HDFC ERGO Individual Easy Health Insurance
HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan comes in handy in covering the emergency medical expenses as well as the planned in-patient expenses. The plan comes with an additional benefit to cover critical illness and sum insured restoration where the insurance never feels short of coverage in case of an emergency. This policy can be useful in covering the pregnancy-related expenses as an in-built benefit. Attractions like Ayush cover, lifelong renewability, health assessment etc. have made this plan worth your money. Let’s gather some information about the plan here:
Key Features of HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan
The policy comes with unique features with maximum coverage. The basic features of HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Plan include:
- The policy comes with maximum policy ceasing age
- It offers lifelong renewability
- The policy can be issued for individual/family floater sum insured basis
- Add-on benefit offered for listed critical illnesses
- The policy can be bought for 1 year. After that, it needs to be renewed to enjoy continuous benefits
- Option to choose the sum insured from 3/4/5/7.5/10/15/20/25/50 lakhs
- Avail tax benefits for the premiums paid towards HDFC ERGO Health (formerly known as Apollo Munich) Easy Health plan
- Cashless hospitalisation in 4500+ hospitals across India
- Additional discounts under Stat Active Programme
- Ayush treatment cover
- Track your health appointments and medicinal intake through alerts
- Exclusive health newsletter & helpline services
- E-opinion in respect to critical illness
- Annual health check-ups in every four claim-free year
- Critical Advantage Rider in case of sum insured Rs. 10 lakh or above
- Online health assessment
- Customized diet plan & exercise plan from experts
- Digitally stored medical reports for 24X7 access
Policy Benefits of HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Insurance
||Hospitalisation expenses including barding, nursing, room rent, cost of medicines, doctors’ consultation, ICU cost, OT cost etc.
||Medical expenses incurred during 60 days prior to hospitalisation
||Medical expenses incurred during 90 days post hospitalisation
||Daycare procedures covered, treating of which don’t require 24 hours of hospitalisation
||Expenses for availing treatment at home which would otherwise have required hospitalisation
|Organ Donor Cover
||Medical expenses for harvesting an organ in case of organ transplantation
||Medical expenses for in-patient treatment availed under Ayurveda, Sidha, Unani, andHomoeopathy- minimum Rs. 25,000- Rs. 50,000
|Daily Cash Allowance for Shared Accommodation
Daily cash allowance for choosing shared accommodation in-network hospital, where hospitalisation exceeds 48 hours-
- 500-3000: SI 3lakhs/4lkahs/5lakhs
- 800-4800: SI 7.5 lakhs/10 lakhs
- 1000-6000: SI 15lakhs/20 lakhs/25 lakhs/50 lakhs
||An optional cover for listed critical illnesses
||Up to 1% of the policy sum insured, after four years of continuous renewals
||Rs. 10,000 (only for sum insured 15-50 lakh)
|New Born baby cover
||Optional benefit on payment of extra premium
|Emergency Air Ambulance
||Rs. 2.5 lakh/hospitalisation (only for sum insured 15-50 lakh)
|Maternity Expense Cover
||Covered up to a defined limit according to the type of sum insured chosen
|Critical Advantage Rider
||Only for Sum insured Rs 10,00,000 or above
Exclusions of HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan
The policy doesn’t cover the insured under below conditions:
- No claim will be entertained within the first 30 days of the policy period, except accidental claims
- Complications arising out of a pre-existing illness will not be covered before 3 years of waiting period
- No claim will be entertained for the expenses incurred in treating a specific illness such as hernia, joint replacement surgeries, cataract, surgery of hydrocele etc. without serving a waiting period of 2 years
- Expenses towards HIV/AID or other related diseases that are permanently excluded
- Expenses towards mental disorder, cosmetic surgery, congenital illness, weight loss treatment etc. are not covered
- Any accident leading to hospitalisation while driving under the influence of alcohol or intoxicating substances.
- Injury due to war, warlike situation, due to the use of nuclear weapon and radiation, riot, strike or malicious act
- Expenses towards dental treatment, pregnancy, external aids, unless it is additionally covered by the plan
- Maternity-related claims will not be accepted
- For the complete list of exclusions, please refer to the Policy Fine Print
Waiting Period for HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan
- 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 90 days: any critical illness
(Refer the policy document for the complete list of illnesses covered)
Discount Available under HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan
Cumulative Bonus or NCB Benefit- A cumulative bonus or No Claim Bonus is offered for not claiming the insurance up to 10% and a maximum of 100%. The NCB will be reduced by 10% in case of a claim for the following year.
Additional Benefits Offered Under HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan
Cashless Service - You can avail cashless services at more than 4500 network hospitals of the insurance provider. In order to avail so, a pre-authorisation letter and health card will be required. The process of applying for cashless services is mentioned in the policy document.
