HDFC ERGO Health Insurance

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Highlights
Network Hospitals10,000+
Policies Sold10,63,052
Incurred Claim Ratio63%
RenewabilityLifelong
Claim Settlement Ratio84.08%
In-House Claim Settlement100%
COVID-19 CoverYes

About HDFC ERGO Health Insurance

Formerly known as Apollo Munich Health Insurance, HDFC Ergo Health Insurance Limited is a joint venture between HDFC Limited and ERGO International where the former is India’s premier Housing Finance Institution, and the latter is a primary insurance entity of the Munich Re Group. Founded in the year 2002, the company aims to provide enhanced customer experience with the help of innovative solutions and new age technology. It offers a number of health insurance, travel insurance, and personal accident policies with a host of benefits under them.

HDFC Ergo Health Insurance offers you an array of flexible health insurance policies that you can purchase for self, family, senior citizens, women, children, and even corporate houses. You can purchase HDFC Ergo Health insurance plans at affordable premiums and yet get yourself and your loved ones covered against numerous healthcare expenses. These benefits offered by the insurer have made it a trusted leader in the health insurance sector in India. 

How to Purchase HDFC Ergo Health Insurance Policy at InsuranceDekho?

You can purchase HDFC Ergo Health insurance plans in online and offline modes from InsuranceDekho. Here’s how. 

Buy HDFC Ergo Health Insurance Plan Online at InsuranceDekho

Follow the steps below to buy HDFC Ergo Health insurance plan online at InsuranceDekho:

Step 1: Visit insurancedekho.com and click on the ‘Health’ tab. 

Step 2: Select your gender. Fill in the personal details like Name and Mobile number. You will receive a One Time Password on the entered mobile number. Please enter that. 

Step 3: Tell us ‘When do you want to buy the policy’ by selecting an option from the drop-down menu. Click on ‘View Quotes’. 

Step 4: Select the family members you wish to add in your policy coverage. Click ‘Continue’. 

Step 5: Select the age of the chosen family members. 

Step 6: Enter your Email ID and City. Click on ‘Submit and View Quotes’. You will see the most suitable quotes on your screen. Choose the one you want to purchase. 

Step 7: Select the policy term you wish to purchase the policy for. Enter the required details and pay online. 

Buy HDFC Ergo Health Insurance Plan Offline at InsuranceDekho

To buy HDFC Ergo Health insurance plans offline at InsuranceDekho, you can call on our toll-free number 7551-196-989 and talk to the knowledgeable customer care experts. You can call us on any day of the week between 9:30 AM to 6:30 PM. Alternatively, you may write to us at customersupport@insurancedekho.com in case you require any support.

Top HDFC Ergo Health Insurance Plans

HDFC Ergo Health Insurance offers you a range of health insurance plan types that cover critical illnesses, lifestyle diseases, and other illnesses. Here is a list of top 5 health insurance plans offered by the insurer that meet your varied needs. 

