HDFC ERGO Health Insurance
HDFC ERGO Health Insurance
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HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance)

HDFC ERGO Health Insurance Limited (formerly known as Apollo Munich Health Insurance) is a consolidated collaboration between HDFC Ltd and Munich Health. HDFC Ltd is one of India’s leading housing finance companies in India located in Mumbai and Munich Health is a reinsurance company that has its headquarters in Germany. HDFC ERGO Health Insurance is known for crafting contemporary health plans that cover pre and post hospitalization expenses, daily cash for hospital rooms, free health checkups, medical expert opinion, daycare procedures, worldwide emergency ambulance, special coverage for cancer, hypertension, and diabetes, etc.

Apart from these benefits, HDFC ERGO Health Insurance also offers comprehensive coverage with the optional rider to make it more productive and efficient. With the support of this health cover, wipe out all your health-related anxieties and complexities towards the future expenses pertaining to health.The company is appraised with several awards for instituting innovative health insurance plans that cater to the prevailing health associated needs of the current generation.

Highlights of HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance)

Number of Network Hospitals4500+
Claim Settlement Ratio62.47%
PortabilityAvailable
Renewability of the PolicyLifetime
Additional Rider Benefit availableAvailable
Discounts and RebatesAvailable
Waiting period3 years

**Last Updated on 21-09-2020

Types of HDFC ERGO Health Insurance (formerly known as Apollo Munich Health Insurance)

1. HDFC ERGO Optima Restore

A health insurance plan which is suitable for both individual and family healthcare needs.

Special Features:

  • Cashless treatment for any specified illness at 4,500+ network hospitals located nearby your location.
  • Compensation for the health check-ups up to a maximum of Rs.5000 and the basic sum assured must be equal to or above Rs 5 lakhs.
  • Reinstallment of the entire sum assured on the complete or partial consumption due to past claims.
  • Multiplies the sum assured and raises to 100%, only possible when you do not make any claim for two years.
  • The facility of home treatment, if the insured does not possess the physical strength to shift to a hospital on doctor’s suggestion or due to unavailability of accommodation.
  • 8% discount on every renewal, if the insured accomplishes established step count target which can be calculated through the HDFC ERGO Health mobile application.
  • Optional Coverage for 8 major illnesses that include -
    1. Aorta Graft Surgery
    2. Bone Marrow Transplant
    3. Coronary Artery by-pass surgery
    4. Heart Valve replacement/ repair
    5. Organ Transplant
    6. Cancer
    7. Pulmonary artery graft surgery
    8. Neurosurgery
  • Includes coverage for pre and post hospitalization expenses, emergency ambulance & daily cash for hospital accommodation.
  • Expert opinion in case of any illness where the insured is not satisfied with the opinion of a local doctor and wanted to consult a medical expert who has specialization in treating a particular disease.
  • All day-care procedures are included.
  • Emergency air ambulance cover on choosing a sum assured of more than Rs 10 lakhs where a maximum of Rs 2,50,000.

2. HDFC ERGO Easy Health

HDFC ERGO Easy Health Plan ensures financial assistance. It covers hospitalization costs incurred on the treatment of any defined illness and other related medical expenses of the insured.

Key Features:

  • Discount on the premium, if the insured strives to complete the target of average step count which can be determined by using the mobile application of the company. This benefit is known as Stay Active benefit whose objective is to promote the importance of good health through regular exercises and eliminate unhealthy style of living.
  • A recovery benefit of Rs.10,000 (maximum) will be provided, if the inpatient hospitalization is for a longer period or for more than 10 days.
  • Reimbursement of the expenses incurred on the extraction of an organ for transplantation. Expenses will include in-patient treatment of the donor.
  • Expenses associated with pre and post-hospitalization, daily cash for the hospital room, domiciliary treatment & AYUSH treatment (Ayurveda, Siddha, Unani and Homeopathy).
  • Includes health checkup expenses up to 1% of sum assured and emergency ambulance expenses up to Rs.2000 per hospitalization.
  • Covers maternity expenses.
  • Optional critical illness rider coverage which includes diseases such as cancer, coronary artery (bypass) surgery, first heart attack, kidney failure, major organ transplantation, etc. On diagnosis of any of the illnesses, the insured will receive a lump sum payment up to a maximum of Rs.10 lakhs.
  • Optional Critical Advantage Rider gives coverage for 8 major illnesses related to the brain, lungs, liver, arteries, heart, etc. This rider is applicable only for the sum assured of Rs.10 lakhs & above.