- Portability - The insurer offers portability benefit as well, where you can switch to HDFC ERGO Health (formerly known as Apollo Munich) without a hassle. If you are not satisfied with the existing insurance provider, you can check the plans of HDFC ERGO Health (formerly known as Apollo Munich) and transfer your existing policy without losing the policy benefits such as accumulated NCB benefit or waiting period. With portability, you need not to have to serve the waiting period again for covering pre-existing illness, as the insurer will consider the served waiting period as valid.
- Tax Benefits- With HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan, you can save on tax under Section 80D of Income Tax Act. The premiums paid towards the policy are exempted from the tax
- Renewal Benefits for Inpatient Treatment- No Claim Bonus of 10% is offered for every claim-free policy year. The bonus can be availed up to 100% for every consecutive year on renewal.
- Stay Active Benefit- The insurer offers a discount on policy premiums to encourage health and fitness. A defined discount is offered to those who achieve the target of Stay Active programme. One can track progress through a mobile application.
- Enhancement of Sum Insured- Sum insured can be enhanced at the time of renewal, subject to no claim has been made. However, medical test or waiting period may be applied a fresh depending on up to the amount the SI has been increased.
Eligibility Criteria for HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan
|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
HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan Renewal Process
HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan comes with no maximum policy ceasing age, which means the policy can be availed for a lifetime. In order to avail the continuous benefits, it has to be renewed in a year or two, paying the premiums on time. Failing which lead to a lapsed policy. As you can’t afford a lapsed HDFC ERGO Health (formerly known as Apollo Munich) Health Insurance policy and bear the medical expenses in case of an emergency, it is better to track your renewal date and follow the formalities accordingly. You can renew the policy either online by visiting the official website of the insurer and paying the premiums through various online modes of payment. Or you can visit the branch office, approach the concerned officer and pay the premiums.
Remember, the premiums may change as per the prior approval from IRDA. However, the insurance company will intimate the insured at least 3 months prior to the renewal date in case of any change on the premium or terms of conditions related to the policy.
Any change in sum insured can be raised during renewal, where the insurer revises the sum insured by applying terms and conditions. In case of portability, the request shall be made at the time of renewal only. HDFC ERGO Health (formerly known as Apollo Munich) offers hassle-free switch without losing the policy benefits with the existing insurer.
HDFC ERGO Health (formerly known as Apollo Munich) Easy Health Exclusive Plan Claim Process
|Intimation & Assistance
||Procedure to Get Cashless Facility
||Procedure to Reimburse the Medical Expenses
||Claim for E-opinion
|Inform the HDFC ERGO Health (formerly known as Apollo Munich) 48 hours prior to hospitalisation, if it is a planned hospitalisationThe insurer can be connected through:· 24x7 helpline number· Email· Post and courier to the nearest claim branch· Use claim intimation form to inform a claim
- In case of emergency hospitalisation, the insurer must be intimated within 24
- hours of the hospitalisation or start of the treatment
- For any planned hospitalization, seek cashless authorisation from the insurer 48 hours prior the hospitalisation
- The insurer will analyse the insurance coverage as per your eligibility and will send an authorisation letter to the hospital authority or TPA. In case of discrepancy in the documentation, the same shall be conveyed to the hospital authority within 6 hours of receiving of the documents.
- You’ll have to pay the deductibles or the expenses that are not covered by the insurer at the time of discharge
- In case the illness or treatment or expense is not covered
- under the policy, a letter of rejection would be sent
- to the hospital authority within 6 hours. In such a case, the expenses have to be borne by you.
- The cashless facility can be availed at network hospital only
- Send the duly signed and filled claim form along with the supporting documents within 15 days from discharge or completion of the treatment
- The insurer will verify the documents. In case of any discrepancy, you’ll be informed accordingly
- The deficiency letter will be sent within 7 days from the day of receiving of the documents
- Once the complete set of documents, if received and verified, HDFC ERGO Health (formerly known as Apollo Munich) will settle the claim up to the admissible amount within 30 days
- The payment will be made to the insured savings account
- The payment will be made only for the items that are covered by the policy. Anything apart from this has to be paid by the insured.
- The claim form has to be submitted along with medical reports
- Documents such as investigation report, discharge letter have to be submitted
- you can select a panel doctor from HDFC ERGO Health (formerly known as Apollo Munich) to take e-opinion
- Upon receiving a complete set of claim document, the insurer will forward the same to the concerned doctor
- The arrangement for e-opinion will be made within 7 days from the date of receiving, expenses of which will be paid by the insurer.
Written By: PolicyBazaar - Updated: 29 June 2020