  1. HDFC Ergo Health Optima Restore Policy: HDFC Ergo Health Optima Restore Policy not only takes care of you in illness but also rewards you for staying healthy. You can be covered under this policy if you are aged between 91 days and 65 years. The sum insured options range between Rs. 3 lakh and Rs. 50 lakh under this policy. The highlight of this policy is that it automatically reinstates the sum insured if it gets exhausted during a policy year. Also, it comes with Stay Active benefit that lets you earn up to 8% discount of the renewal premium. 
  2. HDFC Ergo Health Easy Health Policy: HDFC Ergo Easy Health Policy is an affordable plan that takes care of your in-patient treatment expenses including hospital room rent, nursing, boarding, ICU, blood, anaesthesia, medicines, drugs, surgical appliances, and diagnostic procedures. The policy can be purchased for sum insured options ranging between Rs. 1 lakh to Rs. 15 lakh for coverage benefits for all daycare procedures, domiciliary treatment, daily cash benefit, pre-hospitalisation and post-hospitalisation expenses, emergency ambulance expenses, etc. 
  3. HDFC Ergo Health Wallet Policy: HDFC Ergo Health Wallet Policy is a revolutionary plan that offers unique reserve benefits. The benefit can be used for any on-payable item under health insurance claim including OPD expenses. You can be covered under this plan if aged between 91 days and 65 years for sum insured options ranging between Rs. 3 lakh and Rs. 50 lakh. Other coverage features under the plan include daycare procedures, domiciliary hospitalisation, organ donor expenses, AYUSH systems of medicines, in-patient hospitalisation expenses, and pre-hospitalisation and post-hospitalisation expenses. 
  4. HDFC Ergo Health Optima Super Policy: HDFC Ergo Health Optima Super Policy is a top-up health insurance policy that adds to your existing health insurance policy. The policy comes with sum insured options of Rs. 5 lakh, Rs. 7 lakh, and Rs. 10 lakh with deductible options of Rs. 1 lakh, Rs. 2 lakh, Rs. 3 lakh, Rs. 4 lakh, Rs. 5 lakh, Rs. 6 lakh, Rs. 7 lakh, and Rs. 10 lakh. You get several benefits under this policy such as cover for in-patient hospitalisation expenses, daycare procedures, organ donor expenses, ambulance expenses, and pre-hospitalisation and post-hospitalisation expenses. 
  5. HDFC Ergo Health iCan Cancer Insurance Policy: HDFC Ergo Health iCan Cancer Insurance Policy covers you against treatment costs related to Cancer. The policy comes with sum insured options ranging between Rs. 5 lakh and Rs. 50 lakh and requires no medical examination. The policy covers you against conventional and advanced medical treatments, second e-opinion, pre-hospitalisation and post-hospitalisation expenses, and follow-up post treatment care. 

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

Health insurance top-up plans come handy when the sum insured of your standard health insurance plan gets exhausted. Looking at the soaring healthcare costs, having a top-up plan proves to be the perfect solution at the time of medical emergencies. Top-up plans come with deductible options. A deductible is an amount that you have to pay from your own pocket to be able to enjoy benefits under your top-up health insurance plan. 

HDFC Ergo Health insurance offers a top-up health insurance plan by the name of Optima Super Policy that can be purchased on individual as well as floater basis for a term of 1 or 2 years. You can be covered under this policy if you are aged between 91 days and 65 years for sum insured options ranging between Rs. 5 lakh and Rs. 10 lakh with deductible options between Rs. 1 lakh and Rs. 10 lakh. You may require pre-policy medical check-up under this policy on the basis of your sum insured and deductible opted for. 

Why Choose HDFC Ergo Health Insurance?

The following features make HDFC Ergo Health Insurance a preferred choice among customers: 

  • 24*7 Customer Support Helpline: HDFC Ergo Health Insurance has a customer support helpline that is operational 24*7. Here you can get your queries answered as well as your grievances addressed.

  • Health Jinn App: HDFC Ergo Health has a Health Jinn App that allows you to access or update your policy details anytime and anywhere, file a claim simply by uploading your documents, renew your policy within a few minutes, and take a note of the network hospitals around you. The app also allows you to chat with general physicians, order medicines, and identify health problems with a symptom checker. 

  • Impressive Claim Settlement Ratio: HDFC Ergo Health Insurance registered an impressive Claim Settlement Ratio of 84.51% in FY19. 

  • Over 10,000 Network Hospitals: HDFC Ergo Health Insurance has a strong network of more than 10,000 network hospitals across India where you can avail cashless treatment without any hassle. 

  • Claim Approval Within 60 Minutes: HDFC Ergo Health Insurance claims that it approves cashless claims within 60 minutes in 90% of the cases.

Benefits of HDFC Ergo Health Insurance Plans

HDFC Ergo Health insurance plans offer you the following benefits:

  • Lifetime Renewability: HDFC Ergo Health insurance plans come with lifetime renewability benefits. This means that once you buy an HDFC Ergo Health insurance plan, then you can keep on renewing it throughout your life, without any restriction on age.
  • Restore Benefit To Auto-Reinstate Your Sum Insured: Under HDFC Ergo Health insurance plans, you can enjoy restore benefit that automatically reinstates your basic sum insured if you exhaust it by making claims during a policy year. 
  • Stay Active Benefit: Apart from covering you against healthcare expenses, HDFC Ergo Health insurance plans even reward you for your healthy lifestyle. You get a discount every time on the renewal if you achieve a specific step count in a specific period of time. 
  • Multiplier Benefit: HDFC Ergo Health insurance plans come with a multiplier benefit that gives you a bonus for every year a claim is not made. 