3. HDFC ERGO Health Wallet

It is the most preferred plan of HDFC ERGO Health Insurance which offers comprehensive cover for hospitalization for all major and minor diseases.

Special Features:

  • Restore the benefit of the basic sum assured of up to 100%.
  • OPD expenses or any other medical expenses can be paid by the restoration benefit amount.
  • Cover for expenses of health check-ups, in-patient treatment taken under Ayurveda, Unani, Siddha and Homeopathy, pre and post-hospitalization.
  • Emergency ambulance cover and maximum coverage of Rs.2000 per hospitalization.
  • Organ donor expenses for organ transplantation in favor of an insured person.
  • Bonus up to a maximum of 100% of sum assured for a claim-free year.
  • Cashless treatment at every network hospital by displaying a health card granted by the insurer.
  • 50% of sum insured up to a maximum of Rs. 20 lakhs for the expenses under worldwide emergency care.
  • Optional critical benefit rider available at a minimal price for sum assured of more than Rs.10 lakhs.
  • Illnesses that are included in the rider are:-
    1. Pulmonary artery graft surgery
    2. Coronary artery by-pass surgery
    3. Neurosurgery
    4. Bone marrow transplant
    5. Cancer treatment
    6. Live-donor organ transplant
    7. Heart valve replacement or repair
    8. Aorta graft surgery

4. HDFC ERGO Optima Super

A plan that offers great coverage options at affordable premiums. The plan is great at providing comprehensive cover.

Special Features:

  • Cover 144 daycare procedures that are treated and can be rectified within 24 hours due to developments in the technology standards. Treatment processes such as cataracts, angiography, tonsillectomy, ear operations, etc.
  • The cashless facility where all the cost of treatment will be borne by HDFC ERGO and insured can enjoy zero cost hospitalization.
  • All the expenses occurred over in-patient hospitalization for the treatment of an illness in any of the network hospitals are duly compensated with cashless service.
  • Covers both pre-hospitalization (before 60 days) and post-hospitalization (up to 90 days) expenses. Expenses such as consultations fee, diagnosis reports, pharmacy, etc are generally included.
  • Get a waiver of deductibles by maintaining consistency in the payment of the premium on every renewal date of the policy.
  • Includes expenses related to the treatment of organ donors for organ transplantation.
  • Ambulance cost in case of emergency transportation to the nearest network or non-network hospital.

5. HDFC ERGO Optima Cash

An individual plan that is crafted to meet the increasing cost of healthcare sector and provides timely coverage to the insured with 4,500 hospitals located in 800 cities.

Key features

  • It gives you a daily cash limit of up to Rs.3000.
  • Get reimbursement of expenses on giving birth to a child and is valid for once in the whole policy term.
  • Convalescence cash for hospitalization extending beyond 7 days.
  • Get regular cash limit for the cost of various types of hospitalization:
    1. Cash for availing ICU facility for any illness or accident applicable only for 15 days of hospitalization.
    2. Cash compensation for a maximum of 6 daycare procedures whose treatment does not consume more than one day.
    3. Daily cash limit for accidental hospitalization up to 90 days per policy year.
    4. Cash for joint hospitalization occurred solely due to accidents.

6. HDFC ERGO Optima Plus

This plan covers all the necessary medical costs that are crucial for the health of the insured and becomes effective at the time of retirement.

What Medical Expenses Does It Cover?

  • One sum assured that covers all the major critical illnesses when the insured reaches the retirement age.
  • No waiting period for any specific diseases and insured will receive a guaranteed sum assured on retirement.
  • Lesser and cheaper premiums for taking the Optima Plus Health Insurance Plan between the age group of 91 days to 45 years.
  • There are no sub-limits imposed on choosing the type of room for daycare treatment.
  • 140 daycare processes are covered under the plan, especially for the minor ailments or injuries whose treatment can be completed in 24 hours.
  • 10% discount on including family members equal to or more than 2.
  • Get full-time coverage till 100 years of age for regular renewals.

7. HDFC ERGO Optima Vital

A uniquely designed health insurance that covers critical diseases whose treatment is way too extravagant that may leave you bankrupt at a point of time. The plan safeguard the savings and create an additional reserve of money for medical expenses.

Key features

  • Gives you financial assistance, if the insured gets diagnosed with any critical diseases such as Alzheimer’s Disease, End-stage Lung Disease, Brain Surgery, Permanent Paralysis of Limbs, Cancer, kidney failure, Anaemia, coma, etc.
  • It lowers the financial burden over the family by providing prompt coverage on request with an accurate declaration of the critical disease caused.
  • Second expert opinion for any critical illness from the medical specialist registered in the penal of the company.
  • The increased sum assured when the insured does not file any claim during a year or for consecutive years. Assured must apply for renewal after every policy year to get this benefit.
  • Cashless treatment facility at 4,500 network hospitals with 10,000 specialized and proficient doctors.

