HDFC ERGO Health Insurance Claim Settlement Ratio

(3 Reviews)
Insurer Highlights

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

*Tax benefit is subject to changes in tax laws. Standard T&C Apply

Back
Get insured from the comfort of your home
Get insured from the comfort of your home
  • 1
  • 2
  • 3
  • 4

Who would you like to insure?

  • Previous step
    Continue
    By clicking on “Continue”, you agree to our Privacy Policy and Terms of use
    Previous step
    Continue

      Popular Cities

      Previous step
      Continue
      Previous step
      Continue

      Do you have an existing illness or medical history?

      This helps us find plans that cover your condition and avoid claim rejection

      Get updates on WhatsApp

      Previous step

      When did you recover from Covid-19?

      Some plans are available only after a certain time

      Previous step
      Advantages of
      entering a valid number
      You save time, money and effort,
      Our experts will help you choose the right plan in less than 20 minutes & save you upto 80% on your premium

      HDFC ERGO Health Insurance Claim Settlement Ratio

      HDFC ERGO General Insurance Company has an efficient in-house claim settlement team that decides on all the claims without third party administrator (TPA) involvement. As a result, the Company ensured an impressive HDFC ERGO health insurance claim settlement ratio of 95% in FY 2021-22.

      Read More

      The claim settlement ratio (CSR) indicates the total claims paid compared to the total number of claims received. Thus, the above CSR suggests that the insurance company paid 95% of the total claims received in the financial year ending March 31, 2022.

      Claim Process of HDFC ERGO Health Insurance Plans

      HDFC ERGO General Insurance Company has an easy and hassle-free claim process. Policyholders can either raise a cashless health insurance claim or a reimbursement claim. Take a look at the step-by-step guide to file a claim through both methods below:

      Cashless Claim Process:

      Follow the steps given below to file an cashless claim with HDFC ERGO health insurance:

      Step 1: Inform the Insurer

      Policyholders must inform the insurance company about their planned hospitalization at least 48 hours in advance and about emergency hospitalization within 24 hours.

      Step 2: Display Documents for Cashless Treatment

      Show your HDFC ERGO health card and a valid photo ID at the network hospital for cashless treatment.

      Step 3: Pre-authorization Form

      The network hospital will send the pre-authorization form to the HDFC ERGO General Insurance Company and seek approval for cashless treatment.

      Step 4: Cashless Claim Approval

      The insurer will go through the documents received by the hospital and will approve/reject your cashless claim request.

      Step 5: Document Submission

      If approved, the hospital will send the final bill and other required documents to the insurer for final authorization after your treatment.

      Step 6: Claim Settlement

      The insurer will verify all the documents and authorize the claim within 2 hours of receiving all the documents. The bill amount will be paid directly to the network hospital.

      Reimbursement Claim Process:

      Here are the steps to file a reimbursement claim with HDFC ERGO health insurance:

      Step 1: Inform the Insurer and Obtain Treatment

      Inform HDFC ERGO General Insurance Company about your hospitalization within the specified timeline and obtain the treatment.

      Step 2: Pay Hospital Bills

      While getting discharged from the hospital, pay all the medical bills and collect all the medical documents.

      Step 3: Upload All Documents

      Upload all the required documents to the insurer’s website for claim processing.

      Step 4: Claim Settlement

      The insurance company will review all the submitted documents and process the claims within 7 days. The claim amount will be paid to you online.

      Documents Required for HDFC ERGO Health Insurance Claims

      Take a look at the list of documents required to file an HDFC ERGO health insurance claim:

      • Duly filled and signed HDFC ERGO health insurance claim form
      • Original hospital bill with detailed break-up and payment receipts
      • Original hospital discharge summary
      • Original pharmacy invoices supported by doctor’s prescriptions
      • Original investigation reports, such as X-ray reports, blood test reports, etc.
      • Implant sticker/invoice
      • Past treatment documents, if any
      • FIR or Medico Legal Certificate (MLC) in case of accident claims
      • Nominee details in case of proposer’s death
      • Legal heir certificate if the proposer is a minor
      • NEFT details for online payment
      • KYC form with a photocopy of any one KYC document for claims of Rs 1 lakh and above
      • Other relevant documents, if any
      Policybazaar exclusive benefits
      • 30 minutes claim support*(In 120+ cities)
      • Relationship manager For every customer
      • 24*7 claims assistance In 30 mins. guaranteed*
      • Instant policy issuance No medical tests*
      Disclaimer: Policybazaar does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer.

      Health insurance articles

      Recent Articles
      Popular Articles
      Does HDFC ERGO Health Insurance Cover Dental Treatments?

      22 May 2024

      HDFC ERGO General Insurance Company offers various health
      Read more
      Does Aditya Birla Health Insurance Cover Dental Treatments?

      17 May 2024

      Dental insurance is vital in maintaining oral health by covering
      Read more
      Does Niva Bupa Health Insurance Cover Dental Treatments?

      06 May 2024

      Dental insurance covers regular dental check-ups and treatments to
      Read more
      Surgeries Covered by TATA AIG Health Insurance Plans

      26 Apr 2024

      Amidst the escalating healthcare costs nationwide, managing the
      Read more
      Surgeries Covered by Liberty Health Insurance Plans

      26 Apr 2024

      Liberty General Insurance Limited offers a range of comprehensive
      Read more
      How to Apply for Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY)?
      Ayushman Bharat Yojana is a flagship health insurance scheme launched by the Government of India to offer universal
      Read more
      Best Health Insurance Plans for Senior Citizens
      Senior citizens are the most prone to diseases. Considering the medical inflation in India, buying health insurance
      Read more
      Does Health Insurance Provide Coverage for LASIK Eye Surgery?
      A vast majority of the Indian population is suffering from vision problems. For some of them, LASIK eye surgery is
      Read more
      Zero Waiting Period in Health Insurance Plans
      Every medical insurance plan comes with a few terms & conditions, and the waiting period is one of them. A
      Read more
      Heart Surgery Cost in India
      Heart diseases are the leading cause of death across the globe. As per a survey by the World Health Organisation
      Read more

      top
      Close
      Download the Policybazaar app
      to manage all your insurance needs.
      INSTALL