HDFC ERGO Easy Health Individual Plan

HDFC ERGO Health Easy Health is an individual plan with comprehensive features. Apart from covering the unforeseen medical expenses arising out of an accident or illness, the policy extends coverage towards maternity as well. The coverage can be availed as an individual basis, where add-on coverage option is available for listed critical illnesses. The plan is tailor-made for you with recovery benefit and health check-up in every fourth renewal. Let’s delve into details:

Salient Features of HDFC ERGO Health Easy Health Plan

 The policy comes with the following features:

  • Avail cashless access to over 4500+ network hospitals in over 800 cities
  • NCB bonus of 10% for every claim-free year, a maximum up to 100%
  • Maternity/Recovery/AYUSH treatment cover
  • The plan comes with no co-payment
  • Pre-existing illness covered after 3 years of waiting period
  • Tax benefit for the premiums paid towards HDFC ERGO Health Easy Health plan
  • The policy comes with lifelong renewability
  • Opt for a higher coverage with sum insured from 3 lakh to 50 lakh
  • The policy comes with portability benefit as well
  • New Born baby cover
  • Optional coverage for critical illness
  • Health check-ups available in every four-year renewal
  • Portability benefit with easy access to customised plans

Benefits of HDFC ERGO Health Easy Health Plan

Benefit                                            Sum Insured Option
  3 lakhs/4 lakhs/5 lakhs 7.5 lakhs/10 lakhs 15/20/25/50 lakhs
In-patient treatment Covered Covered Covered
Pre-hospitalisation 60 days 60 days 60 days
Post-hospitalisation 90 days 90 days 90 days
Day-care Procedure Covered Covered Covered
Domiciliary Treatment Covered Covered Covered
Organ Donor Expense Covered Covered Covered
Emergency Ambulance cover Up to 2000 per hospitalisation
Ayush Benefit Expenses incurred in-patient treatment taken under Ayurveda, Unani, Siddha and Homeopathy
Daily Cash for shared accommodation Rs.500 to maximum Rs.3,000/per day Rs. 800 to maximum of Rs. 48,000/per day Rs. 1000 to maximum Rs. 6,000/per day
Daily allowance for accompanying an insured child Rs.300 to maximum Rs.9,000 Rs. 500 to maximum of Rs. 15,000 Rs. 800 to maximum of Rs. 24,000
Critical Illness Cover optional cover for listed ailments, where a lump sum is offered on the survival of the insured up to 30 days from the diagnosis.
Recovery Benefit Not covered Not covered Up to Rs. 10,000
Emergency Air Ambulance Not covered Not covered Up to Rs.2.5 Lacs per hospitalisation
Pregnancy cover (subjected to waiting period) Normal delivery: Rs. 15,000Caesarean delivery: Rs. 25,000per/post natal expense up to Rs. 1500 (WP: 6 years) Normal delivery: Rs. 25,000Caesarean delivery: Rs. 40,000per/post natal expense up to Rs. 2500 (WP: 6 years) Normal delivery: Rs. 30,000Caesarean delivery: Rs. 50,000per/post natal expense up to Rs. 5000 (WP: 4 years)
New Born Baby Cover Rs. 2000 Rs. 3500 Rs. 5000
Critical Advantage Rider when basic Sum Insured is Rs. 10 lakhs and above
Health Check-up 1% of sum insured up to a maximum of Rs. 5,000 in every 4 continuous renewals.

Additional Benefits under HDFC ERGO Health Easy Health Plan

  • Cumulative Bonus - 10% increase in basic sum insured or discount in the premium for not claiming the insurance policy, up to a maximum of 100%. In case of a claim, the accumulated bonus will be reduced by 10%.
  • Health Check-up - At the end of every 4-continuous claim-free years, free health check-up facility is offered
  • Stay Active Benefit - To encourage fitness, the insurer offers 8% discount on premiums for achieving the average targeted number of steps on a daily The policyholder receives this reward either by opting for walking or running. This can be availed at the end of the policy tenure as a discount on renewal premium.
  • Portability Benefit - The insurer offers a smooth portability option in case you are not satisfied with the current insurer and want to shift to HDFC ERGO Health .