8. HDFC ERGO Energy Plan

An exclusive health insurance plan to deal with widespread diseases called diabetes whether it is Type 1 or Type 2. This gives financial assistance to combat and treats the complicated illness of diabetes.

What medical expenses and benefits does it cover?

  • A health insurance product by HDFC ERGO is designed to meet the treatment expenses sprouting out of diabetes and hypertension.
  • Freedom from the hustle of waiting periods to receive the coverage for a specific treatment.
  • 25% discount is given on the premium amount on the policy renewal through participation in the wellness management program. Insured can earn points based on the health standard acknowledged through annual health checkups for Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and/or Hypertension.
  • The plan has two variants according to which wellness tests are offered yearly or half-yearly:
    1. Silver Plan: If you opt for this plan, wellness tests or medical checkups are not covered and you have to pay for the medical tests expenses.
    2. Gold Plan: On opting for this variant, all your medical tests expenses for better health will be borne by the company and will be treated by the impaneled medical practitioners.
  • Reimbursement will be provided only on expenses like consultation charges, medicines and drugs, diagnostic reports, dental treatments, and other miscellaneous medical charges barely given any coverage.
  • Consists of inpatient treatment that involves intensive treatment of a disease taking more than a day. The factor that forms inpatient treatment expenses is hospital room rent or boarding expenses, nursing, ICU charges, Medical Practitioner’s charges, anesthesia, blood, oxygen, operation theatre charges, etc.
  • Pre-hospitalization expenses for 30 days before and post-hospitalization expenses for up to 60 days after the insured is released or discharged.
  • 182-day care procedures are included to ensure the utmost health benefits of the policyholders.
  • Emergency ambulance, organ donor expenses, shared accommodation are some of the common features that are given.

9. HDFC ERGO Maxima Plan

A special plan dedicated to providing coverage for minor illnesses that are excluded from the many other health insurance plans. This plan takes care of all the minor injuries to illness such as a normal stomach infection, allergies, sore throat, eyesight weakness, dental treatment, etc.

Key Features

  • Covers In-patient treatment.
  • Covers all your small pharmacy or medicine bills which may be insignificant for other health insurance companies.
  • Diagnostic tests taken for the investigation of a particular illness are also liable to get the cover.
  • No sub-limits on the medical expenses where the policyholder is free from following any cost limitation. The policyholder can avail OPD vouchers in accordance with the necessities without being anxious about the limitations.
  • If you are suffering from any illness before the policy purchase and when you buy the Maxima Plan, you will receive coverage for pre-existing diseases from the first day of policy commencement.
  • The facility of annual health check-ups for any age between 18 years to 44 years from the first day of the policy inception. While people above 45 years can use this benefit after the completion of the first year.
  • Out-patient treatment cover where there is no requirement of bed and illness can be attended conveniently.
  • Outpatient consultations up to a maximum of 6 doctor consultation based on the number of members included in the policy.
  • Cumulative bonus of up to a maximum of 50% of the sum assured is credited to accumulated benefit reserve of insured.
  • Covers the maternity expenses for normal delivery to cesarean delivery. Also, get coverage for newborn babies which covers expenses incurred during the first 90 days after birth.
  • Additional critical illness cover for treating major illnesses that are pernicious to the health in the long run.

10. HDFC ERGO iCan Cancer Insurance

This plan will give you advanced protection from cancer which has rapidly built its home in the human body. To eradicate the roots of cancer, this plan ensures complete coverage for the treatment without any limitation.

The plan is divided into two variants-

  • iCan Essential: It covers all the necessary medical expenses.
  • iCan Enhance: It contains all benefits under the 'Essential' variant plus extra benefits like two lump-sum payments, CritiCare benefits, family care benefits and much more.

Key Features

  • Covers all varieties of cancers under both variants.
  • Cashless treatment of cancer at any network hospital on requesting the preauthorization from the company.
  • Advance cover for ordinary treatment that contains Chemotherapy, Radiotherapy, Organ transplantation (part of Cancer treatment), surgeries for excision of cancerous tissue or removal of organs/ tissues (Onco-surgery).
  • All the inpatient hospitalization, daycare procedures and outpatient treatment for the cure of cancer are covered through the payment of sum assured.
  • Pre and post-hospitalization cost that may arise before and after the real operation of the disease carried on in a hospital under medical practitioner surveillance.
  • Compensation will be promised for expenses related to an emergency ambulance for transportation.
  • Even if the medical expert has found no traces of cancer in the body of the insured and has advised discontinuing the treatment for at least 6 months, the company will still pay for the medical tests administered for investigation of the same. Insured will receive a reimbursement of up to Rs.3000 twice a year.

