HDFC ERGO Health Insurance
HDFC ERGO Health Insurance is offered by HDFC ERGO General Insurance Company Limited. HDFC ERGO is 4th largest general insurance company in India. It was founded in the year 2002 and operates in 89 cities through its 109 branches. It is a JV between HDFC Ltd and ERGO International AG. ERGO International AG is the primary entity of the Munich Re Group, whereas HDFC Ltd is India's leading housing finance company. ERGO International AG holds 49% stake while HDFC holds 51% stake, making HDFC Ltd the major shareholder in the venture. This is headquartered at Mumbai.
HDFC ERGO Health Insurance at a Glance:
Incurred Claim Ratio
Why to Buy HDFC ERGO Health Insurance?
HDFC ERGO General Insurance Company offers a wide range of health insurance plans that cover an individual and the family as well. These plans offer comprehensive coverage at affordable premium prices and are backed by more than 5,000 hospitals all over India. Offering significant features like cashless hospitalization, high no health claim benefit, and flexible payment modes, these health insurance plans are highly recommended for today's generation whose lifestyle makes them more prone to diseases that result from poor choices that eventually require medical intervention. Any medical emergency in the event of an accident or sickness requiring daycare procedures along with both pre and post hospitalization costs is covered by these affordable health insurance plans. These mediclaim plans also assure happiness to your family as well as you, thereby providing you with lump sum benefit.
Advantages and Benefits of Availing HDFC ERGO Health Insurance
The HDFC ERGO General Insurance Company is called the leader in the insurance industry because it gives its customers a little extra benefit when they buy any HDFC ERGO health insurance plan from the HDFC ERGO. Below are the advantages of buying HDFC ERGO health insurance plans:
- HDFC health insurance has a tie-up with 9,000+ network hospitals across the country, which facilitates cashless facility and other health care services
- There is a facility of 24*7 call assistance for settlement of health insurance claims
- The insurance company offers Value Added Services which enables the policyholder to enhance the sum insured in cases of claim free years
- The list of Services provided by the insurance company includes cover for pre-hospitalization and post-hospitalization expenses, day care procedures, costs incurred at home towards the treatment of the patient (domiciliary) and other such related expenditures
- The company offers a quick and easy insurance policy renewal process
Critical Factors of the HDFC Ergo Health Insurance Plan
- With a network of more than 9,000+ hospitals in the country, availing cashless hospitalization and healthcare facilities is very easy with HDFC ERGO Health Insurance
- The policy period of the plan can be of 1 year or 2 years, with the basic sum insured per year between Rs. 3 lakhs and Rs. 10 lakhs
- HDFC ERGO Health insurance offers the additional benefit of ‘Cumulative Bonus’ after every claim-free year as well as reimbursement of health check-ups expenses after the completion of 4 consecutive claim-free years
- The plan also offers Income Tax benefits. The company promises a hassle-free claim procedure
- The plan does not have a cap on hospital room rents, hospital charges, specific diseases and even doctor
HDFC ERGO Health Insurance Highlights
The highlights of HDFC ERGO Health Insurance are:
- Tax Benefit under section 80D
- No Medical Check-up up to 45 years
- No sub-limits on any disease, room rent, hospital charge and doctor’s fee
- Cashless Treatment at Network Hospitals
- 5% bonus on Sum Insured for every claim-free year
- Offers one-year or two-year policy coverage period
- Avail a family discount of 10% if 2 or more members of a family are covered under the same individual policy
- Life Long Renewability
HDFC ERGO Health Insurance offers two types of policies:
- Indemnity Health Insurance Policy
- Lump Sum Payment Health Insurance Policy
Indemnity Health Insurance Plan
Under this category, the health policy buyer gets compensations for the actual amount of financial losses incurred by him, subject to maximum amount of the sum insured.
Lump Sum Payment Health Insurance Plan
Under this category, the payment is made to the policyholders as soon as the illness or accident or any kind of related event occurs. This helps the policy holder to take care of every small expense to be made
- During the course of treatment.
- Comes at affordable pricing.
- Available on an Individual or FHPL basis.
- This health insurance plan offers Income Tax exemption u/s 80D of Income Tax Act
- Insurance claim settlement procedure is very easy and hassle-free.
