HDFC Ergo Health Insurance

We function in a stressful environment every day and hence, health hazards are inevitable. Investing in health insurance is now a basic necessity.

HDFC ERGO has a range of products such as health insurance, motor insurance, travel insurance etc.

HDFC Ergo, one of the most trusted names in the health insurance space, provides a variety of health insurance plans that are designed intuitively to suit everyone. Promising great customer service, the company offers Health Suraksha plan, Critical illness policy and also has a plan in place to cover personal accidents. With health insurance plans from HDFC Ergo, all you have to worry about is your well-being.

Key Features of HDFC ERGO Health Insurance

  • No. of members- The plan covers maximum 4 members of your family with up to 2 children and 2 adults.
  • Lifelong Renewal – The plans offered are lifelong renewable, hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
  • No Sub-Limits on Room Rent - As sub-limits on room rent practically eat into your sum insured, HDRC ERGO scores brownie points for their plans without any sub-limits on the room rent.
  • Wide Sum Insured Options – For every claim-free year you earn 5% bonus.
  • Pre & Post hospitalization cover- The plan covers medical expenses for 60 days prior to hospitalization and 90 days post hospitalization only for related medical expenses.
  • Health Check-ups – On successful completion of 4 claim-free years, the health check-up expenses are reimbursed.
  • Pre-existing diseases- Pre-existing diseases are covered after 4 years of waiting period.
  • Co-payment- The plan has no co-payment policy.

Benefits of Buying Health Insurance from HDFC ERGO Health Insurance

  • 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
  • Great customer service post sales
  • The incurred claim settlement ratio of HDFC ERGO Health Insurance for F.Y.2017-18 is 52.58%.

Interesting Facts about HDFC Ergo Health Insurance

  • HDFC Ergo has a 30 minute-turnaround time (TAT) for processing of pre-authorized cashless health insurance claims.
  • 15 minute-TAT to process pre-authorized cashless motor insurance claims.
  • It comes with DIA, an AI-enabled chat bot service made available on the company’s website, Amazon Alexa and Google Assistant.

Types of HDFC ERGO Health Insurance Plans

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 Rs. 3 lakh and Rs. 5 lakh 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.

Family Floater Coverage :

  • This is a basic family floater plan, which covers health costs of the entire family in the range of Rs. 3 lakh and Rs. 5 lakh.

  • 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.

    For more information on this policy, 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 Rs. 2 lakh and Rs. 10 lakh 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.

Family Floater Coverage :

  • This is a family floater plan, which covers health costs of the entire family in the range of Rs. 2 lakh and Rs. 10 lakh.

  • 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 a health insurance plan with additional benefits on diagnosis of critical illnesses 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 Rs. 3 lakh and Rs. 10 lakh 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 Rs. 2 lakh and Rs.10 lakh.

  • 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 Rs. 2 lakh and Rs. 10 lakh and the deductible amount is in the range of Rs. 1 lakh and Rs. 5 lakh.

  • This plan offers basic coverage like pre and post hospitalization expenses, no sub-limits, no-claim bonus, hospital expense cover, ambulance cover, etc.

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 Rs. 2 lakh and Rs.10 lakh and the deductible amount is in range of Rs.1 lakh and Rs.5 lakh.

  • 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.

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 Rs.1 lakh and Rs.50 lakh for individuals between age 5 years and 65 years.

  • In this plan a lump sum amount equal to sum insured is offered to policyholder 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.

Critical Illness Gold Policy

  • This plan specially offers individual cover for critical illness in the range of Rs.1 lakh and Rs.50 lakh for individuals between age 5 years and 65 years.

  • In this plan a lump sum amount equal to the sum insured is offered to policyholder 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 Rs.1 lakh and Rs.50 lakh5 for individuals between age 5 years and 65 years.

