HDFC ERGO Health Easy Health Premium Plan
HDFC ERGO Health Easy Health Premium plan offers comprehensive coverage for emergency medical conditions arising out of accident or illness. Apart from the regular in-patient coverage, the policy comes with additional features such as maternity expenses, recovery benefit, out-patient dental cover, cost of spectacles & hearing aids and coverage for listed critical illness (optional). The policy can be availed for individual sum insured basis, where up to 6 family members can be covered. The coverage can be extended to dependent parents, grandparents and parents-in-law as well.
Key Features of HDFC ERGO Health Easy Health Premium Plan
The policy comes with unique features with maximum coverage. The basic features of HDFC ERGO Health 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 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
- Maternity benefit
- Digitally stored medical reports for 24X7 access
HDFC ERGO Health Easy Health Premium Plan Benefits
||Sum Insured Options
|In-patient Cover- Expenses incurred due to hospitalisation including room rent, nursing cost, boarding, ICU cost, OT cost, medicine and drug cost, surgery, doctor’s consultation etc.
||Covered for 60 days
||Covered for 60 days
||Covered for 60 days
||Covered for 90 days
||Covered for 90 days
||Covered for 90 days
|Day Care Procedures
||Covered for the expenses incurred in availing treatment at home which would otherwise have required hospitalisation
||Treatment expenses while transplanting an organ
||Up to Rs.2000 per hospitalisation
||Up to Rs 25,000
||Up to Rs 50,000
|Daily cash allowance for choosing Shared Accommodation
|Daily cash allowance for accompanying an insured child
||Optional cover on payment of additional premium
|Emergency Air Ambulance
||up to Rs. 2.5 lakhs
||Normal delivery: Rs. 15000Caesarean Delivery Rs. 25,000
||Normal delivery: Rs. 25,000Caesarean Delivery Rs. 40,000
||Normal delivery: Rs. 30,000Caesarean Delivery Rs. 50,000
|Outpatient Dental Treatment (waiting period 3 years)
||1% of sum insured up to a maximum of Rs. 5,000
||1% of sum insured up to a maximum of Rs. 7,500
|Spectacles, Hearing Aid, Contact Lenses (every third year)
||Up to Rs. 5000
||Up to Rs. 7500
|E-Opinion in respect of a Critical Illness
||Second opinion in case of critical illness from a medical practitioner form HDFC ERGO Health Panel
|Critical Illness Rider
||50% or 100% sum insured of in-patient SI (optional cover)
||50% or 100% sum insured of in-patient SI, up to a maximum of Rs. 10 lakhs (optional cover)
||An extensive health check-up including a number of health tests after four years of continuous renewal
|Critical Advantage Rider
||Covered only for sum insured Rs. 10 lakh or above
Exclusions of HDFC ERGO Health Easy Health Premium 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 periods Under HDFC ERGO Health Easy Health Premium Plan
- 30 Days: Initial waiting period for claiming the policy for any health issue. Only accidental injuries are covered
- Covered after 2 years: specific illnesses
- Covered after 3 years: Pre-existing illnesses
- Cover after 3 years: out-patient dental treatment
Discount Available under HDFC ERGO Health Easy Health Premium Plan
- Cumulative Bonus or NCB Benefit- the insurer offered a no claim bonus or cumulative bonus for not claiming the insurance policy. The NCB benefit can be availed up to 10% and a maximum of 100%. In case of a claim, the NCB will be reduced by 10%.
- 5% Discount on Premium: 5% discount if 2 family members are covered
- 10% Discount on Premium: 10% discount on premiums if 3 or more family members are covered
Additional Benefits Offered Under HDFC ERGO Health Easy Health Premium Plan
- Cashless Service – You can avail cashless services at more than 4500 network hospitals of the insurance provider. In order to avail cashless service, a cashless request letter and health card will be required. The process of applying for cashless services is mentioned in the policy document.
- Tax Benefits - With HDFC ERGO Health Easy Health Premium Plan, you can save on tax under Section 80D of Income Tax Act, for the premiums paid towards availing the plan benefits.
