HDFC ERGO Maxima Health Insurance Policy

You usually avoid visiting hospitals for small health issues such as stomachache, headache, sore throat. Moreover, you may not consider the small expenses that are bearable. But it would be great if you can insure yourself for regular illnesses and little niggles. Here comes HDFC ERGO Health Maxima Health Insurance into the picture that takes care of your regular healthcare needs. Let’s know how does it work:

Salient Features of HDFC ERGO Health Maxima Health Insurance

The policy comes with unique features with maximum coverage. The basic features of HDFC ERGO Health Maxima Plan include:

  • The policy comes with maximum policy ceasing age
  • It offers lifelong renewability
  • The policy can be issued for both individual and family. The family coverage will be on floater basic where two adults and 2 children can be covered
  • The policy can be bought for 1 year. After that, it needs to be renewed to enjoy continuous benefits
  • Avail tax benefits for the premiums paid towards HDFC ERGO Health Maxima Health plan
  • Cashless hospitalisation in more than 4500 hospitals across India
  • You can include your spouse, children or dependent parents as well
  • Online health assessment
  • Customized diet & exercise plan from the experts
  • E- storage facilities to store your medical reports for 24X7 access
  • Additional discounts on health products
  • Set alerts to track your health appointments and medicinal intake
  • Exclusive health newsletter & helpline services

Benefits of HDFC ERGO Health Maxima Health Insurance

The benefits offered under HDFC ERGO Health Maxima Health insurance can be categorised into Out-patient and in-patient cover.

Out-patient Cover



Out-patient Consultations

Consultations with a medical practitioner(s) are covered. 4/6/8 consultations as per the plan opted

Diagnostic Tests

diagnostic tests taken by the policyholder (not necessarily to be suggested by Network Hospital doctor)

Chemist Expenses

Medicines prescribed by a Medical Practitioner (not necessarily to be suggested by Network Hospital doctor)

Dental Treatment

Any dental treatment taken by the insured provided it is not a cosmetic surgery

Spectacles, Contact lenses

a prescribed pair of spectacles or contact lenses by an Eye Specialist

Annual Health Check Up

Health check-up at network hospital (not applicable for the person above 45 years old in the first policy year and below 18 years old)


In-patient Cover



In-patient Treatment

Covers hospitalisation expenses due to an accident or illness. It includes room rent, nursing expenses, boarding expenses, ICU rent, medicines, consumables, diagnostic expenses, expenses related to prosthetic, surgical expenses etc.

Pre-hospitalisation Expense

Medical expenses incurred towards treatment 30 days prior to hospitalisation. This can be extended up to 60 days if the claim is intimated 5 days prior to hospitalisation

Post-hospitalisation Expense

Medical expenses incurred towards treatment 60 days prior to hospitalisation, which can be further extended up to 90 days if the claim is intimated 5 days prior to hospitalisation

Day Care procedures

the expenses incurred for treatment availed at home, which would otherwise have required hospitalisation

Organ Donor

expenses incurred in harvesting an organ are covered

Emergency Ambulance

Up to Rs. 2000 per hospitalisation for transporting the policyholder from the spot of emergency to hospital or from one hospital to another if better medical assistance is required

Maternity Expenses

Pregnancy-related expenses including pre and post-natal expenses, after serving a waiting period of 4 years

Newborn Cover

Newborn baby to be covered from day 1 to 90 days for in-patient treatment (optional cover)

Daily Cash for choosing shared accommodation

Daily cash allowance is offered in case of using a shared accommodation during hospitalisation and in case of hospitalisation exceeding 48 hours

Daily Cash for accompanying an Insured Child

If the insured child is below 12 years old, daily cash for one adult where hospitalisation exceeds 72 hours

Optional Benefit under HDFC ERGO Health Maxima Plan

The policy comes with an optional benefit of Critical Illness where a lump sum benefit is payable towards listed critical illnesses. The policy benefit is payable once the insured is diagnosed with an illness and survives for a period of 30 days after diagnosis. This cover can be availed on payment of an additional premium. It is extended to all members on an individual sum insured basis up to Rs. 300,000. The policy cannot be renewed beyond the age of 70 years.