For Enhance Plan Only:

  • In addition to the essential plan, this will also cover treatments such as proton beam therapy, immunotherapy including immunology agents (e.g. Interferon, TNF), personalized & targeted therapy, hormonal therapy or endocrine manipulation, stem cell transplantation and much more.
  • Lump-Sum payment of 100% of the sum insured as Family Care Benefit over and above the basic sum insured in case of any of the two cancer conditions-
  1. Advanced metastatic Cancer (Stage IV)
  2. Recurrence of Cancer
  • Critical Care Benefit which promises 60% of sum insured over and above the basic sum insured on the detection of cancer of specified seriousness. Please mark that this benefit doesn’t apply to the ‘Essential’ variant.

11. HDFC ERGO iCan Cancer Insurance for Women

HDFC ERGO’s concern towards growing cancer cases mostly in the female population. Hence, the company has designed iCan Cancer Insurance which takes care of the women and mainly cancer issues.

This plan is divided into two plans namely-

  • Standard Plan: It will cover all the necessary treatments, daycare processes and hospitalization related to cancer that are mandatory to get rid of the diseases.
  • Advanced Plan: This is an extension of the above plan that encompasses the benefits of the standard plan and supplementary inclusion of advanced treatment procedures.

Key features

  • Expert opinion if the insured is skeptical upon the first diagnosis of cancer and wanted assistance from medically specialized doctors listed on the company’s panel. The doctors through the practice of artificial intelligence, deep analytics & cognitive software will generate genuine test results that will confirm the presence of disease.
  • All commonly known conventional treatments are covered such as Chemotherapy, Radiotherapy, Organ transplantation(part of Cancer treatment), Surgery for excision of cancerous tissue or removal of organs/ tissues (Onco-surgery).
  • Coverage for the expenses incurred before the reception of cancer infected insured into the hospital for inpatient treatment. Also called pre-hospitalization expenses covered up to 30 days.
  • Emergency service of an ambulance for the transportation of insured from home to the nearby hospital. A maximum payment of Rs 2000 per hospitalization is determined for this benefit.
  • A compensation of Rs 300 twice a year will be provided for the medical health checkups organized to check whether there are any manifestations of cancer in the body. This expense will be paid even if the doctor has recommended ceasing the treatment of cancer for at least 6 months as “No Evidence Of Disease (NED)” is found.

For Advanced Plan:

  • Covers all the latest treatments that are developed to treat cancer from roots and are labeled proven solutions.
  • In addition to the standard plan, this will also cover treatments such as-
  1. Bone marrow transplantation
  2. Hormonal therapy or endocrine manipulation
  3. Personalized & targeted therapy
  4. Stem cell transplantation
  5. Proton beam therapy, immunotherapy including immunology agents (e.g. Interferon, TNF).

12. HDFC ERGO Dengue Care Plan

A dengue specific plan that covers the expenses arising from hospitalization whether in-patient or outpatient treatment. Anybody from a child to an adult person can easily purchase the plan as there are no age limitations.

Key Features?

  • No Medical examination is demanded by HDFC ERGO for the purchase of health policy.
  • Freedom from submitting co-payments or sharing the cost of the claim.
  • No defined sub-limits which mostly makes the policyholder feel constrained.
  • Cover room rent expense where the insured can enjoy the facility of a single private A/c room.
  • OPD expenses up to Rs 10,000 on the detection of Dengue.
  • Treatment facility at home where all the medical procedures for Dengue like consultations, diagnostic tests, and nursing are operated at home under the advice of a medical professional.
  • No waiting period to obtain coverage for the specified illness.
  • Pharmaceutical bills, diagnostic tests, doctor consultations, etc may arise on an outpatient treatment basis are duly covered.
  • Shared accommodation in any of the network hospitals is waived off.
  • The same premium amount for all ages i.e Rs.444 for sum assured of Rs.50,000 and Rs.578 for sum assured of Rs.1,00,000.
  • Non-medical expenses are also covered if the shared accommodation benefit has been chosen by the insurer.
  • Pre-hospitalization and post-hospitalization costs are covered for 15 days in both cases after and before the in-patient treatment of disease.