- 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.
- Portability – The insurer offers portability benefit as well, where you can switch to HDFC ERGO Health without a hassle. If you are not satisfied with the existing insurance provider, you can check the plans of HDFC ERGO Health and transfer your existing policy without losing the policy benefits such as accumulated NCB benefit or waiting period. You are not required to serve the waiting period again, as the previous one is considered.
Eligibility Criteria for HDFC ERGO Health Easy Health Premium 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 on the sum insured or other related factors
1 & 2 years
HDFC ERGO Health Easy Health Premium Plan Renewal Process
HDFC ERGO Health Easy Health Premium Plan requires timely renewal to avail the benefits continuously. However, the plan comes with lifelong renewability, where there is no maximum policy ceasing age for the insured. To renew the policy you can go either online or offline. Online renewal can be ensured in a smooth way by visiting the official website of HDFC ERGO Health , click on the renewal option, mention the 10-digit or 12-digit policy number, calculate the premiums online and pay it online using credit/debit card or via net banking.
If you want to renew the policy offline, just visit the branch office and approach the concerned officer. You can approach an authorised agent as well who can help you complete the renewal formalities.
The premiums are subject to change with due approval from IRDA, which can be applicable at the time of renewal. However, the insurer has to inform the policyholder at least 3 months prior to the renewal date. Also, if you want to increase or decrease the sum insured, the same can be raised at the time of renewal. The insurer may impose the waiting period clause or may ask to undergo the medical test again, depending the amount up to which, the sum insured has been increased.
Moreover, the insurer comes with an easy portability benefit where a person holding a policy from another insurer can switch to anyHDFC ERGO Health Health Insurance. And this can be ensured without losing the existing benefits such as NCB or waiting period.
HDFC ERGO Health Easy Health Premium Plan Claim Process
In order to ensure a smooth claim process with HDFC ERGO Health , just follow the below claim steps:
Intimation & Assistance: It is essential to intimate the insurers without a fail inform with 48 hours prior to hospitalisation, in case of a planned hospitalisation. You can contact through
- 24x7 helpline number
- Post and courier to the nearest claim branch
- The claim intimation form is required to register a claim
Procedure to Get Cashless Facility
To avail cashless facility and in case of emergency hospitalisation, inform the insurer within 24 hours of hospitalisation.
- For cashless services, seek pre-authorisation from the insurer approaching the hospital help-desk or TPA. Submit the form along with the documents to the insurer
- The insurer will analyse the insurance coverage, check the eligibility, and convey its decision to the hospital authority
- In case of any discrepancy in the documentation, the same will be informed to the hospital authority within 6 hours of receiving of the documents
- The additional amount that is not covered by the insurer are to be borne by you, up to the deductible
- In case the treatment is not covered by the insurance company, the expenses will be paid by you at the time of discharge. A letter of rejection will be sent accordingly within 6 hours
- The cashless facility can be availed at network hospital only
Procedure to Reimburse the Medical Expense
In case of reimbursement claim, avail the treatment from a non-network hospital and register a claim later:
Send the duly completed claim form along with the supporting documents and bills within 15 days from the day of discharge
The insurance company will verify the document upon receiving. In case of any discrepancy, the same will be informed within 6 days with a discrepancy letter.
HDFC ERGO Health will settle the claim once receiving the complete set of document and verifying everything. The admissible amount will be transferred within 30 working days from the receiving of the document.
The payment will be made in the name of the policyholder. Anything that is not covered by the insurance policy has to be borne by the insured.
Claiming for E-Opinion
In case of critical illness cover, the insured can avail the benefit of E-opinion. The claim process is as below:
- The claim form has to be submitted along with medical reports
- Documents such as investigation report, discharge letter have to be submitted
- The next step is to select a panel doctor from HDFC ERGO Health to take e-opinion.
- Upon receiving a complete set of claim document, the same will be forwarded to the concerned doctor from the panel
- The insurer will make all the arrangement regarding the same within 7 days from the date of receiving of the claim form and covers the expenses incurred.
Written By: PolicyBazaar - Updated: 08 January 2021