Exclusions of HDFC ERGO Health Maxima Health 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 4 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 before 4 years of waiting period

For the complete list of exclusions, please refer to the Policy Fine Print

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 claiming the policy for any health issues, except accidental injury
  • Covered after 2 years: specific illnesses
  • Covered after 3 years: Pre-existing illnesses
  • Covered after 4 years: Pregnancy and childbirth

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

Discount Offered under HDFC ERGO Health Maxima Health Plan

  • Cumulative Bonus or NCB Benefit- A cumulative bonus of 10% of the Sum Insured is offered for not claiming your insurance up to a maximum of 50%. If the policy is claimed, the cumulative bonus will be reduced by 10% on renewal.

Additional Benefits Offered Under HDFC ERGO Health Optima Plus

  • 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 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. With portability, you need not 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 Optima Cash 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 50% for every consecutive year on renewal.
  • Renewal Benefit for Out-Patient Treatment – you can carry forward an unutilised benefit up to 50% to the next policy year, excluding annual health check-up.

Eligibility Criteria for HDFC ERGO Health Maxima Health Plan

Minimum Entry Age

91 days- 5 years (if any of the parents is covered)

Maximum Entry Age

65 years

Policy Tenure

1 year

Members to be Covered

spouse, 2 dependent children and dependent parents


Based as per the age of the eldest member (floater cover)

HDFC ERGO Health Maxima Health Plan Renewal Process

HDFC ERGO Health Maxima Health insurance can be renewed either online or offline. Online renewal is the most preferred and convenient way of renewing a policy where you can pay the premiums online and get a renewed policy instantly. On the other hand, in the offline renewal process, you can approach a trustworthy agent to do the formalities or you can visit the branch and approach the concerned officer to renew the policy. You can pay the premiums by cash or cheque.

Below are the steps of renewing the policy online:

  • Visit the official website of HDFC ERGO Health and navigate through the ‘Renew Your Policy’ option
  • Mention the policy number. If you have renewed the policy earlier, mention the 12-digit policy number. If you are renewing for the first time, mention the 10-digit policy number and proceed
  • Calculate the premiums online and pay it using a credit/debit card or net banking
  • You’ll receive an instant renewal message with an acknowledgement. The renewed policy will be sent to the registered email Id. You can download the policy instantly.

The premiums are subject to change as per the prior approval from IRDA. However, the insurance company is obliged to intimate the insured about any change 3 months prior to the renewal date.

HDFC ERGO Health Maxima Health Claim Process

HDFC ERGO Health ensures hassle-free claim settlement. However, you can claim your policy in a smooth manner only if you approach the right way. In this regard, the insurer has set certain easy steps to claim HDFC ERGO Health Maxima policy.

Whether it is regular health insurance, top-up plan or critical illness plan, the claim process can be initiated in two ways-cashless claims and reimbursement claim. This further can be categorised into Planned and Emergency Hospitalisation. When a cashless claim only can be availed at a network hospital, the reimbursement claim services can be availed at any hospital of your preference.

Claim Intimation: The foremost step to claim your insurance is to inform the insurance company. In case of planned hospitalisation, inform them 48 hours prior to hospitalisation. While in case of emergency, intimate it within 24 hours of hospitalisation. A claim can be registered by calling at the 24x7 helpline number of the HDFC ERGO Health or writing to their official email ID.

At the time of registering a claim, you’ll require to provide the below information:

  • Your contact details
  • Name of the Insured
  • Policy number
  • Date and time of incident/illness
  • Nature of illness/injury
  • Location of incident/illness/injury

Seek Permission for Cashless Service: A pre-authorisation letter has to be filled and submit seeking permission from the insurer for availing cashless services.

Claim Settlement: Once the insurer approves the request and convey its decision to the hospital authority, the treatment can be availed free of cost. The incurred expenses will be settled directly by HDFC ERGO Health with the hospital authority.

In case of reimbursement claim, avail the treat an any of your preferred hospitals, pay the medical expenses and register a claim. The duly filled claim form along with the supporting documents has to be submitted within a stipulated time limit. The insurer will settle the claim after verifying the original documents and bills. The reimbursed amount is transferred to the insured’s account.

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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