- Provides coverage for inpatient treatment which includes all the hospitalization expenses.
- Provides a reimbursement of pre and post hospitalization expenses for up to 60 days and 90 days, respectively.
- Provides reimbursements incurred towards any kind of transportation charges or towards organ donor charges, if any kind of organ transplantation has been done.
- Provides Ayush Benefits i.e. inpatient hospitalization expenses undertaken under Ayurvedic, Sidha and Homeopathy are covered by the plan.
List of Health Insurance Policies from HDFC ERGO
The HDFC health insurance policies come in seven variants. Let us take a look at each of them in detail:
- HDFC ERGO my:health Suraksha Silver Smart Plan
- HDFC ERGO my:health Suraksha Gold Smart
- HDFC ERGO my:health Suraksha Platinum Smart
The HDFC ERGO my:health Suraksha Silver Smart is a comprehensive plan that protects individuals as well as their families in case of any medical illness or emergency.
|Type of Health Plan
|Individual/ Family Floater
||Adult-18 / Children-91days to 25 years
||3 Lakhs,4 Lakhs, 5 Lakhs
||Family Discount,Loyality Discount, Long Term Policy Discount,
Key Features and Benefits of HDFC ERGO my:health Suraksha Silver Smart Plan
The various features and benefits provided by this HDFC health insurance plan are given below:
- Options to choose sum insured amount from Rs 3 lakhs to Rs 5 lakhs
- Policy tenure options of 1 year, 2 years and 3 years
- Long-term policy discount of 7.5% and 12.5% to people opting for 2-year and 3-year policy tenure respectively
- No pre-policy health check-up for applicants up to 45 years
- A family discount of 10% applicable if more than two family members are covered under this HDFC ERGO Health Insurance plan
- Loyalty discount of 2.5% granted to people who have purchased other insurance policies from HDFC ERGO
- Comes with the sum insured rebound benefit
- Covers hospitalization expenses that include both room rent and ICU charges. The plan provides flexibility to decide the cap on room rent charges
- Pre-hospitalization expenses up to 60 days before getting admitted and post-hospitalization expenses up to 180 days after discharge
- Provides coverage for mental healthcare, daycare procedures, domiciliary hospitalization, home healthcare and recovery benefit
- Cost of emergency road ambulance is also covered under this HDFC ERGO Health Insurance plan
- Covers charges involved in the hospitalization of organ donor for a transplant surgery
- Cost of treatment by Ayurveda, Unani, Homeopathy and Siddha is also covered under this HDFC ERGO Health Insurance
- Optional covers such as non-medical expenses cover and extended cumulative bonus are also available
- Comes with the optional benefit of Parent & Child Care cover that includes maternity expenses, pre & post natal expenses, newborn baby cover, vaccination charges and infertility treatment expenses
- Choose amongst the co-payment option of 10% and 20%
- Add-on cover for Critical Illness and daily hospital cash available under this HDFC Health Insurance plan
- Enhances sum insured amount by 10% for every claim-free year
- Income Tax benefit under Section 80 D of the Income Tax Act
- Annual preventive health check-up upon renewal
- Fitness discount under my: Health Active at the time of renewal
The HDFC ERGO my:health Suraksha Gold Smart is a plan that focuses on providing assistance and financial aid to the insured during any medical or accidental emergencies.
