HDFC ERGO Health Insurance Claim Form

HDFC ERGO Health Insurance Claim Form

HDFC ERGO health insurance claim form is an official document provided by HDFC ERGO General Insurance Company Limited required to be submitted for filing a claim request. It is an important document through which the insured can raise a request to get a refund for the medical expenses incurred by them under HDFC ERGO health insurance plans.

What is the HDFC ERGO Health Insurance Claim Form?

The HDFC ERGO mediclaim form is a document containing all essential details pertaining to the health insurance plan, insured, hospitalization, medical bills and insurance history. It is important for the policyholder to submit a completely filled out and signed claim form to ensure their request is not denied.

Types of HDFC ERGO Health Insurance Claim Forms

Claims in health insurance can be of two types, reimbursement and cashless. There are separate forms available for both the claims.

• Reimbursement health insurance requires the policyholder to initially pay the medical bill out of their own pockets and later file for a refund. There are two parts of the HDFC ERGO reimbursement claim form – Part A and B, which are both integral for raising a successful claim request.
• For a cashless hospitalization, the insurer settles the bill directly with the hospital, eliminating the need for the policyholder to pay the expenses upfront. For this, the insured must submit a document called the pre-authorization form.

How to Download the HDFC ERGO Health Insurance Claim Form?

Check out the different ways through which the policyholder can download the HDFC ERGO health insurance claim form:

Website

• Visit the official website of the HDFC ERGO General Insurance Company Limited.
• Select the 'Claim' tab on the main horizontal navigation bar.
• Click on 'Claim Forms.' You will be redirected to the Downloads page.
• Select the HDFC health insurance plan for which you want to download the claim form.
• The claim form will open in the new tab.

Mobile Application

The policyholder can also download the claim forms via 'Here by HDFC ERGO' app.

Other ways to get the HDFC ERGO health insurance claim form:

A physical copy of the HDFC ERGO claim form can be obtained from the nearest branch office.

How to Fill the HDFC ERGO Health Insurance Claim Form?

Here is how to fill a HDFC ERGO health insurance claim form:

1. Part A of the HDFC ERGO Health Insurance Claim Form

   The policyholder (or insured) must fill out the following particulars of the Part A of the HDFC ERGO claim from:

   Section A - Details of Primary Insured

   Policy number, Sl. No./Certificate no., Company/TPA ID no., Policyholder's name and address, and contact details

   Section B - Details of Insurance History

   If currently covered by any other health insurance policy, date of its commencement, insurer name, policy number, sum insured, if hospitalized in the last 4 years, its date and diagnosis, and if previously covered by other health insurance

   Section C - Details of Insured Person Hospitalized

   Name, relationship, date of birth, age, address, gender, occupation, and contact details

   Section D - Details of Hospitalization

   Name of the hospital where admitted, room category occupied, hospitalization reason, date of injury or first disease detection, date and time of admission, date and time of discharge, cause of injury, system of medicine, etc.

   Section E - Details of Claim

   Details of treatment expenses claimed under hospitalization cover, claim for domiciliary hospitalization, claim for preventive health check-up, applicable optional covers/ add-ons, claim documents submitted checklist for hospitalization claim, checklist of additional documents for critical illness claims, etc.

   Section F- Details of Bills Enclosed

   S.no., bill number, date, issued by, towards, and amount

   Section G - Details of Primary Insured's Bank Account

   PAN, account number, bank name and branch, cheque/DD payable details, IFSC code, and MICR number

   Section H- Declaration by the Insured

   Date, place, and signature of the insured

   Disclaimer: The above-mentioned claim form details are indicative only. The policyholder must fill out all required details in the claim form provided by HDFC ERGO General Health Insurance Company Limited.

2. Part B of the HDFC ERGO Health Insurance Claim Form

   The HDFC ERGO health insurance claim form Part B is to be filled out by the hospital.

Common Mistakes to Avoid when Submitting HDFC ERGO Health Insurance Claim Form

The policyholder must avoid the following mistakes while submitting the HDFC ERGO health insurance claim form:

• Not mentioning about medical history
• Incorrect details, like wrong policy number, mismatch in the name
• Not attaching original medical bills and receipts
• Not submitting all the mandatory documents
• Mentioning claims for conditions that are excluded
• Mentioning claim amount higher than the allowed limit
• Incorrect signature

Documents Required with the HDFC ERGO Health Insurance Claim Form

The insured must submit the following mandatory documents along with the HDFC ERGO health insurance claim form for a successful request initiation:

• Original hospital bills with detailed breakdown
• Discharge summary
• Medical reports and prescriptions
• Pharmacy bills
• Identity proof
• Bank details
• Employer ID, in case of group medical policy
• FIR or Medico-Legal Certificate (MLC), in accidental cases
• Medical certificate mentioning diagnosis and illness duration, in case of critical illness

FAQs on HDFC ERGO Health Insurance Claim Form