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HDFC ERGO Health Insurance

HDFC ERGO General Insurance Company operates in 91 cities with over 108 branches across India. The company has a massive distribution channel with readily available brokers, direct sales, retail, corporate agents, and bancassurance.

It offers a wide range of insurance products like health insurance, motor, marine and liability, travel, and home insurance. The variety in its services has established HDFC Ergo as one of the leading insurance companies in the private sector.

HDFC Ergo Health Insurance is primarily focused on providing a completely hassle-free insurance experience to its clients.

HDFC Ergo Health Insurance Plan at a Glance

Key Features Highlights
Incurred Claim Ratio 76.90%
Network Hospitals 4800+
Renewability Lifelong
Waiting Period 4 yrs.

Key Features of the HDFC ERGO Company

  • iAAA rating from the ICRA
  • High claim settlement ratio
  • Excellent customer service with 24/7 assistance in settlement of insurance claims
  • The plan has a tax exemption benefit u/s 80(D) of the IT Act
  • Least documentation is required
  • Seamless claim settlement process
  • Offers a cumulative bonus for every claim-free year
  • It can be renewed for a lifetime; hence, saving you from a lifetime of worrying about medical emergency funds.

HDFC Ergo Health Insurance Plans

Plan Name Entry Age Sum Insured Plan Type Pre-medical check-ups
HDFC Ergo Health Suraksha Plan No restriction Rs. 3 lakhs to 10 lakhs Individual/ Family Floater After 45 years
HDFC Ergo Health Suraksha Gold Plan 91 days and above Rs. 3 lakhs to 10 lakhs Individual/ Family Floater After 45 years
HDFC ERGO Health Suraksha with Regain & ECB No limit Rs. 3 lakhs to 10 lakhs Individual/ Family Floater
HDFC ERGO Health Suraksha Gold with Regain & ECB No limit Rs. 3 lakhs to 10 lakhs Individual/ Family Floater
HDFC ERGO my: health Medisure Classic 91 days and above Rs. 2 lakhs to 5 lakhs Individual/ Family Floater After 50 years
HDFC ERGO my: health Medisure Super Top-up Adults: 18 to 65 years

Children: 91 days to 23 years

6 lakhs to 16 lakhs Individual/ Family Floater After 55 years
HDFC ERGO Critical Illness Silver & Platinum 5 to 45 years Rs. 5 to Rs.10 lakhs ( lumpsum) After 45 years
Personal Accident Insurance Up to 65 years Rs.2.5 lakhs to Rs.15 lakhs Individual/ Family Floater N/A

Types of HDFC Health Insurance Plans

The insurance products with HDFC ERGO medical Insurance are offered either in Family or individual packages.

  1. HDFC ERGO’s Health Suraksha Plan – This plan is uniquely designed to cover your parents. The sum assured each year ranges from Rs. 3 lakhs to Rs. 10 lakhs.
  2. my:health Medisure Classic Insurance – There is no upper age limit to buy this HDFC Ergo senior citizen health insurance plan and covers pre-existing ailments after 3 years.
  3. HDFC ERGO’s Health Suraksha Gold- The policy offers a lifetime renewal, no age limit set to join for both family floater and individual packages, and sum assured of Rs. 3 lakhs to Rs. 10 lakhs.
  4. HDFC ERGO’s Health Suraksha Regain & ECB- No age limit is set and the sum assured options provided are Rs. 3 to Rs. 10 lakhs. 10% discount is provided for 2-year policy plans.
  5. HDFC ERGO’s Health Suraksha Top-up Plus-It is a lifetime cover with no exit age and sum assured options range from Rs.2 lakhs to Rs.10 lakhs.
  6. HDFC ERGO’s Health Critical Illness Insurance- This is an individual cover with sum assured ranging from Rs. 2.5 lakhs to 10 lakhs.
  7. HDFC ERGO’s Health Critical Illness Platinum- This is also an individual cover with sum assured ranging from Rs 2 Lakhs to Rs 10 lakhs. The minimum entry age minimum is 5 years and the maximum is 65 years.
  8. HDFC ERGO Personal Accident Insurance- It covers you and your family in case of an accident and the sum assured ranges from Rs. 2.5 lakhs to Rs.15 lakhs.

