HDFC ERGO Claim Process
  • HDFC ERGO Claims
  • Reimbursement Claims
  • Cashless Claims
HDFC ERGO Claim Process
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HDFC ERGO Health Insurance Claim Process

HDFC Ergo Claim Process is the interaction between the insured and insurer, where the policyholder seeks compensation for the medical expenses incurred during the treatment. The company orchestrated a quick and efficient claims process which enables the customer to access medical treatment without any delays. They have designed a user-friendly website, where the policyholder can easily register the claims and upload documents. This provides a seamless and efficient experience to the policyholders even in the time of medical emergencies. Let us explore how HDFC Ergo Online Claim Process works.

Claim Process Offered by HDFC Ergo Health Insurance

Based on the type of hospitalization and the timing of payment of medical bills, the HDFC Ergo Claim Process is divided into two categories. Lets us examine each type one by one:

Cashless Claims: A type of health insurance claim, where the policyholder can avail of a treatment, without paying the bills upfront. The insurance company later settles the bill with the hospital.

Reimbursement Claims: These claims where the policyholder seeks compensation for the medical expenses incurred during treatment at the non-network hospital. The policyholder pays the bill at the time of discharge and later the insurance company settles the claim by transferring the amount into the customer’s bank account.

HDFC Ergo Reimbursement Process

For planned hospitalization, the policyholder needs to inform the company 48 hours before, being admitted to the hospital, and for emergency hospitalization within 24 hours of hospitalization. HDFC Ergo Reimbursement process can be performed in four simple steps. Let us have a look at the procedure:

Step 1: Claim Registration

  • Visit the company’s office website of HDFC Ergo. Locate the ’Claims’ option on the top menu of the page. From the drop-down menu select ’Health Insurance. On the next page, click on the ’Reimbursement ’ tab. On clicking the option you will find the link to download the ’Claim Form’.
  • The page also has a link to upload documents related to medical treatment. Scan the documents and upload them on the provided link.

Note:

  • Claims must be resisted within 15 days of discharge from the hospital.
  • The link to download the claim form and upload the documents is available on the page. Hit ’Click Here’ to upload and download the document.

Step 2: Processing of Claims

HDFC Ergo’s team of doctors will verify all the documents. On successful verification of the documents a ’Post Satisfactory Receipt ’ will be sent to the customer, within 7 days.

Note:

  • HDFC Ergo Health Insurance Claims update will be sent to the customers on their registered mobile number.
  • They can even check the policy status from the same page. Hit the ’Click Here’ option under the ’Processing of Claims’ section.

Step 3: Uploading any Pending Document

The company may even ask for additional documents, and scan and upload the document.

Step 4: Settlement of the Claim

After successful verification, HDFC Ergo Health Insurance Company will settle all the claims by transferring the amount to the customer’s bank account through NEFT.

Note: The amount will be transferred, within 7 days of the last document received by the company.

Cashless Claims:

HDFC Ego cashless claims are unmatched, as the company settles the bill just 2 hours after receiving the last document. for cashless claims, policyholders need to inform the company within 24 hours of emergency hospitalization and 48 hours for planned hospitalization. The process for cashless claims is as follows:

Step 1: Hospitalization

  • The company has provided the network hospital locator on the official website. Visit the official website and click on ’Claims’, then select ’Health Insurance’ from the drop-down menu and go to the ’Cashless Claims’ tab.
  • On this page, you will find the link to upload the document.
  • You can even load the ’Pre-Authorization Form’, from the same page.

Step 2: Submit the Documents

After receiving the treatment, collect all the documents. Scan and submit all the documents to the company.

Step 3: Pre-Authorization

  • The network hospital administration will coordinate with the company and will complete the form and submit it to HDFC Ergo Health Insurance Company.
  • The hospital may assign TPA that acts as a mediator between the hospital and the insurance company.
  • The policyholder can even hand over all the documents along with the policy details to the TPA. Later the TPA will complete all the paperwork and verify all details on behalf of the hospital.

Step 4: Verification

The company will verify all the submitted documents and details. HDFC Ergo has an in-house team of doctors that verify the documents.

Step 5: Claim Settlement

As soon as the claims and the documents are verified the company will transfer the amount to the hospital.

Step 6: Status Update

HDFC Ergo Health Insurance company keeps the policyholder informed via text messages at every stage of the claim. The text messages are sent to the registered mobile number of the customer.

Point To Be Noted:

If the policyholders are facing any issue at any stage of claim processing, they can call customer care of the company. HDFC Ergo Health Insurance Customer Support Number is: 022 6234 6234 / 0120 6234 6234

Documents Required To Submit HDFC Ergo Health Insurance Claim

The list of the documents is as follows:

  • Duly Filled and signed Claim Form
  • Discharge Summary
  • Original Final Bill
  • Payment Receipts
  • Medicine invoices
  • Investigation Reports
  • Implants Sticker Invoice

Conclusion

HDFC Ergo Health Insurance offers a hassle-free claim process. Policyholders can easily submit their documents online or opt for offline options through the TPA. This smooth claim process makes HDFC Ergo one of the top choices for buying health insurance.

HDFC ERGO Health Insurance Network Hospital List

HDFC ERGO Health Insurance Network Hospitals are present in 31 states nationwide. With a wide network of hospitals, HDFC ERGO Health Insurance ensures that you are medically secured, irrespective of the city you reside in.

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HDFC ERGO Health Insurance Claim Process: FAQs

1. What is the process of HDFC Ergo health insurance registration?

The claims can be registered through the website. Visit the official website of the company, and locate the ’Claim’ option on the top menu of the webpage. Choose ’Health Insurance’ from the drop-down menu and then upload your documents with the claim form to register the claims.

2. How to claim HDFC Ergo Health Insurance?

To claim HDFC Ergo Health Insurance, the policyholder has to visit the official website of the company and register the claim under the ’Claims’ section of the website. Submit all the documents online and then wait for the company to verify and settle the claim.

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Bindiya Sinha

Written By: Bindiya Sinha

Bindiya is a seasoned content writer specializing in keeping readers acquainted with the insurance industry, term insurance developments, and life insurance sector shifts. With an experience of 3 years in insurance, Bindiya ensures that her readers stay well informed with the insurance developments and factually correct information.