  • In this plan a lump sum amount equal to sum insured is offered to policyholder 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.(Heart Attack , Multiple Sclerosis, Stroke Cancer, Major Organ Transplantation, Coronary Artery Bypass Surgery, Paralysis, Kidney failure, Aorta Graft Surgery, Primary Pulmonary Arterial Hypertension, Heart Valve Replacement, Parkinson's Disease, Alzheimer's Disease, End Stage Liver Disease, Benign Brain Tumor.

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 Rs. 2.5 Lakh and Rs. 15 Lakh 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.

Health Medisure Classic Insurance

A health insurance plan designed specifically to meet the medical necessities of your parents. This plan provides protective cover for your parents or senior citizens.

Features and Benefits:

  • You can avail 5% cumulative bonus at the end of each claim-free year.
  • It comes with lifelong renewability, entry and no upper age limit.
  • It comes with two policy tenure options - 1 or 2 years.
  • There is an option to select Double Sum Insured for critical illness as an add-on rider.
  • Hospital Cash and Benefit

Health Medisure Super Top Up Insurance

This is a top-up plan which can be availed over and above your existing health insurance plan, and offers a wider range of benefits along with enhanced protection. Individuals can benefit from higher sum insured against aggregate deductible at an affordable premium.

Features and Benefits:

  • Lifelong renewability.
  • No medical tests till the age of 55 years.
  • Fixed premium from the age of 61 years.
  • Avail a 5% discount for a 2-year policy and 10% family discount when you add 2 or 3 family members under individual sum insurance.
  • Guaranteed response within 6 hours on every cashless claim.
  • Covers Pre-Hospitalization & Post-Hospitalization expenses - 30 days for Pre-Hospitalization and 60 days for post.

Product Portfolio HDFC Ergo Health Insurance Plans

HDFC Ergo provides the following health insurance plans - Indemnity and Lump Sum benefit. Under the former, you will be compensated for the actual financial losses even if the actual sum insured is higher. Under the latter, the entire amount is paid as a lump sum benefit in the event of an accident. Based on these two aspects, HDFC Ergo offers multiple health policies.

Indemnity CoverLump Sum Cover
Hospital Room Rent CostsRehabilitation/Physiotherapy
Doctor’s FeeFollow up medical investigations & diagnostic tests
Operation Theatre ChargesPurchases like ergonomic furniture & house modificationFollow up medical investigations & diagnostic tests
Pre and Post Hospitalization ChargesDietary supplements, BP monitoring machines

Reasons to Choose HDFC ERGO Health Insurance Policy

  • Brand reputation - HDFC Ergo is trusted by millions of Indians. They have a customer base of over 75 lakhs and the brand has iAAA’ rating by ICRA indicating its highest claim paying ability.
  • All time support - HDFC Ergo provides 24/7 customer support along with a complete hassle-free experience.
  • Vast network - HDFC Ergo has a huge list of network hospitals - over 6000 across India.
  • Multiple plans - You have a wide range of plans to select from. Each plan is highly customizable.

Claims Process at HDFC ERGO Health Insurance Policy

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.

Documents Required for Claim Settlement

  • KYC details - ID, Age and Address Proof.
  • NEFT and Bank details along with a cancelled cheque.
  • Duly filled and signed Claim Form with HDFC Ergo policy number Claim Form
  • Original Discharge Summary
  • Original final bill with detailed breakup, payment receipt and, original pharmacy invoices supported by prescriptions
  • Original Investigation reports (e.g. blood reports, X-Ray, etc.)
  • Implant sticker/invoice, if used (e.g. for stent in angioplasty, lens cataract, etc.)
  • Past Treatment documents, if any
  • In cases of Accident, Medico Legal Certificate (MLC) or FIR
  • Other relevant documents, if any
  • NEFT details for payment: Cancelled cheque in the name of the Proposer or passbook copy attested by bank) For all claims of Rs. 1 lakh and above: KYC form along with photocopy of any one KYC document (e.g. Aadhaar card, passport, driving license, voter ID, etc.)
  • For all claims of Rs. 1 lakh and above: KYC form along with photocopy of any one KYC document (e.g. Aadhaar card, passport, driving license, voter ID, etc.) KYC Form

Renewal of HDFC ERGO Health Insurance Plans

The online process of renewal is the most convenient and fastest method of policy renewal. Simply visit the official website of HDFC Ergo and select the ‘Instant Renewal’ option. Enter your policy details and policy number, and the premium will be auto-generated for renewal. Pay via debit/credit/net banking and your policy will be renewed. Additionally, you can also call 1800 2700 700 and renew instantly.