Claim Procedure of HDFC Ergo Health Insurance Company

You can make cashless claims or as for reimbursements under an HDFC Health Insurance Plan-

  1. HDFC Ergo Cashless Claim

    For cashless claim settlement, the treatment should be carried out in a network hospital only. To avail the treatment, it is important to seek an authorization from the insurer based on the procedures laid down in the HDFC Ergo medical insurance

The procedure is defined below-

  • If the hospitalization was planned in advance, you need to inform the insurer at least 48 to 72 hours before the 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.
  1. HDFC Ergo Claim Reimbursement

    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 of your medical bills after discharge, you need to submit the 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.

Renewal Process

HDFC Ergo follows a seamless renewal process. You can conveniently renew health insurance plans for self, parents, family and senior citizens. By renewing the policy online you can save both time and efforts. Elucidated below are steps that you can follow to renew your insurance policy online-

  1. Visit their site and select the Instant Renewal option
  2. Enter your health insurance plan details
  3. Enter the plan details and the premium will be generated
  4. Pay online and instantaneous renewal of your policy will be done

Get 5% of cumulative bonus (max. up to 50%) for every claim free year. After 4 years of the policy period, up to 1 percent of SI is compensated for health check-ups.

Note: It is suggested that you check the HDFC Ergo company reviews online before renewing the policy.

HDFC Ergo Health Insurance Inclusions

The coverage may vary based on the plan you have opted for. However, the plans cover the expenses incurred on the following-

  • In-patient Treatment
  • Pre-hospitalization
  • Post-hospitalization
  • Domiciliary Treatment
  • Day Care Medical Procedures
  • Organ Donor Expenses
  • Emergency Ambulance Cover
  • AYUSH Benefit
  • Cumulative Bonus
  • Enhanced Cumulative Bonus
  • Regain Benefits
  • Medical Checkups
  • Maternity Benefit
  • Convalescence Benefit
  • E-Opinion for Critical Illness

HDFC Ergo Health Insurance Exclusions

  • Any disease that is diagnosed within 30 days of the policy issuance date
  • Pre-existing ailments are not covered until 2 years
  • Any act of violation of law or criminal act
  • 2 years waiting period for specific treatments and illnesses such as cysts, surgery on tonsils, internal tumor etc.
  • Hospitalization required in case of war conditions
  • Terrorist activities, war, and radioactivity
  • Acquired Immune Deficiency Syndrome (AIDS) and HIV conditions
  • Any suicidal attempt, self-inflicted injuries are not covered
  • Any health ailments resulting due to consumption of drugs or intoxication is not covered
  • Plastic or cosmetic surgery ( unless required as part of the health treatment)
  • Vaccinations taken as preventive measures

Benefits of HDFC ERGO Health Plans

  • The policy provides pre and post hospitalization cover plans. 60 days prior to hospitalization and 90 days after hospitalization charges are covered under the plan.
  • It covers a maximum of 4 family members; 2 children and 2 adults.
  • Room rents have no sub-limits which mean it does not consume your sum assured.
  • It offers a wide range of sum assured options and in addition, you earn a 5% bonus for each year if you do not claim your insurance.
  • Any pre-existing medical conditions are covered by the policy after 4 years of premium payments.
  • Avail add-on covers like maternity cover, critical illness cover, hospital cash benefits etc.
  • day-care procedures and domiciliary hospitalization (treatments that are taken at home as per the hospital recommendation are covered under the policy.

How to Calculate the Premium?

HDFC Ergo Medical Insurance Plans have been designed to provide an extensive health cover to reduce your financial burden during a medical emergency. It is suggested that you go through the policy features, inclusions and exclusions before purchasing a health insurance plan online. Correspondingly, it is equally important to calculate the health insurance premium.

