HDFC Ergo General Health Insurance Claim Settlement Ratio

HDFC Ergo General Insurance Company ensures timely claim settlement. The company’s health claim settlement ratio of 92% assures that the insurer has a good claim settlement record.

The claim ratio for health insurance companies between 80%-90% assures credibility. The health claim defined the percentage of claims settled in a financial year against the number of claims received.

Claim Process of HDFC Ergo General Health Insurance

Claims filed for HDFC Ergo medical insurance plans are settled in a timely manner. The company boasts of settling cashless claims in 20-minutes. You can file both cashless and reimbursement claims and the process are illustrated below:

Claim Process for Cashless Treatment

With HDFC Ergo General health insurance plans you can avail cashless treatment in more than 10000 hospitals across India. For cashless claim settlement, the treatment should be carried out in a network hospital only. To avail of the treatment, it is important to seek authorization from the insurer based on the procedures laid down in the HDFC Ergo medical insurance form. 

The procedure is defined below:

  • If the hospitalization was planned, you need to inform the insurer at least 48 to 72 hours before admission. It is only applicable to panel hospitals
  • In case of an unplanned hospitalization, inform the insurance company soon after admission
  • Do not forget to carry your photo ID card and the health card
  • After verification, the hospital will ask you to submit the duly signed and filled pre-authorizations request to their claim settlement team
  • Once the pre-authorization request form is verified, the insurer will send the approval to the, after that the cashless health treatment will begin

Claim Process for Reimbursement Treatment

To get reimbursement of the hospitalization expenses incurred in a non-network hospital, you need to inform the insurance company as per their prescribed procedures. The procedure is listed below-

  • If the treatment is taking place in any of the non-network hospitals, then you will have the pay the hospital bills from your own pocket. After that, you will have to file for reimbursement within a week of discharge from the hospital
  • To get compensation for your medical bills after discharge, you need to submit all the required documents along with the claim form
  • Once the request is verified and approved, the insurer will reimburse the claim amount within a month of receiving the documents

In case of a medical emergency, you will need to inform the insurance company within 24 hours of getting admitted into the hospital. If hospitalization was planned, the insurer should be notified 48 hours before getting hospitalized. 

Documents Required for HDFC Ergo General Health Insurance

Submit the below-mentioned documents for smooth processing of your claim- 

  • Duly signed and filled HDFC Ergo medical insurance claim form with the policy number
  • The discharge summary from the hospital ( original copy)
  • Investigation reports such as medical test, x-ray, blood reports, etc. ( original copy)
  • Documents of any previous healthcare treatments
  • Final hospital bills/receipts/ invoices with a detailed breakup
  • Chemists’ invoices with prescriptions
  • Invoice/Implant sticker, if used (such as for lens in cataract, a stent in angioplasty, etc.)
  • For accidental treatments, a Police FIR report of Medico-legal certificate is required
  • Other documents ( if required)
  • NEFT details for payment: Cancelled cheque in Proposer’s name or a copy of passbook attested by the bank
  • For HDFC Ergo medical insurance claims above Rs. 1lakh, KYC form is required with a Xerox copy along with your Driving license/ Passport/ Aadhar card/ Voter ID, etc.)

For more details, you can write to us or speak to our health insurance experts from the comfort of your home.

Written By: PolicyBazaar - Updated: 02 February 2021

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