HDFC ERGO offers two types of claim settlements – cashless and reimbursement. Follow the steps to raise a claim:
- Find the nearest network hospital of HDFC ERGO
- Get admitted to the hospital
- Notify the insurance company about the hospitalization
- In case of pre-planned hospitalization, intimate the insurer before hospital admission.
- Fill up the pre-authorization form and submit it to the hospital staff
- The pre-authorization form will be sent to HDFC ERGO for approval.
- Once approved, obtain medical treatment.
- At the time of discharge, sign all the medical documents.
- Pay for the items/services not covered under the HDFC ERGO policy
- The network hospital will send the hospital bill to HDFC ERGO.
- After review, the insurance company will pay the bill amount directly to the network hospital.
- Intimate HDFC ERGO about the hospitalization
- In case of planned hospitalization, inform the insurance provider before hospital admission.
- Obtain medical treatment
- During discharge, pay the hospital bill in full.
- Collect all the medical documents, hospital bills and receipts
Our Claim specialists in below cities will reach your hospital or home in 30 minutes to support your health insurance claim
About HDFC ERGO Health Insurance
HDFC ERGO Health Insurance plans are offered by HDFC ERGO General Insurance Company Limited. The Company was founded as a joint venture between India’s HDFC Ltd. and Germany-based ERGO International AG in 2002. These health insurance plans offer comprehensive medical coverage to individuals, families and women at competitive prices.
Types of HDFC ERGO Insurance Plans
HDFC ERGO my:health Koti Suraksha is a unique plan that offers medical coverage and personal accident cover with a higher sum insured and lower premiums.
Features and Benefits:
- Cost of hospitalization, home healthcare and domiciliary hospitalization is covered
- Accidental death, permanent disablement and temporary total disablement are available
- Alternative treatments, pre-post hospitalization and road ambulance services are covered
- Broken bones, chauffeur benefit and hospital cash for accidents are available
- Preventive health check-ups, cumulative bonus and fitness discounts on renewal are available
- Non-medical expenses, emergency worldwide coverage, room rent waiver and waiting period modification options are available
- Renewal premium benefit, parental care benefit, medical evacuation and dependent children education benefit are also available as optional covers
The HDFC ERGO Optima Secure plan provides multiple unique benefits to the insured, enhancing the medical coverage to 4x for no additional cost.
Features and Benefits:
- Hospitalization expenses, AYUSH treatment and home healthcare are covered
- E-opinion for critical illness and daily cash for choosing shared accommodation are available
- Pre-post hospitalization costs, ambulance charges and organ donor expenses are covered
- While the secure benefit offers 2x coverage from day 1, plus benefit increases the coverage by 100% after 2 years
- Plus benefit and restore benefit are available
- Critical illness cover, hospital cash benefit and unlimited restore benefit are available as optional covers
The HDFC ERGO Critical Illness Insurance policy pays a lump sum benefit to the policyholder on the first diagnosis of up to 15 critical illnesses. The plan is available in three variants – Silver, Gold and Platinum.
Features and Benefits:
- The Silver plan covers 8 illnesses, the Gold plan covers 11 illnesses, and the Platinum plan covers 15 critical illnesses
- Option to choose a survival period of 15 days/30 days
The HDFC ERGO Day2day Care plan provides coverage for medical expenses incurred on an outpatient basis from day 1. The plan is available in two variants – Silver and Gold.
Features and Benefits:
- Unlimited outpatient general & specialist consultations at network providers
- Cost of pharmacy and diagnostic tests is covered
- Annual health check-ups are available to every insured
The HDFC ERGO Dengue Care plan covers in-patient and outpatient medical expenses incurred on the treatment of dengue.
Features and Benefits:
- In-patient hospitalization, pre-hospitalization and post-hospitalization costs are covered
- OPD coverage for doctor consultations, pharmacy and diagnostic tests are available
- Cost of home nursing services is also covered
- Shared accommodation benefit is available with non-medical expenses cover
- No medical check-up is required and one premium is charged regardless of the age
- Wellness offers may be provided from time-to-time
- No sub-limits or co-payments are applicable
The HDFC ERGO Energy Health Insurance plan covers the hospitalization cost of diabetes, hypertension and related complications from day 1. The plan is available in two variants – Silver and Gold.