HDFC Ergo Health Insurance Claim Settlement Ratio

Claim Settlement Ratio (CSR) is the percentage of claims a health insurance company has settled against the total number of claims admitted in a financial year. One must always check for the CSR of an insurer before buying its policies. The higher the CSR, the better it is. The following Claim Settlement Ratios were registered by HDFC Ergo Health Insurance in the past years.

Financial Year

Claim Settlement Ratio

FY 2017-2018

84.08%

FY 2018-2019

84.51%


(Source: IBAI’s General Insurance Claim Insights Handbook For Policyholders - 3rd & 4th Edition) 

Network Hospitals of HDFC Ergo Health Insurance

A network hospital is a hospital which has tie-up with the insurer and where you can avail cashless treatment in accordance with the terms and conditions of your health insurance policy. HDFC Ergo Health insurance has tie-ups with more than 10,000 network hospitals pan India where you can avail treatment in a cashless manner.

HDFC Ergo Health Insurance Policy Terms

HDFC Ergo Health insurance plans come with the following terms:

Minimum Entry Age

3 months

Maximum Entry Age

65 years

Policy Renewal

Lifetime renewability

Renewal Premiums

Renewal premiums are subject to change.

General Waiting Period

A general waiting period of 30 days is applicable starting from the date of inception of the policy.

Note that these features may differ with different HDFC Ergo Health insurance plans. 

HDFC Ergo Health Insurance Claim Process

HDFC Ergo Health insurance has an easy and quick claim settlement process. Under HDFC Ergo Health insurance plans,you can make cashless claims at the network hospitals and reimbursement claims at non-network hospitals. Read below to understand the process for both.
 
How To Make HDFC Ergo Health Insurance Cashless Claim?

To make a cashless claim under your HDFC Ergo Health insurance plan, follow the steps given below: 

Step 1: Get Hospitalised 
To avail cashless treatment, get hospitalised in a network hospital of your choice. Inform the insurer not later than 24 hours after hospitalisation in case of emergency hospitalisation and within 48 hours in case of emergency hospitalisation. You can intimate the company by visiting the customer portal or downloading the Health Jinn App.  

Step 2: Provide Required Documents 
Show your Health ID card at the hospital along with a valid ID proof. 

Step 3: Pre-Authorization Form 
Ask your doctor to fill the pre-authorization form along with the required documents and upload them directly on the Health Jinn App. 

Step 4: Documents Verification 
Your documents and the pre-authorization letter will be verified and checked if they are in accordance with the terms and conditions of the policy.  

Step 5: Claim Settlement
You will get your cashless claim approved (within 60 minutes in most cases) and the bills will be directly settled at the hospital. 

How To Make HDFC Ergo Health Reimbursement Claim? 

To make a reimbursement claim under your HDFC Ergo Health insurance plan, follow the steps given below: 

Step 1: Get Hospitalised And Avail Treatment
Get hospitalised at a non-network hospital of your choice and avail treatment. Inform HDFC Ergo Health through the customer portal or Health Jinn App.    

Step 2: Settle The Bills At The Hospital
Settle the bills at the hospital.  

Step 3: Collect The Relevant Documents
Collect the relevant documents from the hospital. Find the documents to be submitted below: 

Documents Required For HDFC Ergo Health Insurance Claim Settlement

You are required to submit the following documents for HDFC Ergo Health reimbursement claim: 

  • Original discharge summary document
  • All laboratory and test reports
  • Copy of stickers/invoice/barcode in case of implants
  • Original hospital bills and other receipts  
  • First consultation letter from the doctor
  • KYC form 

Step 4: Claim Settlement
After your documents have been verified and the claim has been made according to the terms and conditions of the policy, then the company will release the claimed amount.  

HDFC Ergo Health Insurance Renewal Process

HDFC Ergo Health insurance plans are available for a policy term of 1 year, 2 year, and 3 years. After that, you need to renew your plan to be able to avail benefits. Note that your health insurance premium may change at the  time of renewal. You can renew your HDFC Ergo Health insurance plans online by following a few easy steps that saves your time and effort: 

Step 1: Visit the official website of HDFC Ergo Health and search for ‘Health Insurance Renewal’ page. 
Step 2: Enter your policy number and click on the submit button. 
Step 3: Pick your renewal quote.
Step 4: Pay online via a secured payment gateway. 

