ donor at the time of organ transplant
  • Domiciliary Treatment - The treatment expenses incurred in availing treatment at home due to the health condition of the patient
  • Emergency Ambulance - Up toRs. 2000 is paid towards ambulance service availed in transporting the insured to hospital.
  • Ayush Benefit - Expenses for non-allopathic treatment taken under Ayurveda, Unani, Sidha and Homeopathy.
  • Worldwide Emergency Care - Covers emergency hospitalisation expenses outside the country up to a specified limit.
  • Health Check-up - Preventive health check-ups expense cover
  • Critical Illness Rider - It is a rider cover where 8 major critical illnesses are covered including Cancer, Live Donor Organ, Neurosurgery, Coronary Artery by-pass surgery, Heart Valve replacement, Pulmonary artery graft surgery, Bone Marrow Transplant, and Aorta Graft Surgery. You can avail coverage at network hospitals worldwide. Apart from availing quality health care, the coverage is extended to accommodation, cost of accompanying a relative, availing the second opinion and post hospitalisation expenses. This cover can be availed with a basic sum insured Rs. 10 or above.

Additional Benefits

The added benefits to be earned are:

  • Waiver of Deductible benefit - The policy can be converted to a full-fledged health insurance plan with no medical test, between the age 55 to 60 years. The only condition is that the insured has to be enrolled with the insurance company before the age of 50 years. Also, the policy has been renewed continuously throughout.
  • Cashless Service - Cashless services can be availed at more than 55000 hospitals across the country. A pre-authorisation from the insurer is required to avail cashless service. In case of planned hospitalisation, the process has to be initiated 48 hours before the hospitalisation by informing the insurer. In case of emergency, the insurer has to be notified within 24 hours post hospitalisation.
  • Sum Insured Enhancement - Policy sum insured can be enhanced if you feel it insufficient as per your growing requirements with time. This can be possible only at the time of renewal. No medical is required if the enhancement is up to one grid. But if it is more than one grid up, a fresh medical will be required. Also, depending on the increased sum insured amount, a fresh waiting period will be applied.
  • Portability - Under portability benefit, you can switch your existing policy to HDFC ERGO Health (formerly known as Apollo Munich). And this is possible without compromising on the accrued benefits with the existing insurer.
  • Tax Benefits - With the Health Wallet Insurance Plan you can avail tax benefits under Section 80D of Income Tax Act.

Exclusions of HDFC ERGO Health Wallet Policy (formerly known as Apollo Munich Health Wallet Policy)

The policy doesn’t cover the insured person during the below circumstances:

  • No claims are accepted arising from pre-existing illness before 3 years
  • Expenses incurred due to treating HIV/AIDS or other related illnesses
  • Mental disorder, congenital disease, expenses of cosmetic surgery, weight loss program etc. are excluded
  • Injury due to the abuse of drugs, alcohol or intoxicant
  • Injury leading to hospitalisation due to war or war-like situation, an act of a foreign enemy, use of the nuclear weapon
  • Pregnancy, dental treatment, external aids, and appliances
  • Items that are used for personal comfort and convenience
  • Experimental, investigative and unproven treatment devices

HDFC ERGO Health Wallet Claim Process (formerly known as Apollo Munich Health Wallet Claim)

Claiming HDFC ERGO Health (formerly known as Apollo Munich) is easy. If you want to claim cashless service at a network hospital, the following steps need to be ensured:

  • Avail a pre-authorisation letter from the TPA at the hospital. Sign the filled-in form and submit it along with an ID proof
  • The same will be submitted to the insurer for approval of cashless service.
  • If the insurer approves it the same will be coordinated to the hospital authority. If not, the insurer will notify the reason of rejection within a few hours.
  • On approval, you can avail cashless treatment, where the incurred bill will be settled by the insurer directly with the hospital authority.
  • In case your cashless request is rejected then pay the expenses initially and register a claim later.
  • Collect all the original bills, report and submit along with the filled-in claim form. The insurer will reimburse the amount after verifying the documents.

HDFC ERGO Health Wallet Renewal Process (formerly known as Apollo Munich Health Wallet Renewal)

Health wallet policy comes with lifelong renewal feature which means there is no maximum cover ceasing age. However, the policy requires timely renewal. The insurer provides 30 days grace period, in case you miss the renewal due date.

The applicable waiting period gets reduced by 1 year with every continuous renewal of HDFC ERGO Health Wallet plan (formerly known as Apollo Munich Health Health Wallet plan). Renewal premiums are subject to change as per the prior notice of IRDA. However, the insured has to be informed at least 3 months prior to any change to be made.

Written By: PolicyBazaar - Updated: 10 June 2020
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Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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