|Type of Health Plan
|Individual/ Family Floater
||Children-91 days to 25 years / Adult- 18 years
||7.5 Lakhs,10 Lakhs,15 Lakhs
||Loyality Discount, Family Discount, Long Term Policy Discount
Key Features and Benefits of HDFC ERGO my:health Suraksha Gold Smart Plan
The Gold Smart plan by HDFC ERGO Health Insurance comes with a bounty full of features and benefits including:
- No pre-policy check-up for applicants up to 45 years of age
- Sum insured options starting from Rs 7.5 lakhs to Rs 15 lakhs
- Option to choose policy term of 1, 2 and 3 years
- A 2.5% of loyalty discount applicable on people who have already have other types of insurance policies from HDFC ERGO
- Family discount of 10% can be availed if more than two family members are included in the same HDFC ERGO Health Insurance policy
- A long-term policy discount of 7.5% and 12.5% offered to people who opt for 2-year and 3-year policy tenure respectively
- Sum insured rebound benefit available under this HDFC Health Insurance plan
- A cumulative discount of 10% upon renewal for every claim-free year
- Covers the cost of hospitalization which includes ICU charges and room rent. It also allows the insured to decide the limit for room rent
- The plan offers pre-hospitalization expenses for up to 60 days and the post-hospitalization expenses extending up to 180 days after discharge
- Hospitalization due to mental illness is also covered under this plan by HDFC ERGO Health Insurance
- The Gold Smart plan covers daycare procedures, domiciliary hospitalization, home healthcare and recovery benefit
- Covers charges of emergency road ambulance as well as the air ambulance
- Hospitalization expenses of organ donor in case of transplant surgery are covered under this HDFC ERGO my:health Suraksha Gold Smart plan
- Provides coverage for alternative treatment expenses including Ayurveda, Homeopathy, Unani and Siddha
- Option to select either 15% or 25% co-payment option
- Non-medical expenses cover as an optional cover offered under this HDFC Health Insurance plan
- Parent & Child Care cover including maternity cover, pre & post natal expenses, newborn baby cover, vaccination expenses and treatment cost for infertility
- Flexibility to decide the extended cumulative bonus amount amongst 25% or 50%
- Additional covers such as critical illness cover and hospital cash benefit are offered to the insured
- Comes with tax benefit under Section 80D of the Income Tax Act
- Free annual health check-up during policy renewal
- Avail fitness discounts during renewal under my:Health Active
The Platinum Smart plan is the most beneficial plan variant under my:health Suraksha plan by HDFC ERGO that protects the insured from expenses incurred due to a medical illness or accidental injury.
|Health Insurance Type of Health Plan
|Individual Family Floater
||Children-91 days to 25 years / Adult - 18 years to no age limit
||20 Lakhs, 25 Lakhs, 50 Lakhs, 75 Lakhs
||Family discount,Long Term Policy Discount, Loyality Discount
Key Features and Benefits of HDFC ERGO my:health Suraksha Platinum Smart Plan
Under the Platinum Smart plan by HDFC ERGO Health Insurance, the insured can avail maximum coverage through a wide range of benefits that includes:
- Higher sum insured options ranging from Rs 20 lakhs to Rs 75 lakhs
- No pre-policy health check-up for people opting for the sum insured amount of Rs 20 lakhs
- Policy available for 1-year, 2 years or 3-year policy tenure options
- A 10% family discount available for families where more than 2 members are insured under this plan by HDFC ERGO Health Insurance
- If the applicant has one more than HDFC ERGO policies, then he/ she is eligible for a loyalty discount of 2.5%
- A 7.5% and 12.5% long-term policy discount available for applicants choosing 2 years and 3 years policy term respectively
- This HDFC Health Insurance plan offers the sum insured rebound benefit to the insured
- A 25% cumulative bonus available for every claim-free year
- Covers cost of hospitalization that includes the ICU charges and the rent for the hospital room. The insured has the freedom to fix the limit for room rent
- Provides both pre and post hospitalization expenses for up to 60 days and 180 days respectively
- This plan covers expenses incurred on the treatment of mental illness
- Coverage for daycare procedures, domiciliary hospitalization, home healthcare as well as recovery benefit is also available
- Emergency road ambulance and air ambulance coverage included under the HDFC ERGO my:health Suraksha Platinum Smart plan
- Covers hospitalization expenses of the donor for organ harvesting for an organ transplant surgery
- Expenses incurred on treatment taken through Ayurveda, Homeopathy, Unani and Siddha is also included
- Freedom to opt for non-medical expenses cover and an extended cumulative bonus of 50%
- Flexibility to opt for Parent & Child Care cover that includes infertility treatment expenses, maternity expenses, newborn baby cover, pre & post natal care and the vaccination cost