Features & Benefits:
- Coverage for in-patient hospitalization and day care procedures are available
- Pre-post hospitalization costs, organ donor expenses and ambulance charges are covered
- HbA1C check-up benefit and shared accommodation benefit are available
- Restore benefit and cumulative bonus are available
- Wellness programmes and wellness benefit are also available
HDFC ERGO Easy Health Insurance is a comprehensive health policy for families and individuals that provides attractive health benefits to physically active people. The plan comes with three variants – Standard, Exclusive and Premium.
Features and Benefits:
- In-patient treatment, pre-hospitalization and post-hospitalization expenses are covered
- AYUSH benefit, daily cash for shared accommodation and recovery benefit are available
- Maternity expenses, newborn baby expenses and road ambulance charges are covered
- Daily cash for accompanying a child and air ambulance cover are available
- Organ donor expenses and day care procedures are covered
- Cumulative bonus, preventive health check-ups and stay active benefit are available
- Critical illness cover is available as an add-on cover
HDFC ERGO Health Wallet is a unique health insurance policy that reserves the unused sum insured from the previous year and adds it to the base sum insured for the next year.
Features and Benefits:
- Coverage for in-patient treatment, AYUSH treatment and domiciliary treatment are available
- Day care procedures, ambulance charges and pre-post hospitalization expenses are covered
- Reserve benefit, recovery benefit, restore benefit and multiplier benefit are available
- Cost of worldwide emergency care and preventive health check-ups are covered
- Deductible option is also available
- Unlimited restore benefit is available as an add-on cover
The HDFC ERGO Health Suraksha Top-up Pro plan provides additional coverage in case the base policy sum insured has exhausted. The plan is activated only after the policyholder pays the deductible amount.
Features and Benefits:
- In-patient treatment, emergency road ambulance and day care procedures are covered
- Domiciliary treatment and organ donor cover are available
- Both pre-hospitalization and post-hospitalization expenses are covered
- 5% cumulative bonus for up to 50% is available for every claim-free year
The HDFC ERGO Health Suraksha Top-up Plus plan provides additional medical coverage if the aggregate of multiple medical claims exceeds the deductible amount.
Features and Benefits:
- Cost of in-patient treatment and domiciliary treatment is covered
- Organ donor cover and emergency ambulance cover are available
- Day care procedures, pre-hospitalization and post-hospitalization expenses are covered
- 5% cumulative bonus for up to 50% for every claim-free year is available
- No medical check-up is required for up to 55 years
- No sub-limits are applicable on hospitalization or any disease
The HDFC ERGO iCan Insurance plan covers the medical expenses incurred on the treatment of cancer. The plan is available in two variants – Standard and Advanced.
Features and Benefits:
- In-patient treatment, outpatient treatment and follow-up care post treatment are covered
- Second opinion, day care procedures and emergency ambulance cover are available
- Both pre-hospitalization and post-hospitalization expenses are covered
- CritiCare benefit and family care benefit are available under the Advanced plan only
- Advanced treatment is available as an optional cover
The HDFC ERGO Maxima Insurance provides coverage for the everyday health needs of the insured by covering both in-patient and outpatient medical expenses.
Features and Benefits:
- Coverage for OPD doctor consultations, diagnostic tests and dental treatments are available
- In-patient hospitalization along with pre-post hospitalization expenses are covered
- Maternity benefit, newborn baby cover and daily cash for accompanying insured child are available
- Day care procedures, organ donor expenses and domiciliary treatment are covered
- Annual health check-ups and daily cash for choosing shared accommodation are available
- Cost of spectacles, contact lenses and ambulance services are covered
- Critical illness cover is available as an add-on cover
The HDFC ERGO my:health Women Suraksha plan provides comprehensive coverage for the health needs of modern-day women. The plan is available in 6 variants – Women Cancer plan, Women Cancer Plus plan, Women Cardiac plan, Women CI Essential plan, Women Comprehensive plan and Women Assault & Burns.
Features & Benefits:
- Coverage for malignant cancer, major cancers, carcinoma in situ of the breast and carcinoma in situ of the cervix uteri are available
- 41 critical illnesses and 3 major illnesses are covered
- Coverage for cardiac ailments & procedures, surgical procedures, assault and burns are available
- Preventive health check-ups and my:health Active benefit are available
- Waiver of 50% of the renewal premium for 5 years is available with the reduced premium benefit
- Pregnancy & newborn complications, post-diagnosis support and loss of job are available as optional covers
The HDFC ERGO my:health MediSure Super Top Up plan provides higher medical coverage to the insured for lower premiums. This plan can be used for backup coverage if the base policy gets exhausted.