HDFC Ergo Health Insurance Tax Benefits

Along with several coverage benefits, you can also avail tax benefits on the premium paid for HDFC Ergo Health insurance plans under Section 80D of the Income Tax Act, 1961. To understand the current structure for tax deductions, refer to the table below:

Situations

Premium Paid

Deduction under Section 80D of the Income Tax Act

Self, Family, Children

Parents

When the policyholder and parents are aged less than 60 years

Rs. 25,000

Rs. 25,000

Rs. 50,000

When the policyholder and family members are aged less than 60 years with parents aged more than 60 years

Rs. 25,000

Rs. 50,000

Rs. 75,000

When the policyholder, family members, and parents are aged over 60 years

Rs. 50,000

Rs. 50,000

Rs. 1,00,000

Members of the Hindu Undivided Family (HUF)

Rs. 25,000

Rs. 25,000

Rs. 25,000

Non-Resident Individuals

Rs. 25,000

Rs. 25,000

Rs. 25,000

HDFC Ergo Health Insurance Premium Calculation

Health insurance premium is the amount that you pay to avail benefits under a health insurance plan. You can pay a health insurance premium for your HDFC Ergo Health insurance plans on a monthly, half-yearly, quarterly, and yearly basis. To know about the factors on the basis of which the premium for your HDFC Ergo health insurance plan is calculated, read further:

  • Age: Age is one of the most important factors that decide your premium for HDFC Ergo Health insurance plans. The younger you are, the lesser premium you are required to pay and vice versa. This is because you are relatively healthier at early stages of your life than the later ones and hence there are fewer chances of you making health insurance claims. 
  • Add-On Covers: Add-on covers are additional features that you can purchase to avail enhanced coverage. Your health insurance premium will increase if you purchase add-on covers with your HDFC Ergo Health insurance plans as you will enjoy greater coverage. Some add-on covers that you can purchase under your HDFC Ergo Health insurance plans are critical illness cover, critical advantage rider, deductible benefit, etc.    
  • Type Of Plan You Opt For: The premium that you pay also depends on the type of plan you chose as it decides the coverage of your plan. For instance, if you buy an individual health insurance plan, then your premium will be higher in comparison to family floater health insurance plans. Or, you will be required to pay a lesser premium if you buy a top-up plan in comparison to a senior citizen health insurance plan.  
  • Body Mass Index (BMI): If you have a higher Body Mass Index or BMI, then you will be at a higher risk of contracting heart diseases, joint pain, and diabetes and hence will be more likely to make a claim under HDFC Ergo health insurance plans. Therefore, you will be required to pay a higher premium in this case.   
  • Poor Medical History: If your or your family members have a poor medical history including cases of heart attacks, high blood pressure etc., then you are also more likely to face health risks related to these diseases and hence you will be required to pay a higher premium for your HDFC Ergo Health insurance plans.   

What All Is Covered Under HDFC Ergo Health Insurance Plans?

HDFC Ergo Health insurance plans cover you against the following healthcare expenses: 

  • In-Patient Hospitalisation Expenses: HDFC Ergo Health insurance plans cover you against in-patient hospitalisation expenses incurred during hospitalisation for at least 24 hours. These expenses include room rent, ICU charges, nursing charges, boarding charges, doctor’s fee, blood, oxygen, etc. 

  • Pre-Hospitalisation And Post-Hospitalisation Expenses: HDFC Ergo Health insurance plans cover you against pre-hospitalisation and post-hospitalisation expenses for 60 and 180 days respectively. These are the expenses incurred before and after getting admitted in a hospital. These include consultation fee, several tests, X-ray, medicine cost, etc.
  • Domiciliary Treatment Expenses: Domiciliary treatment is when you avail medical treatment for any illness/sickness/injury/disease at home because hospitalisation is not feasible. 
  • Organ Donor Expenses: HDFC Ergo Health insurance plans cover the treatment expenses incurred by the organ donor at the time of organ transplant.
  • Daycare Procedures: HDFC Ergo Health insurance plans cover you against expenses incurred on daycare procedures. These are the procedures that do not require hospitalisation for at least 24 hours. For instance, cataract surgery, radiation, chemotherapy, and dialysis. 

