HDFC ERGO Health Insurance

HDFC ERGO is a 51:49 joint venture between HDFC Ltd and ERGO, which is the primary insurance entity of the Munich Re Group of Germany. HDFC ERGO, the 3rd largest Private General Insurer with a 6.2% market share, offers products like Motor, Health, Travel, Home, Personal Accident, and Cyber Insurance in the retail space and customized products like Property, Marine, and Liability Insurance in the corporate space through its network of 203 branches spread across 170 cities and a wide distribution network. The company is also committed to delivering customised insurance solutions for the Property, Marine, and Liability insurance requirements of its corporate customers.

HDFC General Insurance was conferred with ICAI Award for Excellence in Financial Reporting in FY 2014-15 as well as in 2015-16. The insurer has been assigned an ‘iAAA’ rating by ICRA, indicating its highest claim paying ability. HDFC Ergo General Insurance won the 2016 Best Customer Experience Award of the Year in the financial sector by KamiKaze for its unparalleled customer service.

In the health insurance space, HDFC Ergo General Insurance features a wide array of products including customized policies made for Individuals, Families, Parents and Senior Citizens. The company also offers tailor-made solutions for Critical Illnesses and Personal Accidents.

There are a number of factors that affect the amount of your health insurance policy. The awareness of such factors help you choose a policy as per your requirements and budget. The following are the factors that affect the amount which you pay as a Fpremium for a health insurance plan.

• Age - The premium amount increases with the age of the policyholder. This is because at an older age you are more prone to diseases. Thus, it is wise to buy a health insurance plan at the earliest.
• Pre-Existing Medical Conditions - Another factor that affects the premium amount if the history of your medical condition. People with pre-existing illnesses may get their plans rejected or get them at a high premium.
• Unhealthy Lifestyle/Habits - Unhealthy lifestyle and bad habits like smoking, excessive drinking, chewing of tobacco makes an individual more vulnerable to diseases. Thus, people with such lifestyles are offered health insurance plans at relatively higher premium amounts.
• Sum Insured - Sum insured refers to the maximum amount which an insurer promises to pay under the health insurance plan. The higher the sum insured, the higher is the premium amount of the plan.

HDFC Ergo General Insurance offers a variety of health insurance plans to its customers. Following are the top 3 health insurance plans offered by HDFC Ergo General Insurance:

1. HDFC Ergo My Health Suraksha Plan: It is a comprehensive health insurance plan which is available on individual as well as on a floater basis. The coverage under this plan includes expenses incurred for inpatient hospitalisation, pre-hospitalisation, post-hospitalisation, day care procedures, domiciliary treatment, organ donor, emergency ambulance, AYUSH treatments and health check-ups. The policy is available with a tenure of 1 year as well as 2 years, with lifetime renewability. Moreover, the plan provides you with an additional benefit of a cumulative bonus as a reward if you do not make a claim during the policy period.

2. HDFC Ergo Critical Illness Insurance Plan: As the name suggests, it is a critical illness health insurance plan which covers upto 15 critical illnesses including heart attack, stroke, cancer, paralysis, and kidney failure. This plan is available in two variants. This plan requires no medical check-ups up to the age of 45 years and comes with the benefit of lifetime renewability.

3. HDFC Ergo My Health Medisure Super Top-up Plan: This helps you ensure enough cushion cover in case your existing plan is not able to meet all the incurred health costs. This plan helps you get the best medical treatment by taking care of limitations of sum insured of your existing plan. The HDFC Ergo Medisure Super Top-up Plan provides you cover for inpatient hospitalisation, pre-hospitalisation, post-hospitalisation as well as day care procedures.

4. HDFC Ergo My Health Women Suraksha Plan: This plan is available in three variants namely Women Cancer Plus Plan, Women CI Essential Plan and Women CI Comprehensive Plan. The HDFC Ergo My Health Women Suraksha Plan, provides coverage for cancer, major illnesses, preventive health-checkups, wellness and health coach, surgical procedures, and cardiac ailments and procedures. The plan also provides coverage for pregnancy and newborn complications are covered to an extent of 25% of the sum insured subject to a maximum of Rs. 5 lakh. A special feature of the plan loss of job benefits, which is available as 50% of monthly salary, up to 6 months.