13. HDFC ERGO Optima Senior

Simple health insurance that guarantees coverage for medical expenses occurred over the treatment and hospitalization of senior citizens. Anybody who is above the age of 61 years can buy this plan and can live the rest of life tension free.

Key features

  • Inpatient treatment taken for a specified illness will be covered and a cashless facility is given if treatment is operated at network hospitals.
  • Second E-Opinion for expert analysis on a serious illness directly coming from the medical practitioners registered on the company’s panel that possess wisdom and years of experience.
  • Expenses related to domiciliary treatment, emergency ambulance, and organ donors are fully covered.
  • 140-day care procedures that include ailments that require lesser time like cataract, coronary angiography, chemotherapy, fractures, ear operations, etc.
  • Pre-hospitalization up to 30 days before admission to hospital and post-hospitalization up to 60 days after the issue of discharge.
  • No increase in premium on renewal and the premium will remain the same throughout the policy tenure.
  • 7.5% discount on premium by selecting a two-year health policy instead of one-year.
  • No claim discount of 5% on a claim-free year. Insured should apply for regular renewals to avail of this benefit.

HDFC ERGO Health Insurance Eligibility Criteria (formerly known as Apollo Munich Health Insurance)

Name of the productMinimum Age of entry Maximum Age of entrySum Insured/ Daily CashNumber members can be included Premium Paying ModesPolicy Term
For Individuals and Family:
Health Wallet5 years/ 91 days (for children)65 yearsRs 3 lakhs to Rs 50 lakhsIndividuals and Family Floater: 6 membersAnnually/ MonthlyOne Year/Two Year
Optima Restore5 years/ 91 days (for children)65 yearsRs 3 lakhs to Rs 50 lakhsIndividual: 6 members Family Floater: 6 members (2 adults & 5 children)Annually/ MonthlyOne Year/ Two Year
Easy Health5 years/ 91 days (for children)65 yearsFor Individual: Rs 1 to 15 lakhs For the family: Rs 3 lakhs to Rs 50 lakhsIndividual: 6 members (4 adults & 5 children) Family Floater: 6 members (maximum of 5 adults and 2 children)Annually/ MonthlyOne Year/ Two Year
Day2Day Care- SilverFor children: 91 days to 25 years For Adults: 18 years65 yearsNot SpecifiedIndividual: 6 members Family Floater: 4 membersAnnually/ MonthlyOne Year/ Two Year
Optima Super5 years/ 91 days (For children)65 yearsRs 5 lakhs/ 7 lakhs/ 10 lakhsIndividual: 6 members Family Floater: 4 members (maximum of 2 adults and 2 children)Annually/ MonthlyOne Year/ Two Year
For Individuals Only
Optima Cash5 years/ 91 days (for children)65 yearsRs 1000/ 2000/ 3000Not ApplicableAnnually/ MonthlyOne Year/ Two Year
Optima Plus5 years/ 91 days (for children)65 yearsRs 5 lakhs6 members (maximum of 4 adults and 5 children)Annually/ MonthlyOne Year/ Two Year
Optima Vital18 years65 yearsRs 1 lakhs to Rs 50 lakhs6 members (maximum of 4 adults and 5 children)Annually/ MonthlyOne Year/ Two Year
Energy Plan18 years65 yearsRs 2/ 3/ 5/ 10/ 15/ 20/ 25/ 50 lakhsOnly for one memberAnnually/ MonthlyOne Year/ Two Year
Maxima Plan5 years/ 90 days (for children)65 yearsRs 3 lakhsOnly for one individualAnnually/ MonthlyOne Year/ Two Year
iCan Cancer Insurance5 yearsThe whole of the lifeRs 5/ 10/ 15/ 20/ 25/ 50 lakhsOnly for one individualAnnually/ MonthlyOne Year/ Two Year
iCan Cancer Insurance for Women18 yearsThe whole of the lifeRs 5/ 10/ 15/ 20 lakhsOnly for one female individualAnnually/ MonthlyOne Year/ Two Year
Dengue plan91 days to 25 years (for children 18 years (for adults)65 yearsRs 50,000 to 1 lakh6 members (Maximum of 4 adults and a maximum of 5 children)Annually/ MonthlyOne Year/ Two Year
For Senior Citizens:
Optima Senior61 yearsNo maximum age limitationsRs 2/ 3/ 5 lakhs

**Last Updated on 21-09-2020

HDFC ERGO Health Insurance Plans Benefits (formerly known as Apollo Munich Health Insurance)

Claim Settlement Ratio

Before taking a step to buy health insurance, a person must check the company’s claim settlement ratio to get an idea about the credibility of the insurer. HDFC ERGO Health Insurance with its decent claim ratio has maintained a trustworthy image in the health insurance sector.

