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 ensures an HDFC ERGO health insurance claim settlement ratio of 98.5%.

The claim settlement ratio (CSR) indicates the total claims paid compared to the total number of claims received. Thus, the above CSR suggests that 98.5% of the total claims received were paid in the last three months.

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 processes below:

1. Cashless Claim Process

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 to avail 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

The hospital will send the final bill and other required documents to the insurer for final authorization after the 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 to the network hospital.

2. Reimbursement Claim Process

Step 1: Inform the Insurer and Obtain Treatment

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

Step 2: Pay Hospital Bills

At the time of 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 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