Checklist Before Buying HDFC ERGO Health Insurance Plans

  • Any financial constraints
  • Number of family members to be covered
  • Time taken to be able to pay premium
  • Any pre-existing diseases
  • Additional dependents
  • Tenure of the policy
  • No of add-on riders

Documents required for Buying HDFC ERGO Health Insurance Policies

  • KYC Documents and 1 passport size photograph
  • Medical records and latest health report
  • Application form

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%.

Frequently Asked Questions On HDFC ERGO Health Insurance

What is HDFC ERGO Online Facilities?

HDFC Ergo offers complete, hassle-free, online facilities for purchasing a policy as well as for claim settlement.

What does HDFC ERGO Health Insurance Policy Cover?

  • In-patient treatment due to illness and accident.
  • Pre-hospitalization costs incurred 60 days prior hospitalization.
  • Post-hospitalization costs incurred 90 days post discharge.
  • Day care treatment that do not require 24-hour hospitalization.
  • Domiciliary Treatment, as advised by medical practitioner.
  • Organ Donor Treatment.
  • Emergency Ambulance.
  • Non Allopathic Treatment under AYUSH - Ayurveda, Unani, Siddha and Homeopathy.
  • Maternity expenses and New Born baby covered up to limits specified.

What does HDFC ERGO Health Insurance Policy Not Cover?

  • War or any act of war, invasion, war-like operations, etc.
  • Criminal or unlawful act, intentional self-injury or attempted suicide while sane or insane.
  • Participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing.
  • Intoxicating drugs and alcohol.
  • Venereal disease, "AIDS” (Acquired Immune deficiency Syndrome) and/or infection with HIV.
  • Any treatment arising from pregnancy (including voluntary termination), miscarriage, maternity or birth (including caesarean section).

How to buy HDFC ERGO Health Insurance Policy from online?

Simply visit the official website of HDFC Ergo and select the online option. You will be required to register with a login ID and Password. Select the desired policy and fill in the requested KCY details. Based on the information provided, your premium will be automatically calculated. Simply make the payment online via debit/credit/net banking and the policy will be delivered to your inbox.

How to calculate the premium for Health Insurance Plan from HDFC Ergo?

Simply visit the official website of HDFC Ergo and select the online premium calculator. Fill in the requested details such as name, age, family members, etc. and click on submit. Post submission, the premium will be automatically calculated with respect to the policy selected.

Is there an entry age for buying HDFC ERGO health insurances?

The minimum age at entry is 3 months to 65 years.

Can I find hospitals where I can avail the cashless facility online?

Yes, simply visit the official website of HDFC Ergo and select the list of network hospitals under the cashless facility hospital locator.

What other policies are offered by HDFC ERGO Health Insurance Company?

Other policies offered by HDFC ERGO include car, bike, travel, home and retail cyber insurance.

How can I check policy status for HDFC Ergo health insurance?

Simply visit the official website of HDFC Ergo and login with your registered user ID and Password. Once you are logged in, you will be able to see all the details regarding your policy status.

What tax benefits will I get?

You can claim tax deductions as per Sec 80D of the Income Tax Act, 1961.

What do you mean by Pre and Post-Hospitalization charges?

These are the expenses which have occurred pre or post medical treatment at the hospital. Pre-hospitalization expenses include doctor’s appointment fee while post includes follow-ups after treatment.

Why should I get a health card from HDFC ERGO health insurance?

The health card will help you make cashless claims at a faster rate and it will also help the network hospital identify you as a policyholder.

Does HDFC Ergo cover pregnancy?

Yes, but not all policies provide cover for maternity and newborn expenses.

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