Waiting Period for HDFC ERGO Health Optima Restore Plan

  • From day 1: Only accidental claims will be accepted
  • Covered after 30 Days: Initial waiting period for paying off a regular claim, except those for a specific illness and pre-existing illness
  • Covered after 2 years: specific illnesses
  • Covered after 3 years: Pre-existing illnesses

(Refer the policy document for the complete list of illnesses covered)

Exclusions for HDFC ERGO Health Easy Health Plan

The policy will not entertain any claim arising out of the following situations:

  • No claim will be entertained in the initial 30 days, except accidental claims
  • Any claim arising out of pre-existing illnesses before completing 3 years of waiting period
  • No claim arising for specific illnesses before 2 years of waiting period
  • Treatment of HIV/AIDS/Mental disorder
  • Intentional injury, suicide or attempt to suicide
  • Accidental injury leading to hospitalisation while driving under the influence of alcohol
  • In case of an accident, if the driver is not carrying a valid license and met with an accident
  • War, warlike situation, malicious act, riot, terrorism, use of a nuclear weapon
  • Injury while participating in the operation of Army, Navy or Air Force
  • Expenses incurred for cosmetic or plastic surgery

 (For the complete list of exclusion, please refer to the policy document)

Eligibility Criteria of HDFC ERGO Health Easy Health Plan

Feature

Age

Minimum entry age

Children- 91 days/5 years

 

Maximum entry age

65 years

Renewal age

lifelong

Family Definition

Individual Plan - A maximum of 4 adults and a maximum of 5 children can be included

Calculation of premium

Basis of age and the sum insured chosen

 

Discount to be Availed under HDFC ERGO Health Easy Health Plan

  • 5% discount on premium if 2 family members are covered
  • 10% discount if 3 or more family members are covered
  • 5% discount on purchasing of a long-term policy

HDFC ERGO Health Easy Health Plan Renewal Process

HDFC ERGO Health Easy Health Plan comes with lifelong renewal benefit where there is no maximum policy ceasing age. The policy needs to be renewed every year or two, either online or offline. The insured can avail a 30-days grace period to renew an expired policy. If not, the policy will lapse and he/she will no more be able to utilise the policy benefits. In order to renew the HDFC ERGO Health Easy Health Plan online, follow the below steps

  • Visit the official website of the insurer and navigate through the renewal option
  • Mention the policy details on the respective field. In case of first time access, mention the 10-digit policy number, while the second time user is required to 12-digit policy number
  • Calculate the premiums online and pay through debit/credit cards or net banking
  • An instant acknowledgement on renewal will be sent to the registered email Id. The renewed policy can be downloaded from the mail Id as well.

Those who don’t want to renew the policy online and still prefer visiting insurer’s office, kindly approach a nearby branch and pay the premiums physically. The premiums of HDFC ERGO Health Easy Health Plan are subjected to change with the prior approval from IRDA. However, the insurer is bound to inform the insured about the same at least 3 months prior to the renewal due date.

HDFC ERGO Health Easy Health: Claim Process

HDFC ERGO Health Easy Health insurance can be claimed in two ways- cashless and reimbursement claim. While cashless claim can be availed only at a network hospital, the reimbursement facility can avail at any of your preferred hospitals. Let’s know the claim process for both:

1. Cashless Claim:

Claim Intimation: immediately inform the insurer by calling on the toll-free number. You can write to them or visit the nearest branch office to register a claim. A claim executive will guide you through the process and provide you with the claim form. In case of planned hospitalisation, the insurer has to be informed 48 hours prior to the hospitalisation, while in case of emergency the initiation window is within 2 hours of hospitalisation.

Required Information: While registering a claim, you’ll need to provide the following information:

  • Policy number
  • Contact details
  • Name of the insured
  • Nature of the accident/illness
  • Date and time of the occurrence
  • Any previous treatment availed

A claim reference number will be provided for future use.

Pre-authorisation Letter:  In order to avail cashless services, a pre-authorisation request has to be filled and submitted to the insurer. The cashless services can only be availed after the insurer approves the request.

Claim Settlement: Avail the treatment from the hospital. The insurer will directly settle the incurred expenses with the hospital authority up to the approved amount. You will have to bear the deductibles or the expenses that are not covered by the insurer.

2. Reimbursement Claim

When you avail the treatment form a non-network hospital, the claim is settled under the reimbursement clause. The hospital expenses are paid by your initially and claim is settled later. To initiate a reimbursement claim:

  • Approach any of the non-network hospitals as per your convenience and avail the treatment
  • Pay the hospital expenses and collect the original bills and receipts at the time of discharge
  • Register a claim by approaching the customer care or writing a mail directly
  • Duly fill and sign the claim form and submit to the insurer along with the relevant documents
  • Upon receiving the claim form along with the supporting documents, the insurer will analyse the case and process the claim
  • In case of any discrepancy, the same will be intimated within 7 days
  • If everything is at par, the claim will be settled within 30 days by transferring the amount to the registered bank account
  • In case of claim rejection, you will be informed accordingly

Document Required

 The following documents are to be furnished to claim HDFC ERGO Health Optima Plan:

  • Duly filled claim form
  • Police FIR in case of accidental claim
  • Pre-authorisation letter for cashless claim
  • Duly signed doctors report on the nature of the illness
  • 1st Investigation report
  • KYC document of the insured
  • Discharge report
  • In case of reimbursement claim, original medical bills and receipts are required

The insurer may ask for other documents supporting the claim

Written By: PolicyBazaar - Updated: 08 January 2021
Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

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