- This HDFC ERGO Health Insurance plan comes with a co-payment option of 15% and 25%
- Provides preventive health check-up booster annually
- Enjoy fitness discounts at the time of renewal as part of my:Health Active program
- This plan comes with a tax benefit under Section 80D of the IT Act
General Exclusions of HDFC ERGO my:health Suraksha Plans
Certain illness and medical situations are not covered under the HDFC ERGO Health Insurance. No matter which my:health Suraksha plan variant you buy amongst Silver Smart, Gold Smart and Platinum Smart plan, the following exclusions will not be covered:
Key Features and Benefits of HDFC Health Suraksha Gold Regain Insurance Policy
- No hospitalization expenses in the first 30 days of policy commencement are covered
- A 2-year waiting period for any illness or surgeries if the underlying disease is cancer
- A waiting period of 3 years for pre-existing diseases
- Parent & Child Care cover comes with a waiting period of 4 years
- Any claims attributed to war, any act of war or any act of foreign enemy and invasion is not included under this HDFC Health Insurance plan
- Expenses incurred on illness or injuries arising due to events such as civil war, revolution, insurrection or an act of military usurper is excluded
- Claims arising out of chemical, biological or nuclear weapons or radiation is not covered
- Any intentional self-injury such as suicide or an act of suicide or criminal breach of law is excluded
- Claims attributed to involvement in defence forces operations or participation in adventure sports activities are not included under HDFC ERGO my:health Suraksha Silver Smart plan
- Any claims related to abuse of intoxicants or hallucinogenic substance such as alcohol and drugs are not covered
- Treatment cost of obesity or weight-related procedures, Alzheimer’s disease or sleep apnoea and congenital diseases, anomalies or defects are excluded
- Claims related to growth hormone therapy or stem cell harvesting is not covered
- Venereal diseases, sexually transmitted diseases, infertility, sterility, circumcisions
- No claims related to pregnancy, miscarriage, abortion or childbirth, surrogate pregnancy and birth control will be covered under this policy by HDFC ERGO Health Insurance
- Any dental treatment cost which does not involve hospitalization will not be covered
- Treatment expenses related to plastic or cosmetic surgeries, vision-correction surgeries, convalescence, private nurse duty, etc are not included
- Experimental, unproven or investigational treatment expenses will be excluded
- Hospitalization for diagnostic purposes and non-medical expenses are not covered
- Cost of vaccinations immunisations and inoculation is excluded under this plan by HDFC ERGO my:health Suraksha Silver Smart plan
- Any claims related to preventive care investigations and tests are not covered
- Cost of OPD treatment, vitamins and tonics prescribed by the doctor, fitting hearing aids, contact lenses and spectacles are excluded
- Treatment taken by an unauthorized medical practitioner will not be covered
- Expenses incurred on baldness, crutches, artificial limbs, wigs, etc. will be excluded under this HDFC Health Insurance plan
- Claims arising out of pre-existing diseases that were not disclosed initially will not be entertained
HDFC ERGO Online Facilities
One can easily purchase HDFC ERGO Health Insurance online by following the below steps:
- Calculating the premium using health insurance premium calculator
- Providing all your details
- Making the payment
Other than that, HDFC ERGO offers several other online facilities. These are:
- E-Mail Policy Copy
- 80D Tax Certificate
- Updating Contact Details Online (Email id/Contact Number/Address)
- Make Changes/Endorsement
- Transfer of Insurance - Motor
- Creation of Service Request
- Upload Documents
- Cancellation Of Policy
- Track Interaction Status
- Claim Status
- Link Aadhaar and PAN
- Motor Claim Intimation
HDFC ERGO Health Insurance Premium Calculator
At PolicyBazaar, we provide you with an all-inclusive health insurance premium calculator to enable you to calculate the premium you are liable to pay in exchange for HDFC ERGO Health Insurance coverage. You can log onto policybazaar.com and calculate your health insurance premium by providing certain details of yours. HDFC ERGO medical insurance premium calculator facilitates you to purchase adequate health coverage for your family and you. All you need to do is select and provide the right details at the time of calculating the health premium.
HDFC ERGO Health Insurance Renewal:
If you’ve bought HDFC ERGO health insurance policy, you must take the renewal of the policy into consideration. Renewal of your health insurance plan is equally important as that of buying one. HDFC ERGO health insurance renewal is a quick, easy and hassle-free process. It will take just a few minutes to renew your policy online.
Here is a step-by-step procedure to renew your health insurance policy:
Step 1: Visit the official website of the insurance provider
Step 2: Hit the ‘Instant Renewal’ button.