Features and Benefits:
- No pre-policy medical tests are available for up to 55 years
- Coverage for in-patient hospitalization and day care procedures are available
- Both pre-hospitalization and post-hospitalization costs are covered
- Critical illness cover and hospital cash benefit are available as add-on covers
The HDFC ERGO Optima Restore plan offers medical coverage to the insured with the restore benefit.
Features and Benefits:
- Hospitalization expenses, organ donor expenses and domiciliary treatments are covered
- Daily cash for choosing shared accommodation and e-opinion for critical illness are available
- Day care procedures, road ambulance and air ambulance expenses are covered
- Restore benefit, multiplier benefit and preventive health check-up benefit are available
- Unlimited restore benefit is available as an optional benefit
The HDFC ERGO Optima Senior plan has been designed to cover the medical expenses incurred by senior citizens above 60 years.
Features and Benefits:
- Coverage for in-patient treatment, emergency ambulance and day care procedures are available
- Organ donor expenses, domiciliary treatment and pre-post hospitalization expenses are covered
- E-opinion is available for listed critical illnesses
- 5% no claim bonus is available for every claim-free year
HDFC ERGO Optima Super is a top-up insurance plan that can be converted into a regular health insurance policy after five consecutive renewals or between the age of 55 to 60 years.
Features and Benefits:
- Cost of in-patient treatment, ambulance service and day care procedures are covered
- Coverage for organ donor expenses and pre-post hospitalization expenses are available
- Waiver of deductible benefit along with the reduction in waiting period option is available
The HDFC ERGO Equicover Health plan has been designed to cover the medical expenses incurred by persons with disability.
Features and Benefits:
- Coverage for in-patient hospitalization costs and pre-post hospitalization costs are available
- Cataract treatment, modern treatment and AYUSH treatment are covered
- Emergency ground ambulance cover is available
The HDFC ERGO Hospital Cash Insurance provides a daily cash allowance to the insured for each day of in-patient hospitalization.
Features and Benefits:
- Daily cash allowance is paid for each day of hospitalization
- Twice the daily cash amount is paid for ICU admission
- Coverage available for up to 30/60 days per policy year
The HDFC ERGO my:credit Comprehensive Suraksha plan provides coverage to people who have taken a loan from banks/NBFC or other financial institutions. The plan is available in 6 variants – Critical Illness, Women Suraksha, Sachet Critical Illness, Recovery Benefit, Hospital Cash and Permanent Total Disablement - Illness.
Features & Benefits:
- Lump sum payment is made on diagnosis of 51 critical illnesses
- Coverage for cancers, surgical procedures, major illnesses, cardiac ailments & procedures and 41 critical illnesses are available for women
- Cancer cover, heart cover, nervous system cover and other major organ cover are available
- Recovery benefit, hospital cash benefit and permanent total disability cover are available
- Cardiac arrest and molecular gene expression profiling test are available as optional covers
- Pregnancy and newborn baby complications are available as optional cover under the women suraksha section
- Preventive health check-ups, second medical opinion, post diagnosis assistance, loss of job and pre diagnosis cover are available as optional covers
- Reinstatement of the sum insured and waiting period modification option are available as optional covers
The HDFC ERGO Optima Cash plan offers a daily cash allowance to the insured to pay for incidental expenses incurred during hospitalization.
Features & Benefits:
- Sickness hospital cash, day care procedure cash and accidental hospital cash are paid
- Convalescence benefit and childbirth benefit are available
- Parent accommodation benefit and joint hospitalization due to accident benefit are also available
HDFC ERGO my:health Critical Suraksha Plus has been designed to cover the financial needs of the insured on the diagnosis of a critical illness.
