Claim Settlement of HDFC ERGO Health Insurance
If you hold an HDFC Ergo Health Insurance policy, you can easily register a claim and get it settled at your convenience. With a dedicated claim settlement team in place, HDFC Ergo is committed to hassle-free and quick claim settlement processes. Being an ultimate favorite of hundreds and thousands of policyholders, the insurance company makes sure you or any insured member can avail easy access during an emergency. What’s more, is the claims procedure that comes across as extremely customer-friendly. HDFC ERGO allows the policyholders to settle their claims by opting either the cashless facility or reimbursement.
Claim Process for Cashless Treatment
A cashless claim is available in case treatment is done at network hospitals. HDFC ERGO has more than 9,000 hospitals in the network. The steps for cashless claim process are as follow:
- First of all, find an HDFC ERGO network hospital in a city where you want to get cashless treatment
- Intimate HDFC ERGO within 24 hours in emergency hospitalisation and 48 hours before admission in case of planned hospitalisation.
- While visiting the hospital, carry your Health Insurance cashless card issued by HDFC ERGO and one photo ID.
- Pre-authorization is done by the chosen network hospital. (Transfer of cashless request from network hospital to HDFC ERGO and coordination for authorization).
- HDFC ERGO/TPA scrutinizes all the documents and gives the final outlook on the claim.
- You will receive an update via SMS/e-mail on every phase of the claim on your registered email id or mobile number.
- The hospital sends the final bill to HDFC ERGO for authorization purpose.
- After scrutinizing the same, the insurer gives the final authorization (if the transactions are approved) to the hospital.
- The expense of any inadmissible expenses, co-payment, and deductions is to be borne by you.
The reimbursement process is for those who get treatment at a non-network hospital. HDFC ERGO reimburses the amount within a short time. The process for this facility is as follow:
- Contact the nearest hospital and intimate within 24 hours (emergency hospitalisation) or 48 hours (planned hospitalisation).
- Register a claim, fill the claim form and send the same with the required documents to the HDFC ERGO Claim Office.
- After scrutinizing the documents, HDFC ERGO will approve the claim.
- If additional documents or information are needed, HDFC ERGO will contact you.
- After adequate receipt of required documents, the claims will be settled by the insurer.
- You will receive the status update through email/SMS on every phase of the claim.
- On receipt of complete documents, the claim would be processed by HDFC ERGO and paid through NEFT.
Here is a list of documents required for filing a reimbursement claim.
- Original investigation reports
- Final hospital discharge summary
- FIR or post-mortem report if happened
- Pharmacy bills along with the prescription
- Original bills, receipts, and discharge report
- Indoor case papers and duly-filled claim form
- Original hospital bills and a valid photo ID proof
- Treating doctor's report, and original consultation notes
- Nature of operation performed and surgeon's bill and receipt
- Test reports along with attending doctor’s or surgeon’s report
All claims with amount Rs. 1 Lakh and above require KYC form along with a photocopy of anyone KYC document (Aadhaar card, voter ID, passport, driving license, etc).
In case of any query, call InsuranceDekho at 1800-1205-698.
Incurred Claim Ratio (ICR) of HDFC ERGO Health Insurance
The Incurred Claim Ratio (ICR) indicates the overall performance of insurance companies and gives people an overview of what they can expect from their insurer. The Incurred Claim Ratio for HDFC ERGO is 62%. It clearly indicates that HDFC ERGO is in a position to clear claims without having to overburden their finances.