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HDFC ERGO Health Insurance

HDFC ERGO General Insurance Company (IRDA Reg. No 125) is a joint venture of one of the most respected financial institutions that provides housing finance, HDFC, and the insurance arm of Munich Re Group ERGO International AG.

HDFC ERGO has a range of products such as health insurance, motor insurance, travel insurance etc. This general insurance company is one of the leaders in the private sector insurance providers in India. It is ISO certified and was bestowed upon the prestigious iAAA rating by ICRA, which is a reflection of company’s high claim settlement ratio. HDFC ERGO also offers health insurers, and quite a favorite of their loyal customer base.

Plans Offered by HDFC ERGO

HDFC ERGO Health Suraksha Policy

Health Suraksha Policy offered by HDFC ERGO is a basic health insurance plan which covers most of the hospitalization expenses. The coverage under this plan is available as both individual and family floater.

Individual Coverage

  • This policy offers basic coverage in the range of INR 3,00,000 and INR 5,00,000 for individuals of any age above 3 months.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, cashless benefit, hospital expense cover, ambulance cover, etc., are benefits provided in the plan.
  • Maternity benefit, critical illness cover (lump sum amount payment), co-payment, etc. can be additionally opted in the same policy.

If you are under the age of 45, you need not go through a medical checkup. The policy also covers over 140 day care procedures. For more information on this policy, please click here.

Family Floater Coverage

  • This is a basic family floater plan which covers health costs of the entire family in the range of INR 3,00,000 and INR 5,00,000.
  • A maximum of 2 adults and 2 children in the family of any age above 3 months can be covered under this policy.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, cashless benefit,hospital expense cover, ambulance cover, etc., are provided in the plan.
  • Maternity benefit, critical illness cover (lump sum amount payment), co-payment, etc. can be additionally opted in the same policy.

If you want to cover medical expense of your entire family with this plan better know about all the terms and conditions, please click here.

Health Suraksha Gold Policy

Health Suraksha Gold is advanced version of Health Suraksha Plan which has an option to opt for additional critical illness cover.The coverage under this plan is available as both individual and family floater.

Individual Coverage

  • This policy offers basic coverage in the range of INR 2,00,000 and INR 10,00,000 for individuals of any age above 3 months.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, maternity benefit, cashless benefit,hospital expense cover, ambulance cover, etc., are benefits provided in the plan.
  • Critical illness, co-payment, etc. can be additionally opted in the same health insurance policy.

If you want a health insurance plan with additional benefits on diagnosis of critical illnesses know more about Health Suraksha Gold, please click here.

Family Floater Coverage

  • This is a family floater plan which covers health costs of the entire family in the range of INR 2,00,000 and INR 10,00,000.
  • A maximum of 2 adults and 2 children in the family of any age above 3 months can be covered under this policy.
  • Pre and post hospitalization expenses, No sub-limits, No-claim bonus, maternity benefit, cashless benefit,hospital expense cover, ambulance cover, etc., are provided in the plan.
  • Critical illness, co-payment, etc. can be additionally opted in the same policy.

If you want additional critical illnesses cover along with in-patient hospitalization expense cover, for your entire family know more about Health Suraksha Gold, please click here.

Health Suraksha Regain Policy

Health Suraksha Regain is the plan with restore benefit offered by HDFC ERGO. The coverage under this plan is available as both individual and family floater.

Individual Coverage

  • This policy offers basic coverage in the range of INR 3,00,000 and INR 10,00,000 for individuals of any age above 3 months.
  • Pre and post hospitalization expenses, no sub-limits, no-claim bonus, hospital expense cover, ambulance cover, etc., are benefits provided in the plan.
  • In addition to the above mentioned benefits this plan also has a restore benefit facility (this benefit results in automatic restoration of coverage amount in case it is exhausted in a particular year).

Family Floater Coverage

  • This is a family floater plan which covers health costs of the entire family in the range of INR 2,00,000 and INR 10,00,000.
  • A maximum of 2 adults and 2 children in the family of any age above 3 months can be covered under this policy.
  • Pre and post hospitalization expenses, No sub-limits, No-claim bonus, hospital expense cover, ambulance cover, etc., are benefits provided in the plan.
  • In addition to the above mentioned plan this plan also has a restore benefit facility.