5. HDFC Ergo My Health Medisure Classic Insurance Plan: This plan provides coverage for inpatient hospitalisation, pre-hospitalisation and post-hospitalisation expenses. The plan also provides coverage for day care procedures, maternity coverage, newborn baby cover, ayurvedic treatment, and pre-existing disease post 3 years. There is no restriction on entry age under this plan which also gives complete cover for your children till the age of 23 years.

A top-up health insurance is an additional coverage which you can add to your existing health insurance plan. A top-up plan offers coverage benefits when the sum insured of your existing plan gets exhausted. A top-up insurance policy is available as an add-on cover against the payment of an extra premium amount. A top-up plan helps you to ensure financial stability in times when the insurance coverage of your standard plan falls short during a medical emergency. In a nutshell, a top-up plan helps you increase your health insurance coverage at an affordable premium.

Some of the advantages of purchasing a HDFC Ergo health insurance plan are as follows:

• High Claim Settlement Ratio - HDFC Ergo General Insurance featured an impressive claim settlement ratio of 86.52% in FY 2019-20. With its consistent, easy, and affordable service, the insurer has won the trust of more than 1 crore customers.
• 24*7 Customer Support - The customer support team of HDFC Ergo General Insurance is available 24*7 at the service of its customers. The company’s in-house claims team works round the clock to provide hassle-free claim experience to its customers and support in hours of need.
• Good Track Record - HDFC Ergo General Insurance has been catering to the insurance needs of its customers from the last 16 years. HDFC Ergo General Insurance won the Best Customer Experience Award in the financial sector in 2016 by KamiKaze for its great customer service.
• Pan India Presence - HDFC Ergo General Insurance maintains a pan India presence with a wide network of more than 10,000 cashless hospitals, 120+ branch offices and over 3,000 employees.

Following are the benefits which you can enjoy with health Insurance plans offered by HDFC Ergo General Insurance:

• No Medical Test Up to 45 Years: If you are fit and healthy, you can take most of the health insurance plans offered by HDFC Ergo General Insurance without getting any medical tests done. Please note this feature is only available for people up to 45 years of age.
• Free Renewal Health Check-up: Policyholders of health insurance plans offered by HDFC Ergo General Insurance are eligible for a free health check-up within 60 days after the renewal of the policy with the insurer.
• No Entry Age Restriction: All individuals of at least 18 years of age are eligible to buy health insurance plans offered by HDFC Ergo General Insurance. The insurer offers plans to all age groups.
• Lifetime Renewability: The health insurance plans provided by HDFC Ergo General Insurance come with the feature of lifetime renewability. Thus, you need not exit from them.
• Tax Benefit: A policyholder can avail tax deductions under all HDFC Ergo health insurance plans as per section 80D of the Income Tax Act. This tax exemption can be availed on both individual as well as family floater health plans, which offers coverage to you, your spouse, dependent children and parents.
• Cashless Treatment: HDFC Ergo offers cashless medical facilities to their policyholders at their registered network hospitals. Under a cashless facility, a policyholder is not required to worry about arranging money for paying hospital bills as here the insurance provider settles the medical bill directly with the hospital. There are more than 10,000 hospitals registered with HDFC Ergo all over the nation.
• Health Check-Ups: In India, most of the health insurance providers provide the facility of free preventive health check up to the policyholder at regular intervals based on the terms and conditions of the health insurance plans.

(Source: IBAI’s General Insurance Claim Insights Handbook For Policyholders - 4th & 5th Edition)

Let us understand the key features of HDFC Ergo health insurance plan designed specifically to help you in leading a secure and financially healthy life. They are explained as follows:

• Renewability: The insurance plan provides a lifelong renewal with a simple and fast process. It helps you during medical emergencies and keeps you stress free financially so that you are capable of handling any difficult situation with peace of mind.
• No Sub Limit on Room Rent: Generally sub limits on the room rent under a health insurance plan eat into the sum insured opted by the policyholder. However, HDFC Ergo offers health plans without placing any sub limits on room rent.
• Pre and Post Hospitalisation Cover: The health insurance plans offered by HDFC Ergo offers pre-hospitalisation expenses for up to 60 days and post- hospitalisation expenses for up to 90 days.
• Network Hospital: HDFC Ergo insurance company offers cashless hospitalisation facility. Under this facility, the insurance provider directly settles all medical bills incurred during the time of treatment at the network hospital, thus not causing a financial strain on your pocket during difficult times. The insurance company has over 10,000 network hospitals registered with them to serve the insured with emergency hospitalisation in times of need.
• Health Check-Ups: If a policyholder successfully completes four claim free years, the expenses for health check-up can be reimbursed.