Brand Strength

HDFC ERGO Health Insurance is one legal entity that contains the power of two colossal brands namely HDFC Ltd. and Munich Health, recognized as a global player in the health insurance sector. Consequently, when a person buys the policy, they get the benefit of domestic as well as an international brand.

Quick Customer Service

While you purchase a health insurance policy, the factor of customer service should be taken into consideration. HDFC ERGO Health Insurance customer care team strives to settle each claim within 15 to 30 days to keep the customer engaged with current policy and not switch to other health insurers.

Rider Facility

Almost every health insurance plan formulated by HDFC ERGO Health Insurance contains the rider benefit whose objective is to provide additional security to family and individuals. Through the inclusion of these riders, you can make your health plan super worthwhile.

Lifelong Renewability

HDFC ERGO Health Insurance plans give you the feature of lifelong renewability where the policyholder can renew online health cover on every policy anniversary. On renewals, all the benefits scored in the previous year will be carried forward to the next year.

Tax Benefits

Insured, after buying health insurance can receive a huge amount of tax benefits up to Rs 25,000 per year. The tax exemption will be given on the annual Income tax submitted every year on the annual salary or profit earned from a business.

Cashless Treatment

Cashless service at any network hospital is like a blessing to policyholder and settlement of the same is equally significant. HDFC ERGO Health Insurance has statistics of establishing 90% cashless claim authorization within 2 hours if all the information regarding the claim is truly represented by the insured.

Portability

The company also gives complete freedom to port your previous health insurance policy into HDFC ERGO Health Insurance policy, if you are not satisfied. The insured has to submit an application for 30 days before the renewal date by filing a portability form and submitting previous policy details.

Monetary Bonuses

When you buy HDFC ERGO Health Insurance, you get rewards for staying healthy and keeping yourself miles away from consuming tobacco or smoking. The policyholder will get monetary rewards like lower rates of premiums. Also, if the policyholder does not make any claim for one year or more, then a bonus equal to 50% of the sum assured will be added to the basic coverage.

HDFC ERGO Health Insurance Optional Riders

By choosing this additional cover, the insured can enjoy never-ending benefits that come along with the plan. Here’s a list of add-ons to make your plan more efficient in a comprehensive manner:

Critical Advantage Rider

This cover gives you a treatment facility at network hospitals present globally. Also, it also gives coverage transportation expenses of insured and the attending member, accommodation expenses, post-hospitalization, and second opinion expenses.

The illnesses covered under this rider are-

  • Neurosurgery
  • Pulmonary Artery
  • Aorta Graft Surgery
  • Bone Marrow Transplant
  • Live Donor Organ Transplant
  • Cancer
  • Coronary Artery Bypass Surgery
  • Heart Valve Replacement/repair

Benefits Offered:

  • Includes in-patient treatment of the disease for a maximum term of 5 days. This includes the cost of room rent, boarding, nursing, Intensive Care Unit (ICU), Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs and consumables, diagnostic reports, air ambulance, etc.
  • Post-hospitalization expenses occurring after the treatment of the illness so that the illness gets completely erased from the body of the insured.
  • Travel expenses taking shape solely because of treatment of Insured Person where expenses of traveling companion and the living donor, if accompanying for an organ transplant are also covered.
  • A second opinion from our panel of medical practitioners, if the Insured gets confirmed by the doctor of being affected with any of the listed major illnesses.
  • Accommodation Expenses for insured who is taking treatment as well as the person accompanying and the living donor in the case of transplant.

Critical Illness Benefit Rider

In this rider, the policyholder can get protection from 8 major diseases that can degrade the health of the insured if not treated timely.

What illnesses are covered?

  • Aorta Graft Surgery
  • Heart Valve Replacement or repair
  • Neurosurgery
  • Live Donor Organ Transplant
  • Pulmonary artery graft surgery
  • Coronary Artery by-pass surgery
  • Cancer Treatment
  • Bone Marrow Transplant

Benefits Offered:

  • In-patient Treatment for any of the above-listed illnesses up to a maximum period of 30 days. This mainly includes expenses like room rent, boarding expenses, nursing, Intensive Care Unit (ICU), Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs and consumables, diagnostic reports, cost of prosthetic.
  • Post-Hospitalization expenses that enclose doctor consultations fee, medical diagnosis reports, and medicines, etc which are covered until the completion of 30 days after receiving a discharge from the attending hospital authorities.
  • Accommodation expenses for the treatment of insured operating in some foreign land far away from Indian borders. It also covers the traveling companion and the living donor accommodation expenses.
  • Covers repatriation expenses, if the insured or living donor meets his/ her death outside the peripheries of India. Here, the insured bodily remains will respectfully be transported to the home country.
  • Travel expenses of the insured, living donor and the traveling companion if the travel is for the purpose of receiving treatment for a specified illness.
  • The second medical opinion in favor of any major illness pointed above. The opinion should be taken from the medical practitioners mentioned in the company’s panel.