Health Suraksha Top-up Plus Policy

Health Suraksha Top-up as the name suggests is a top-up plan offered by HDFC ERGO. It offers coverage on individual and family floater basis.

Individual Coverage

  • This is a top-up plan (these plans have an agreed upon deductible amount to be paid at the time of claim) for individuals from age 5 years up to 65 years.
  • The coverage amount for this plan is in the range of INR 2,00,000 and INR 10,00,000 and the deductible amount is in the range of INR 1,00,000 and INR 5,00,000.
  • This plan offers basic coverage like pre and post hospitalization expenses, no sub-limits, no-claim bonus, hospital expense cover, ambulance cover, etc.

If you already have a health insurance policy and want an additional coverage without paying higher premium know more about Health Suraksha Top-up plan click here

Family Floater Coverage

This is a family health insurance top up plan (these plans have an agreed upon deductible amount to be paid at the time of claim) which covers health costs of the entire family. The coverage amount for this plan is in the range of INR 2,00,000 and INR 10,00,000 and the deductible amount is in range of INR 1,00,000 and INR 5,00,000. A maximum of 2 adults and 2 children in the family between age 5 years up to 65 years can be covered under this policy. This plan offers basic coverage like pre and post hospitalization expenses, no sub-limits, no-claim bonus, hospital expense cover, ambulance cover, etc.

If you want an additional coverage for your entire family without paying higher premium know more about Health Suraksha Top-up family floater plan click here

Critical Illness Silver Policy

One of the benefit plans offered by HDFC ERGO is the Critical illness plan which offers lump-sum benefit post diagnosis of critical illness. There are two variants available of this plan.

  • This plan specially offers individual cover for critical illness in the range of INR 1,00,000 and INR 50,00,000 for individuals between age 5 years and 65 years.
  • In this plan a lump sum amount equal to sum insured is offered to policy holder in case of critical illness or accident.
  • Critical Illness insurance offers coverage in case of heart attack, coronary bypass surgery, stroke, cancer, kidney failure, major organ transplants, multiple sclerosis and paralysis.

If you want to have additional coverage to cope up with expenses upon diagnosis of critical illnesses or post an accident, know more about critical illness Silver policy by HDFC ERGO.

Critical Illness Gold Policy

  • This plan specially offers individual cover for critical illness in the range of INR 1,00,000 and INR 50,00,000 for individuals between age 5 years and 65 years.
  • In this plan a lump sum amount equal to the sum insured is offered to policy-holder in case of 8 critical illnesses.
  • In addition to the silver plan this plan offers coverage in case of aorta graft surgery, primary pulmonary arterial hypertension, and heart valve replacement.

If you want to be completely sure that all your expenses in case of critical illness are getting covered, then know more about critical illness Gold Plan by HDFC ERGO which is advanced variant of critical illness silver plan.

Critical Illness Platinum Policy

  • This plan specially offers individual cover for critical illness in the range of INR 1,00,000 and INR 50,00,000 for individuals between age 5 years and 65 years.
  • In this plan a lump sum amount equal to sum insured is offered to policy-holder in case of 15 critical illnesses.
  • In addition to the gold plan this plan offers coverage in case of benign tumor, Parkinson's disease, Alzheimer's disease and end stage liver disease.

If you want to cover neurological ailments in addition to critical conditions mentioned under the Gold plan, know more about critical illness Platinum policy offered by HDFC ERGO.

Personal Accident Insurance Policy

Another benefit plan offered by HDFC ERGO which offers lump-sum benefit post death or disability resulting from an accident.

  • This plan offers coverage in case of accidents anywhere in the world in the range of INR 2,50,000 to INR 15,00,000 to individuals below age 65 years.
  • In this plan a lump sum amount in case of accidental death, daily cash in case of illness & accident, covers permanent or temporary total disability, injuries with broken bones or burns as well as ambulance costs.

If you want additional financial coverage in case of death or disability resulting from an accident, know more about Personal Accident policy by HDFC ERGO.

Talk to a Health Insurance Advisor

Understand all the benefits of HDFC ERGO health plans

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Benefits

  • HDFC ERGO has an iAAA rating from the ICRA, indicating that HDFC ERGO insurance have a high ratio of claim settlement
  • Products are designed intuitively and are suited for everyone, whatever your needs be
  • Over 4800 network hospitals
  • No sub-limit for room rents.