HDFC Ergo General Insurance has a wide network of hospitals at which its policyholders can avail the benefits of cashless claims. The insurer has more than 10,000 hospitals in its network spread pan India.

The following are the important terms of health insurance plans offered by HDFC Ergo General Insurance. However, these terms may vary from plan to plan offered by the insurer.

HDFC Ergo offers coverage for hospitalisation expenses incurred due to COVID-19 treatment under their several health insurance policies subject to the terms and conditions stated in the policy document. The insurance company offers coverage for both pre-hospitalisation as well as post-hospitalisation expenses. However, before the coverage begins, you are required to go through a waiting period of 30 days after which you can receive compensation of COVID-19 treatment including in-patient treatment expenses, pre-hospitalisation expenses, post-hospitalisation expenses, and so on.

A Health Insurance claim refers to the process wherein a policyholder requests the insurer to compensate for the expenses incurred by them during a medical emergency, illness or accident. A health insurance claim can be settled in two ways - cashless manner and reimbursement manner.

All claims made at the network hospitals of HDFC Ergo General Insurance’s network, get processed in a cashless manner. Thus, under a cashless claim, you need not pay to the hospital as HDFC Ergo General Insurance pays directly to the hospital subject to the sum insured. You can raise a cashless claim with HDFC Ergo General Insurance by following the below-mentioned steps:

Step 1: Get Hospitalised

Locate your nearest hospital which has partnered with HDFC Ergo General Insurance and get admitted there. You can locate your nearest HDFC Ergo network hospital by clicking here.

Step 2: Fill And Submit The Cashless Claim Form

Collect a cashless claim form from the hospital, duly fill it and submit it back to the hospital with the required documents including your ID proof and health insurance card.

Step 3: Pre-Authorization of Claim

Upon submission of the cashless claim form, the internal claims team of HDFC Ergo General Insurance will approve/reject your claim on the basis of documents submitted, course of treatment and coverage. The insurer claims to complete the claim approval process within 20 minutes.

Step 4: Claim Settlement

On receiving the approval of your claim, you can undergo the required medical treatment. You need not pay anything to the hospital (subject to coverage and sum insured). On discharge from the hospital, the insurer will check the documents and discharge summary and settle the claim directly with the hospital.

When a policyholder gets medical treatment at a hospital outside the network of HDFC Ergo General Insurance, the insurer reimburses you the incurred medical expenses subject to the sum insured. Thus, when you make a reimbursement claim, you are required to pay for all the medical expenses yourself first and then the insurer reimburses the expenses. Follow the below steps to request an HDFC Ergo General Insurance Reimbursement Claim:

Step 1: Get Hospitalised And Intimate the Insurer

Get hospitalised at a non-network hospital and intimate HDFC Ergo General Insurance at 022-6234-6234 / 0120-6234-6234 about your hospitalisation.

Step 2: Collect Documents Post Discharge and Send To Insurer

At the time of discharge, collect all required documents from the hospital and send them to HDFC Ergo General Insurance Company Ltd at the following address via post.

HDFC Ergo General Insurance Company 5th Floor, Tower 1, Stellar IT Park, C-25,
Sector-62, Noida, Uttar Pradesh, 201301.

Documents Required For Health Insurance Reimbursement Claim with HDFC Ergo General Insurance

• Valid ID proof
• Doctor’s letter advising admission
• Original bills from chemists and pharmacies
• Doctor’s prescription for medical tests, medicines, consultations etc.
• Original receipts, bills, and discharge forms signed by the doctor
• Original diagnostic test reports, radiology reports and payment receipts
• First Information Report (FIR), in a police case.

Step 3: Documents Scrutiny And Approval

At this stage, HDFC Ergo General Insurance will check all the documents submitted by you and either accept or reject your claim.

Step 4: Settlement of Claim

Upon approval of your claim, HDFC Ergo General Insurance will reimburse the amount via NEFT. The insurer claims to reimburse the amount within 3 days.