HDFC ERGO Health Insurance (formerly known as Apollo Munich) Premium Calculation

  • Age of the policyholder: The prime factor that determines the amount of premium and calculates premium according to a certain age group. Usually, HDFC ERGO sets lower premium prices for younger ages for higher coverage. However, in Dengue Care Plan, the premiums are fixed and the same for all age groups.
  • Smoking or Non-smoker/ Medical History: The health condition is vital to purchase a health policy and is usually asked by HDFC ERGO to ensure transparency and clarity about the policyholder so that it may not hinder the claim settlement process. Also, non-smokers are given priority in the rate of premium.
  • The number of members included in the plan: The quantity of members attached to the HDFC ERGO Health Insurance plan also changes the values of the premiums by the health insurance calculator. HDFC ERGO appreciates the inclusion of family members in the health policy, that is why they provide a 10% discount on involving more than 2 members.
  • Sum Assured opted: HDFC ERGO offers a wide range of sum assured from minimum Rs 1 lakh to Rs 50 lakhs on individual and family floater basis. As the sum assured increases, the premium also increases. But the increase in the gap is very less as compared to the benefits it offers on the happening of any medical issue. Choosing a higher sum assured can assist you in fighting the soaring medical costs.
  • Male or Female: The premium also depends upon the gender of the policyholder whether female or male. The premiums for the female policyholder is relatively cheaper than the male counterpart. This step was taken to boost the importance of health insurance among women and encourage them to purchase coverage at a lower rate.
  • Type of HDFC ERGO Health Plan: HDFC ERGO has formulated a myriad of health insurance plans for every category whether it is for individuals, family members, and senior citizens. The premiums are different for different plans. For instance, if Ayush (34 years) purchases HDFC ERGO Optima Restore Individual plan where he includes his wife (34 years) and the sum assured opted is Rs 5 lakhs each. The annual premium calculated for covering both the person is Rs.15,176. However, If Ayush purchases Optima Restore Family plan under the same coverage, the premium would be Rs.11,802.

Exclusions

  • Diseases caused due to the transmission of AIDS/HIV infection.
  • Congenital diseases, mental disorders or insanity, cosmetic surgery, aesthetic surgery, and weight control management programs.
  • Any injuries/trauma resulted from wars, nuclear bomb explosions, chemical or biological weapons, and radioactive activities.
  • Any drug or treatment was taken without the consultation of the medical practitioner and intake of which resulted in serious side effects.
  • Illness formed due to regular consumption of alcohol, tobacco, hallucinogenic substances, sedatives, etc.

All these exclusions are common to all HDFC ERGO Health Insurance plans. However, there are specific exclusions for some specific HDFC ERGO plans and the policyholders are requested to check the particular plan page for which they are planning.

HDFC ERGO Health Insurance (formerly known as Apollo Munich) Claim Process

Reimbursement Claim Process

  • Submit duly filled and attested claim intimation form in combination with the required documents. All the documents must be deposited within 15 days after treatment has been accomplished.
  • If you fail to submit complete documents, you will be issued a deficiency letter within 7 days of receipt of claim documents.
  • After the submission of the required documents, the company will pay the requisite amount within 30 days.
  • A settlement statement is also issued with the name of the proposer.

Cashless Claim Process

  • Notify the company about the emergency (within 24 hours)/planned hospitalization (48 hours before admission).
  • The claim request will be overlooked and an authorization letter will be provided to the network hospital stating cashless treatment of the patient.
  • If insufficient documents are submitted, the same will be conveyed to the hospital within 6 hours after the receipt of documents.

Documents Required for Claim Process

Following is the list of documents mandatory for claim settlement process:

  1. Claim Intimation Form (attested and filled).
  2. Original Bills like diagnostic bills, consultation bills and attachments like prescriptions.
  3. Medical reports, history of the patient, investigation report, discharge summaries, etc.
  4. Medical Records of pre and post-hospitalization treatment like consultation notes, prescription bills, diagnosis reports, test results, etc.
  5. ID proofs and address proof of the insured.
  6. Settlement letter from TPA or insurance provider for cashless facility.
  7. FIR and MLC (Medico-Legal Case) in case of an accident claim.