Claim Process at HDFC Ergo

There are two ways to make claim under a Health Insurance Policy: on cashless basis and on reimbursement basis. In simple terms, for making a claim on cashless basis, the treatment must be done only at a network hospital of the insurance company servicing your policy. For availing the treatment, you would have to first seek an authorization as per the procedures laid down and in the prescribed form. In case of claims on reimbursement basis, the insurance company has to be informed as per their prescribed procedures. The policyholder has to ensure that documents such as claim form, discharge summary, prescriptions and bills to be submitted for the claim on reimbursement are obtained after hospitalization.

HDFC Ergo Health Insurance has a well-defined claim processing system.

Cashless Service: seeking Pre-Authorization

  • Complete the pre-authorization form available at the hospital’s insurance/TPA Desk.
  • Send the completed form via email or fax.
  • Approved letter will be sent by the claim management team. Remember that the claim management team could send an inquiry to the hospital or you before authorization.
  • In case the authorization is rejected, initiate the treatment and file for reimbursement claim.

Reimbursement Claim: Claim Submission

  • Complete the necessary form and submit along with required documents, as per the policy terms and conditions.
  • Necessary documents include discharge summary, prescriptions, bills etc.
  • Approved letter will be sent by the claim management team. Remember that you will be answerable to any queries raised by the claim management team before the letter is issued.
  • In case the claim is rejected, the reasons will be communicated by the team.

In case of any emergencies, you need to inform HDFC Ergo within 24 hours of the admission. In case of planned emergencies, the notification has to reach the company 48 hours prior to the hospitalization. The claim intimation can be done via HDFC Ergo's toll free number 1800-2000-700, or fax 1800-2000-600. The same could also be emailed to healthclaims@hdfcergo.com .

Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.

Frequently Asked Questions

- What are the key benefits of HDFC Ergo’s Health Suraksha Plan?

Some of the key benefits of choosing HDFC Ergo’s Health Suraksha Plan are as below:

  • Choose either an Individual Health Insurance or a Family Floater Health Insurance
  • Avail Cumulative Bonus at the end of each claim-free year
  • Health check-up expenses are covered in the plan on completion of 4 claim-free years
  • Avail cashless services from our vast network of more than 5000+ hospitals
  • Avail Income Tax exemption under Section 80D of the Income Tax Act
  • Health check-up not mandatory for individuals below 45 years of age
  • No Sub-limits on hospital room rents, hospital expenses, specific diseases and doctor fees.

- Is Maternity and New Born Baby covered in Health Suraksha Gold plan?

Maternity Benefit available after a waiting period of 4 Yrs along with New Born baby cover.

- What is Regain benefit in Health Suraksha Regain plan?

Regain benefit provides for an automatic availability of basic sum insured upon its exhaustion (inclusive of any cumulative bonus) during the health insurance policy year.

  • Basic sum insured will be re-instated only once in health insurance policy year
  • If the Regain SI is not utilized in a policy year, it shall not be carried forward to any subsequent insurance policy year.
  • Regain benefit cannot be withdrawn at subsequent renewals
  • Regain SI can be used for only future claims and not against any claim for an illness/disease (including its complications) for which a claim has been paid in the current policy year

- What are the discounts offered by EDFC Ergo Health plans?

10% discount for 2 Yr tenure of the policy. Similarly, Family Discount of 10% if 2 or more family members are covered under Health Suraksha on Individual Sum Insured basis. These discounts are application for Health Suraksha Gold, Health Suraksha Regain and Health Suraksha Gold Regain plans.

- Which all hospitals are covered under HDFC Ergo's cashless network?

Cashless services are available at a network hospital. To locate a HDFC Ergo network hospital near you, click here.

Review of HDFC Ergo Health Insurance

When it comes to claim settlement ratio, HDFC ERGO has a very healthy record. That’s strikingly encouraging for their potential customers. Pricing wise, their products perform quite well in comparison to their counterparts from competitors. With respect to deductions and room rent limits, HDFC ERGO health insurance passes with flying colors. They are okay when it comes to waiting periods and their no-claim bonus structure is not the most flattering; they offer a 5% bonus for every claim-free year, with a maximum bonus of 50%.