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

HDFC Ergo Health insurance plans do not cover you against the following expenses:

  • Treatment Required For Any Injury Caused Due To Self-Harm: HDFC Ergo Health insurance plans do not cover you against any injury caused intentionally by self. For instance, attempt of suicide. 
  • Treatment Taken Outside India: HDFC Ergo Health insurance plans do not pay for any expense for the treatments that are taken outside the geographical boundaries of India. 
  • HIV or AIDS: HDFC Ergo Health insurance plans do not cover you against expenses arising from AIDS, HIV, and related diseases. 
  • Expenses Incurred On Unproven Treatments: HDFC Ergo Health insurance plans do not cover you against expenses incurred on any treatment that is unproven, experimental, or investigative in nature. 
  • Mental Disorders: HDFC Ergo Health insurance plans do not cover you against expenses related to treatment of mental disorder or insanity. 

Note that the inclusions and exclusions vary with different HDFC Ergo Health insurance plans. 

HDFC ERGO Health Insurance Plan List

Name of PlanSum Insured
Optima RestoreMin: 91 Days, Max: 65 Years3 Lakh Get Quotes Now
Optima SeniorMin: 61 Years; Max: No Limit 2 Lakh Get Quotes Now
Corona Kavach PolicyMin: 1 day; Max: 65 years50,000 - 5 lakh Get Quotes Now
EnergyMin: 18 Years, Max: 65 Years2 Lakh Get Quotes Now
Health WalletMin: 91 Days; Max: 65 Years3 Lakh Get Quotes Now
Arogya Sanjeevani PolicyMin: 3 Months; Max: 65 Years 1 Lakh - 5 Lakh Get Quotes Now
Maxima HealthMin: 91 Days; Max: 65 Years3 Lakh Get Quotes Now
Optima CashMin: 91 Days; Max: 65 Years1000/day Get Quotes Now
Easy Health ExclusiveMin: 91 Days; Max: 65 Years3 Lakh Get Quotes Now
Optima VitalMin: 18 Years; Max: 65 Years1 Lakh Get Quotes Now
Easy Health PremiumMin: 91 Days; Max: 65 Years4 Lakh Get Quotes Now
Easy Health Standard Min: 91 Days; Max: 65 Years1 Lakh Get Quotes Now
Dengue CareMin: 91 Days; Max: 65 Years50 Thousand Get Quotes Now
iCan CancerMin: 5 Years; Max: 65 Years5 Lakh Get Quotes Now

HDFC ERGO Health Insurance Top Up List

Name of PlanSum Insured
Optima SuperMin: 91 Days; Max: 65 Years5 Lakh Get Quotes Now
Optima PlusMin: 91 Days; Max: 65 Years5 Lakh Get Quotes Now

Claim Process at HDFC ERGO Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

1141 HDFC ERGO Health Insurance Cashless Network Hospitals in India

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HDFC ERGO Health Insurance Contact Details

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HDFC ERGO Health Insurance FAQs

  • How long are the policies of HDFC ERGO Health Insurance valid for?

    The policies of HDFC ERGO Health Insurance are valid for one to two years depending on the policy you have purchased.

  • Is pre-policy medical check-up mandatory?

    No, the pre-policy medical checkup is not mandatory in all cases. It is subject to your age. For example, if you’re 60 or above, you may go for a pre-medical checkup at designated clinics of HDFC ERGO Health Insurance.

  • Who is a third-party administrator (TPA) of HDFC ERGO Health Insurance?

    HDFC ERGO Health Insurance has no TPA. It has its own in-house claim settlement team to handle retail policies. However, the claims of group plans are handled by Family Health Plan Limited (FHPL).

  • Does HDFC ERGO Health Insurance pay all medical expenses or only a share of the bill?

    HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance) pays only the medical bill expenses, subject to the terms of the policy. It doesn’t bear the expenses more than the sum assured by the policy. So, if the amount exceeds the sum insured, it is borne by the insured.

  • What types of medical expenses are covered by HDFC ERGO Health Insurance?

    All reasonable expenses related to inpatient hospitalisation, pre and post hospitalisation, ambulance costs, room rent, etc. are covered to the maximum cap of the sum assured.

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