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HDFC ERGO Maxima Health Insurance

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HDFC ERGO Health Insurance
Maxima Policy
Cashless Approval TATWithin 37 mins
Claim Settlement Ratio99.80%
Network Hospitals13,000+
PED Coverage Starting From3 year
Special Benefits2X Cover from Day 1
Starting Premium Rs. 1090/month

About HDFC ERGO Maxima Health Insurance

Maxima Policy is one of a kind medical insurance policy that takes care of your everyday healthcare requirements. It protects you and your family from doctor’s consultation, diagnostic tests, dental treatment, pharmacy bills, optical services, and annual health check-up. Apart from these, the policy covers you for little illnesses too, under out-patient treatment expenses. You can purchase the policy for 1 year for sum insured of Rs. 3 Lakh for self and family members.

There are several features that make Maxima Policy comprehensive, that includes cashless hospitalisation, add-on benefit of critical illness, renewal benefits, tax benefits on the premium paid for the policy, under Section 80D of the Income Tax Act, 1961, etc. The policy comes with a general waiting period of 30 days during which only claims related to injury/ies will be admissible. The policy shall ordinarily be renewable except on the grounds of fraud, misrepresentation of the facts, etc, for until 70 years of age. In short, the Maxima policy comes at an affordable premium and offers you extensive coverage.

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Key Inclusions and Exclusions of the Plan

What's Included

  • Daycare procedures are covered under this plan
  • In-patient hospitalisation expenses are covered under this plan
  • Out-patient hospitalisation expenses are covered under this plan
  • Domiciliary hospitalisation expenses are covered under this plan
  • Emergency ambulance expenses up to Rs. 2,000 per hospitalisation

What's Not Included

  • Expenses arising from HIV/AIDS and related diseases
  • Abuse of drugs, alcohol, and other addictive substances
  • War, act of war, nuclear, chemical or biological weapon and radiation
  • Non-allopathic treatment
  • Treatment required due to self-injury or attempt to suicide

13214 HDFC ERGO Cashless Network Hospitals in India

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Add-ons to Enhance Benefits

  • Critical Illness Cover

    Critical illness add-on offers cover according to your needs for 8 specified critical illnesses and is always paid as lump sum benefit in addition to any medical expenses you may incur for hospitalisation

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.

FAQs on Maxima Policy Health Insurance Plan

  • Am I covered for outpatient expenses under Maxima Policy?

    Yes. Maxima Policy covers you for the following outpatient expenses:

    • Doctor consultations
    • Pharmacy expenses
    • Diagnostics
    • Specialist services
    • Health check-ups
    • Pre-existing illnesses under OPD benefits

  • Am I covered for dental treatment under Maxima Policy?

    Yes. Maxima Policy covers you for dental treatment, contact lenses, and spectacles, up to a certain limit, as a part of specialist services. 

  • Which in-patient hospitalisation expenses am I covered for under Maxima Policy?

    Maxima Policy covers you for a sum insured of Rs. 3 Lakh that includes in-patient treatment, pre-hospitalisation and post-hospitalisation expenses, daycare procedures, domiciliary treatment, daily cash in case of shared accommodation, etc. The policy also covers you for emergency ambulance expenses, organ donor expenses, daily cash for accompanying the insured child, care for a newborn, and maternity expenses.

  • Can I avail tax benefits on the premium paid for Maxima Policy?

    Yes. You can avail tax benefits on the premium paid for Maxima Policy, under Section 80D of the Income Tax Act, 1961. 

  • Is there any limit on cover for doctor’s consultations under Maxima Policy?

    Yes. If one member is covered under the Maxima Policy, then he/she can avail up to 4 consultations per policy year; if two members are covered under the Maxima Policy, then he/she can avail up to 6 consultations per policy year; whereas if 2 adults+up to 2 children are covered under the policy, then up to 8 consultations can be availed. 

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