HDFC ERGO health insurance calculates the health insurance premium after securing an acceptance from IRDAI. HDFC Ergo health insurance premiums are calculated on the basis of the various factors such as-

  • Age of the proposer – the premium increases with the age of the insurer. With age, health risks also increase and so does the premium.
  • The number of members covered- Premium for Individual health insurance plans will be lesser as compared to HDFC Ergo family floater health insurance plans.
  • Pre-existing medical conditions- The premium may increase based on the family’s medical history and any pre-existing ailments in your medical record.

HDFC Ergo Insurance Premium Calculator

It is one of the most convenient and quick ways to calculate health insurance premium using an online HDFC Ergo health insurance premium calculator. You can also compare different health insurance plans online with the help of this tool. However, the premium should not be the only factor while choosing a health insurance plan, but you can compare the health insurance quotes and then choose the right plan.

The process is straight-forward and convenient. Simply click on ‘Calculate My Health Insurance Premium’ and enter all the required details including your age and other personal details and effortlessly generate health insurance premium for different plans.

Documents Required for HDFC Ergo 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, Police FIR report of Medico-legal certificate is required
  • Other documents ( if required)
  • NEFT details for payment: Cancelled cheque in the name of the Proposer or passbook copy attested by 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.)

HDFC Ergo Health Insurance FAQs

Q1. Can I buy HDFC Ergo Health Insurance policy online?

HDFC Health Insurance Plan has an online platform that makes it easier for clients to purchase and renew the policy. The portal offers an online premium calculator that provides premium details at a single click of a button. It also provides online payment options and instant insurance renewal options.

Claim forms are available online for you to fill at your convenience and submit it to your nearest branch. On the other hand, the online platform can also help you locate your nearest hospital and HDFC ERGO branch near you.

Q2. What is the procedure to buy HDFC Ergo Health Insurance plan online?

The policy purchase is done in 3 easy and simple steps:

  1. Log into the company’s website, select the relevant tab. Once this is done, one is asked to provide the required personal data so as to purchase and calculate the premium. Once the premium is calculated, click on the ‘Proceed’ button.
  1. A new page is opened and one has to fill-in more personal and confidential information as accurately as possible. Once it is done, press on the ‘Proceed’ tab.
  1. A new page is opened whereby one is allowed to make an online premium payment via credit or debit card.

Q3. What is the benefit of buying HDFC ERGO’s Health Suraksha Regain Plan?

You can choose the sum assured options ranging from Rs. 3 lacs, Rs. 4 lacs, Rs. 5 lacs, Rs. 7.5 lacs and Rs. 10 Lacs. 10% discount is provided on purchase of a two year plan. The cumulative bonus is 10% for every claim-free year.

HDFC Ergo Health Suraksha Regain Plan ensures automatic accessibility of sum insured upon its depletion. It covers Inpatient hospitalization costs under Ayurveda, Unani, Siddha, and Homeopathy with no sub-limit as part of AYUSH Cover.

Q4. What is covered under HDFC ERGO’s Health Critical Illness Insurance Policy?

The critical illnesses covered in the plan include Bypass Surgery, Heart Attack (Myocardial Infarction), Coronary Artery, Cancer, Kidney Failure, Stroke, Multiple Sclerosis, organ transplantation, and Paralysis.

Q5. Is there any mobile app for HDFC Ergo health insurance policy?

HDFC ERGO Health Insurance policy has a mobile app that can help you better manage your insurance portfolio 24*7. The app is conversable with all android phones and can be found on google play store.  It has features that are in build to empower you to access information regardless of internet connection.

Q6. How many plans are there in HDFC Ergo Health Suraksha basic policy?

There are 4 diverse plans available under Health Suraksha basic policy – 1 Adult; 2 Adults; 2 Adults and 1 Child; 2 Adults and 2 Children. The coverage ranges from, 3 lakhs- 4 lakhs. Individuals within ages 3 months – 65 years can avail these plans.

Q7. What is the benefit of HDFC Ergo Health Card?

It contains the contact details the HDFC Ergo’s TPA department. You can get in touch with the insurer for assistance on any of the numbers that are provided. Health card is also required during hospitalization, as it helps in easy identification and processing the claim further.