HDFC ERGO Health Insurance Renewal Process

Online Renewal Process of HDFC ERGO Munich health insurance-

  • After purchasing the policy from the company, you can renew it online when the policy anniversary arrives.
  • Insured can visit the website of HDFC ERGO and can apply for a renewal by disclosing the 10 digit policy number as asked during the process.
  • If you have already applied for renewal in the past years, you have to enter a 12 digit policy number on the date of renewal or completion of one year.

Conditions to be followed

  • The company is responsible for giving notices or reminders regarding the renewal of the policy.
  • In most HDFC ERGO health insurance policies, the premiums on renewal will get revised which will change the future amount of premium based on the age and medical conditions of the insured.
  • There will be no extra loading on the premium on renewal as imposed by the company.
  • If the insured fails to renew online the policy on the given date, HDFC ERGO will provide a grace period of 30 days to renew and submit the premium.

HDFC ERGO Health Insurance Review

HDFC ERGO Health Insurance has been rated as the topmost preferred company for ensuring financial protection from health insecurities through broad coverage from the rising expenditure of the medicare sector. It is highly reputed and got excellent reviews from its customers throughout its journey.

With connectivity to 4,550 hospitals spread across various zones of the country and faster settlement of the claim, proposals have earned them satisfied customers. Due to this gesture of service, 80% of the customers are returning to renew their health insurance policy on the policy anniversaries. Also, the benefits which are covered in each HDFC ERGO Health plan are duly paid as promised during the commencement of the policy.

FAQs

1. What is the intimation time period for a claim?

For a planned hospitalization, the HDFC ERGO health insurance company must be informed within 7 days before the event takes place.

In case of emergencies, the company must be notified about the claim within 24 hours of succeeding in the happening of an event.

2. Is Pre-policy check-up necessary before purchasing the policy?

Yes, Pre-Policy check-up is necessary on the basis of age and sum insured value. The medical reports of the check-up are valid for 90 days from the date of check-up.

However, in some of the policies mentioned above, the requirement for a pre-policy medical checkup is not compulsory.

3. Do we get reimbursement for Pre-policy check-ups?

Yes, some HDFC ERGO Health Insurance plans contain 50% to 100% reimbursement of expenses incurred during the medical examination. Please read the policy wordings before purchasing a particular plan to get an idea about the reimbursement of pre-policy medical checkups cost.

4. If we have pre-existing diseases at the time of purchasing the policy, will it be covered?

Yes, pre-existing diseases will be covered after a waiting period of 36 months or from the date of commencement of risk based on the type of health insurance policy chosen.

5. How much time is taken by the HDFC ERGO to settle a claim?

A maximum period of 30 days is taken to settle the payment of the claim for which bank details of the insured are necessary to get the electronic transfer of funds. The payment will be made through a cheque issued in the name of the person proposing the

6. What is Stay Active benefit in Optima Restore?

It allows the insured to gather health rewards in the form of discounts on the premium. The simple requirement to avail of this benefit is to walk as far as possible to gain a healthy body and gain an 8% discount on the premium paid on every renewal.

7. To whom should I submit the claim, HDFC ERGO Health or the respective Third Party Administrator (TPA)?

The documents for the claim settlement will be submitted to the respective TPA, kindly check your ID and user guide for TPA details.

8. Is there any tax benefit in HDFC ERGO Health Insurance?

Yes, there is a tax benefit for the premiums paid for the health insurance plans from HDFC ERGO under Section 80D of the Income Tax Act.

  • For families including self, spouse and children the deduction is Rs.25000.
  • For senior citizens the deduction is Rs.30000.
  • One condition that is there to get the tax benefit is that premiums must be paid by any payment mode rather than cash.

9. May I know who is HDFC ERGO TPA?

For all sales policy, HDFC ERGO has its own efficient claim settlement team and for group policies, the TPA is Family Health Plan Limited (FHPL) instead they have many other TPAs’ for various needs of the company.

10. Will HDFC ERGO pay for the medical health check-ups?

Yes, the insured will pay for the cost of Pre-Policy Check-up (PPC) in which the insured has to do the tests from HDFC ERGO doctors and labs via responsible TPA. Reimbursement of 50% of the expenses will be provided by HDFC ERGO on submitting original bills and receipts.

Last updated on 21-09-2020