HDFC ERGO Health Insurance

About HDFC ERGO

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 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.

How to Purchase Health Insurance Offered By HDFC Ergo General Insurance Policy at InsuranceDekho?

You can buy a health Insurance policy offered by HDFC Ergo General Insurance online as well as offline at InsuranceDekho. 

Buy Health Insurance Plan Offered by HDFC Ergo General Insurance Online At InsuranceDekho

You can follow the below-mentioned step to buy a health Insurance plan offered by HDFC Ergo General Insurance online at InsuranceDekho:

Step 1: Visit InsuraceDekho and click on the tab for ‘health’.

Step 2: Select your Gender. Enter your Name and Mobile Number. You will receive an OTP on the provided mobile number, please enter that. 

Step 3: Tell us when you plan to buy the insurance policy by choosing an option from the drop-down menu. Click on ‘View Instant Quotes’ to proceed.

Step 4: Select the family members you want to include in the plan. Click on ‘Continue’.

Step 5: Select the age of the selected family members. Click ‘Continue’.

Step 6: Enter your Email ID and City and click on the ‘Submit and View Quotes’ button. Quotes matching the details entered by you will appear on your screen. Choose the one which best suits your requirements.

Step 7: Choose the tenure of the selected health insurance plan, provide the required details and proceed with the payment.

Buy Health Insurance Plans Offered By HDFC Ergo General Insurance Offline At InsuranceDekho

To buy a health Insurance plan offered by HDFC Ergo General Insurance offline at InsuranceDekho, you can call us at 7551-196-989 any day of the week (Monday-Sunday) from 9.30 AM to 6.30 PM. 

For any assistance, you can either call us or write to write to us at customersupport@insurancedekho.com.

Top Health Insurance Plan Types Offered By HDFC Ergo General Insurance

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.

What Is A Health Insurance Top-up Plan and Why Should I Buy It?

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. 

Why Choose HDFC Ergo General Insurance?

HDFC Ergo General Insurance is an ideal choice for health insurance as it offers the following benefits to its policyholders:

• 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.

Benefits of Health Insurance Plans Offered By HDFC Ergo General Insurance

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.

HDFC Ergo General Insurance Health Claim Settlement Ratio 

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

Network Hospitals of HDFC Ergo General Insurance

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.

HDFC Ergo General Insurance Policy Terms

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 General Insurance Claim Process

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.

How To Make Health Insurance Cashless Claims with HDFC Ergo General Insurance?

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. 

How To Make Health Insurance Reimbursement Claim with HDFC Ergo General Insurance?

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 a 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.

Health Insurance Renewal Process with HDFC Ergo General Insurance

Like all insurance policies, a health insurance policy is also required to be renewed 

Step 1: Visit the official website of HDFC Ergo General Insurance.

Step 2: Go to the ‘Renew’ section and click on ‘Health Insurance’

Step 3: Enter your Policy Number / Mobile Number / Email ID and click on ‘Renew Now’ button

Step 4: Review the insurance policy details and the premium amount for renewal. 

Step 5: Pay for the amount online using the payment mode of your choice.

Tax Benefits of Health Insurance Plans Offered By HDFC Ergo General Insurance

The premium paid on health insurance plans offered by HDFC Ergo General Insurance qualify for income tax benefits under the Income Tax Act. Following are the tax benefits available to the policyholders of health insurance plans offered by HDFC Ergo General Insurance:

Premium Calculation for Health Insurance Plans Offered By HDFC Ergo General Insurance

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 premium 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.

What All Is Covered Under Health Insurance Plans Offered By HDFC Ergo General Insurance?

Health insurance plans offered by HDFC Ergo General Insurance come with the following coverage. The inclusions may vary from plan to plan offered by the insurer.

• In-patient Hospitalisation: It covers the medical costs incurred due to hospitalisation (for more than 24 hours) of insured members. This includes expenses such as room rent, nursing expenses, doctor’s fees, ICU charges, etc.
• Pre-Hospitalisation and Post-Hospitalisation: All the pre-hospitalisation expenses of up to 90 days of admission like the cost of diagnostics and post-hospitalisation expenses till 180 days are covered by the plan.
• Daycare Procedures: The plans offered by HDFC Ergo General Insurance provide coverage for Medical advancements required in wrapping up important surgeries and treatments in less than 24 hours.
• Organ Donor Expenses: The insurer covers the medical and surgical expenses of the organ donor incurred during a major organ transplant.
• AYUSH Treatment: In addition to the above-mentioned expenses, HDFC Ergo General Insurance also covers the expenses incurred for AYUSH treatment like Ayurveda, Unani, Siddha, and Homeopathy.

What All Is Not Covered Under Health Insurance Plans Offered By HDFC Ergo General Insurance?

Health insurance plans offered by HDFC Ergo General Insurance come with the following exclusions:

• Adventure Sports Injuries: Injuries incurred during or due to participation in any adventure sports are not covered under the health insurance plans offered by HDFC Ergo General Insurance.
• Self-Inflicted Injuries: Self-imposed injuries of the insured are not eligible for claims under the plans.
• War: War situations can be disastrous and unfortunate. However, health insurance plans by HDFC Ergo do not cover claims that are caused due to wars.
• Venereal or Sexually Transmitted Diseases: Health insurance plans provided by HDFC Ergo General Insurance do not provide a cover for venereal or sexually transmitted diseases.
• Obesity Treatment or Cosmetic Surgery: Treatment of obesity or cosmetic surgery is not eligible for coverage under health insurance plans offered by HDFC Ergo.
• Participation in Defense Operations: Injuries incurred during or by participation in defense (Army/Navy/Air Force) operations do not qualify for claims under
• health insurance plans offered by HDFC Ergo. 

The above inclusions and exclusions may vary from plan to plan offered by HDFC Ergo General Insurance.