Step 3: Enter the pre-requisite details of your policy including your name, policy number, etc.
Step 4: Look for some additional covers to improve your coverage to secure the assets.
Step 5: Fill in the necessary details. You will get to know the premium for renewal.
Step 6: Pay the required amount and renew your health insurance policy.
You can also call on Customer Service No : 022 - 62346234 / 0120 - 62346234 (available in India only) for instant renewal of your health insurance plan.
The premium of renewal is calculated basis your coverage and age. You can renew your expired health policy within a term of 30 days from the date of expiry.
How to File a Claim with HDFC ERGO?
Claims are of two categories and these are explained below:
- Cashless Claims: HDFC ERGO Health Insurance has 9,000+ network of hospitals. When policyholders go to any of these hospitals, they are eligible to get a cashless claim since the insurance company will directly settle the bill with the hospital. However, the disease, too, has to be eligible for such a cover.
- Reimbursement Claims: If the hospital is not network-listed, the policyholder can get the expenses reimbursed against the hospital bills.
Below are the documents you need to submit for smooth processing of claims.
- NEFT details in the claim form along with a cancelled cheque.
- KYC form along with a photocopy of any one KYC document for claims amounting to Rs. 1 lakh or more. KYC Documents: Aadhaar Card, Passport, Driving License Voter ID
HDFC ERGO Health Insurance Customer Care
HDFC ERGO Health Insurance has several self-help options, and also a customer care apparatus in place.
By submitting the policy number, mobile no., or email ID, one can also create a service request online.
HDFC ERGO Health Insurance Network Hospitals
With over 4,800+ hospitals across the nation, HDFC ERGO health insurance provides you with an assurance of quality medical treatment at a hospital of your choice. You can avail medical treatment at these hospitals either as planned hospitalization or in the event of a medical emergency. In the meanwhile, keep your TPA informed about your plan to get hospitalized to avail the treatment or as soon as you get hospitalized in an emergency.
HDFC ERGO Health Insurance- FAQs
Ans: HDFC ERGO health insurance plans provide comprehensive coverage to the insured and the family. The company offers affordable health insurance plans with the cashless benefit at over 5000 hospitals all over India. Additional features are flexible payment options, enhanced NCB (No Claim Bonus), and so forth.
Ans: In addition to health insurance, following policies are offered by HDFC ERGO:
- Health Suraksha Top Up Plus Plan
- Critical Illness Policy
- Critical Illness Platinum Policy
Ans: Yes, you can easily apply online for HDFC ERGO health insurance. You can download the policy form from the company website and take a printout. Fill in the details and submit it at the nearby branch.
Ans: HDFC ERGO Health Insurance accepts premium payment in following three modes:
- Auto-deduction from your bank account
- In the form of cash or cheque deposit
- Online payment
Ans: You can check the status of your insurance policy from the company’s website. Log in and right-click on the policy number to get the status details.
Ans: The simplest way to choose the best HDFC ERGO health insurance policy is to compare its various plans and choose the one that offers the maximum coverage within your budget.
Ans: Your health insurance policy is subject to auto-renewal, in case you chose the option auto-debit from your bank account at the time of purchasing the policy. You can also call on Customer Service No : 022 - 62346234 / 0120 - 62346234 (available in India only) for instant renewal of your health insurance plan.
Ans: There is no age limit for policy entry. One can apply for a health insurance plan at the minimum age of 91 days.
Ans: The company provides you with a wide network of over 9,000+ hospitals to avail the cashless facility. Along with the policy documents, you get a list of those hospitals. Alternatively, you can visit the company website and click on network hospitals right on the top to find the nearest hospital in your city.
Ans: For insurance claim settlement, follow the steps listed below:
- Make sure you register your insurance claim not more than 7 days of discharge from the hospital.
- Submit the duly signed insurance claim form along with other required document within 15 days of the occurrence of the particular incident.
- In case of deficiency of any of the document(s) required, you will receive a deficiency letter within 7 days of documents submission.
- The insurance claim settlement statement will be sent to you within 30 days after submitting complete documents along with a permissible payment.
Written By: PolicyBazaar - Updated: 02 January 2020