Features & Benefits:
- Cancer cover, nervous system cover, heart cover and other major organ cover are available
- Preventive health check-up benefit and my:health Active benefit are available
- Pre diagnosis cover, post diagnosis support and loss of job are available as optional covers
- Hospital cash benefit is available as an add-on cover
Key Benefits of HDFC ERGO Health Insurance
or select from popular citiess In case of emergency we are just a call away. Take care of your family, we will do the rest. Our claim specialists will reach your location & complete the formalties from filing the claim to documentation to coordinating with insurer, TPA & hospital. Available in New Delhi and 114+ cities View cities list ›Search HDFC ERGO Cashless Network Hospital list
Policybazaar Claim Process
Here is the list of documents required to file a HDFC ERGO health insurance claim:
-
Claim FormDuly filled and signed HDFC ERGO health insurance claim form
-
Health Card/Policy CopyHealth card or a copy of HDFC ERGO health insurance policy
-
Medical DocumentsHospital discharge card, doctor’s prescriptions, test reports, etc.
-
Medical Bills & Payment ReceiptsAll medical bills, including hospital bills and pharmacy bills, along with payment receipts
-
KYC DocumentsKYC documents to be submitted for claims above ₹1 lakh
Note: The exact list of claim documents varies from case to case. Contact the customer support team for the complete list.
The process to buy a HDFC ERGO Health Insurance plan is given below:
-
Visit the Health Insurance SectionGo to the ‘Health insurance’ section on Policybazaar.com
-
Fill in Personal DetailsProvide necessary details like age, mobile number, city, medical history, gender, etc.
-
Pay the Premium OnlineChoose your preferred HDFC ERGO health insurance policy and pay the premium online
The process to renew a HDFC ERGO Health Insurance plan is given below:
-
Go to the Renewal SectionNavigate to the ‘Renew Your Policy’ tab on Policybazaar.com and select ‘Health Renewal’
-
Verify Your IdentityEnter your registered mobile number and the OTP sent to your device
-
Pay the Renewal Premium OnlineSelect the HDFC ERGO health insurance policy you want to renew and pay the premium online
Here are the contact details of HDFC ERFO General Insurance Company:
| Categories | Contact Details |
|---|---|
| Phone number | 022 6242 6242 (for policy purchase) 022 6234 6234 0120 6234 6234 |
| WhatsApp No. | 8169 500 500 |
| Email id | care@hdfcergo.com nsp@hdfcergo.com (for network hospital issues) preauth@hdfcergo.com (for pre-authorization issues) |
HDFC ERGO Health Insurance: FAQs
-
Q1. What is not covered in HDFC ERGO Health Insurance?
Ans: HDFC ERGO health insurance plans do not provide coverage against medical expenses arising out of cosmetic surgery, dental treatments, external congenital diseases, intentional self-injury, drug addiction, etc. You can check the whole list of exclusions by checking the policy terms and conditions.
-
Q2. What is the waiting period of HDFC ERGO health insurance?
Ans: All HDFC ERGO health insurance plans come with an initial waiting period of 30 days. Apart from this, pre-existing diseases waiting period of 2 to 4 years and specific diseases waiting period of 2 years also apply. Moreover, critical illness insurance has a waiting period of 90 days.
-
Q3. Does HDFC ERGO health insurance cover death?
Ans: HDFC ERGO health insurance plans cover death resulting from an accidental injury.
-
Q. What is the advantage of selecting a policy with a duration of more than 1 year?
Ans: If one buys Aditya Birla Health Insurance for more than a year, one can save 7.5 % and 10% on the 2 and 3 years premium, respectively.
-
Q. How is an Individual cover different from a Floater cover?
Ans: In an Individual cover, coverage is offered to each individual in the family separately. In a Family Floater health insurance plan, each family member is covered based on a floater sum insured.
-
Q. How is an Individual cover different from a Floater cover?
Ans: In an Individual cover, coverage is offered to each individual in the family separately. In a Family Floater health insurance plan, each family member is covered based on a floater sum insured.
-
Q. What is a waiver of a mandatory co-pay cover?
Ans: This benefit is covered on payment of an additional premium. Therefore, any mandatory co-payment that is applicable under the Aditya Birla Activ Health Essential Plan will be waived off.
Compare Your Favourite Health Insurance Companies
Aditya Birla
Bajaj Allianz
Care Health
Cholamandalam MS
ManipalCigna
ZUNO Health Insurance
Future Generali
Go Digit
HDFC ERGO
Liberty General
Magma
New India Assurance
Niva Bupa
Oriental
Raheja QBE
Reliance
Royal Sundaram
SBI General
Star Health
TATA AIG
