HDFC Ergo Health Suraksha Gold Plan Overview
Life is highly unpredictable and full of uncertainties that is why one should stay guarded with an appropriate medical insurance policy. These days hospitalization is very expensive and it can easily make a hole in your pocket. Hospitalization can be both financially and emotionally stressful. Therefore, it is wise to buy a health insurance policy that covers the maximum ailments.
HDFC ERGO's Health Suraksha Gold plan is an affordable policy that offers coverage for in-patient hospitalization expenses, pre and post hospitalization expenses. There is no sub-limit on the hospital charges, hospital room rents, doctor fees, and illnesses.
Key Benefits and Features of HDFC Ergo Health Suraksha Gold Plan
- Optimized medical insurance plans at an economical premium cost
- More than 6000 hospitals to avail cashless medical treatment
- Lifelong renewability option
- There is no limit on the entry age
- Maternity cover along with new-born baby cover after a waiting period of four years
- AYUSH treatment cover without any sub-limits
- No Sub-limits on the hospital charges, room rent, illness, and the doctor fees
- E-opinion cover upon diagnosis of life-threatening diseases
- Option to select from family floater or individual Health Insurance plans.
- Convalescence benefit if hospitalization exceeds 10 days
- Tax exemption benefits under the purview of Section 80D of the IT Act
- Seamless claim procedures with minimum documentation
- 10% discount for the 2-year policy term
- 10% of family discount is available if more than 2 family members are insured under this plan on individual sum insured basis
Inclusions of HDFC Ergo Health Suraksha Gold Plan
- Sum insured per individual on a yearly basis: 3 lakhs, 4 lakhs, 5 lakhs, 7.5 lakhs & 1 lakh
- Sum insured per individual on family floater basis: 3 lakhs, 4 lakhs, 5 lakhs, 7.5 lakhs & 1 lakh
Hospitalization costs for an illness or accident are compensated up to the sum insured limit. It includes the medical expenses for hospital room, nursing expenses, Intensive care unit, surgical appliances, doctor, drugs, anesthesia, oxygen, operation theatre charges, medicines, diagnostic procedures, consumables, drugs and, cost of prosthetic devices, implantations, etc.
- Hospitalization expenses that were incurred immediately 60 prior to the hospitalization
- Hospitalization expenses that were incurred immediately 90 days after the hospitalization
- 144 listed daycare treatments/surgeries where 24-hours of hospitalization is not essential
- Domiciliary treatment cost that would otherwise have required hospitalization on the recommendation of the doctor, if the policyholder could not be moved to a hospital or if there is no hospital bed available
- Organ donor transplantation expenses incurred on harvesting the donated organ up to the sum insured amount
- Emergency ambulance up to Rs. 2,000 for sum insured of Rs. 3 lakhs, 4 lakhs, and 5 lakhs. And for sum insured up to Rs.3500 for Sum Insured of Rs. 7.5 lakhs and 10 lakhs
- AYUSH inpatient hospitalization covers Ayurvedic, Unani, Siddha & Homeopathy up to the sum insured amount
- Newborn baby cover in patient medical expenses within 90 days of birth
- Maternity benefits after completion of 4 years
- Expenses related to Normal Delivery expenses up to Rs. 15,000 & Rs. 25,000 for LSCS and for termination the limit is Rs. 15,000
- Pre and post natal expenses up to Rs. 1,500
- New Born cover up to Rs2,000
- Cumulative Bonus: 5% to 50% of the Basic Sum Insured for every claim free year. If a claim is filed, the cumulative bonus will get reduced by 5% of the basic sum insured.
- Critical Illness E-Opinion: In case of diagnosis of critical illness during the policy term you can take a second opinion from an empaneled doctor. It requires proper information, documentation and the doctor will give the second opinion directly to the insured person.
- Convalescence benefit in case the hospitalization lasts for more than 10 consecutive days. The insurer will pay off in a lump sum up to 10,000 rupees and up to a maximum 1 percent of the Sum Insured.
Exclusions of HDFC Ergo Health Suraksha Gold Plan
- Any hospitalization required within 30 days of the policy commencement date except for accidental injuries
- 2-years of a waiting period for tonsil surgery, cysts, sinuses, internal tumor, etc.
- Pre-existing illnesses are recompenses after 48 months of the continuous policy term
- Expenses incurred on treatment related to AIDS and HIV
- Mental disorders, weight loss treatment, and cosmetic surgeries
- Health issues arising after an overdose of alcohol and drugs
- Hospitalization required due to war, nuclear elements, radiations, and weapons
- Pregnancy complications unless specifically cover
- Dental care and external appliances unless included in the plan
- Terrorist activities, war, and radioactivity
HDFC ERGO Health Insurance Claim Procedure
You can seek reimbursement of your medical expenses or avail cashless hospitalization in this plan-
Reimbursement Claim Procedure
You can file reimbursement of your hospitalization expenses for a treatment taken in a non-network hospital. To avail the benefits you need to notify the insurer and the procedures is listed below:
- For hospitalization in a non-network hospital, initially, the payment needs to be made from your own pocket. The reimbursements need to be filed within 7 days of getting discharged from the hospital
- All the medical bills will be compensated after discharge, provided all the documents are submitted with the claim form
- After verification, your claim request will be approved, and the insurance company will settle the amount within 30 days of document submission
- When there is a medical emergency, the insurance company needs to be informed within 24 hours of hospital admission. For planned hospitalizations, you should notify the insurance company within 48 hours of getting hospitalized
Cashless Claim Procedure
All the treatments that are taken in a network hospital are eligible for cashless claims. To start with the treatment, you would need authorization from the insurance company based on the procedures listed down in the medical insurance form.
The process is listed below-
- For planned hospitalizations, you should inform the insurance company within 48 to 72 hours before starting the treatment in a panel hospital
- In the event of an unplanned hospitalization, you need to inform the insurance provider after admission
- Furnish your health card and a photo identity card
- Once the verification is completed, you will need to submit the duly filled pre-authorization form to the TPA or the claim settlement team.
- Upon verification of the pre-authorization request form, the insurance company will give approval before the cashless treatment starts
Documents Required for Claim Registration
- Duly signed and filled claim form with the policy number
- Discharge summary
- Investigation reports (e.g. X-Ray, blood reports, etc.)
- Final bill with payment receipts, detailed breakup and, original medicine bills with prescriptions
- Implant invoice for example lens in cataract surgery, a stent in angioplasty, etc.
- Past treatment documents
- In accidental cases, FIR or Medico Legal Certificate
- Other documents
Read About All Plan Offered by HDFC ERGO Health Insurance
Written By: PolicyBazaar - Updated: 09 January 2020