Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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Updated on Jul 01, 2025 4 min read
HDFC ERGO Claim Settlement Ratio
With the availability of numerous health insurance companies, selecting an appropriate and suitable health insurance plan has become quite a difficult task. Many times, you end up selecting an insurance plan that fails to meet your entire coverage requirements due to the lack of awareness about health insurance. Thus, to make an informed selection while purchasing health insurance, one needs to have a thorough knowledge of various aspects.
The claim settlement ratio of the insurance company is one such aspect. In India, every health insurance company has a claim settlement ratio. Claim settlement is one of the important factors to be considered while selecting a health insurance company as it tells you about the claim-settling ability of the insurance company. If the company is not able to settle claims in the given period, then the whole purpose of purchasing insurance goes to vain.
The CSR of HDFC Ergo for the year 2025 is 99.16% which is a great achievement.
In the article below, we will be discussing the HDFC ERGO Claim settlement ratio. Take a look below to explore the claim settlement ratio of HDFC ERGO health insurance and its claim settling process:
What is the Claim Settlement Ratio?
Claim Settlement Ratio or CSR, is the number of claims settled against the total number of filed claims during a financial year. Let’s understand how CSR is determined:
For example, ABC health company has a total of 100 registered claims during a financial year, and it settled only 90 claims out of them, then the health claim settlement ratio of that health company will be 90% for that particular year.
How Does CSR Benefit the Policyholders?
Well, before buying any new product, we check its reliability and the brand’s status. The same goes for buying a health insurance plan. By checking the claim settlement ratio of the company, one can get an insight into how the company is performing when it comes to claiming settlement.
Moreover, it will also give you an insight into the company’s claim settlement ability. The higher the percentage, the better the company’s ability to settle claims. Hence, this factor makes a company more trustworthy amongst its customers.
What is the Incurred Claim Ratio?
The Incurred Claim Ratio or ICR is the ratio of a health insurance company’s net claims paid out to the total premium collected. For example, if an insurance company receives INR 10 Crore in premiums and pays out INR 8 Crore in claims, the company’s ICR would be 80%.
The greater the ICR, the better the insurance company’s financial health. It means that the insurer is effectively resolving the majority of claims, which is something that every policyholder looks forward to while purchasing an insurance policy.
Claim Settlement Process of HDFC Ergo Health Insurance
There are two ways to file a claim. Let’s take a look at them one by one:
Cashless Claim Settlement Process
You avail of the cashless facility only at the network hospitals of HDFC ERGO where you are not required to pay any cash for your treatment.
After reaching the insurance desk at the hospital, register with the HDFC Ergo Reach and show your health card issued by HDFC ERGO that includes health-related information.
Download the pre-authorization form from the company’s website. Fill in the details and submit the form. The hospital will share the details with HDFC ERGO.
After the final enhancement of the claim request, the insurance company will then scrutinize all the documents and convey their judgment.
On successful verification and acceptance of the claim, the insured can enjoy a cashless treatment facility.
Reimbursement Claim Settlement Process
The reimbursement procedure includes paying the expenses incurred during the hospitalization procedures and getting the bill amount reimbursed from the insurer.
For this, you have to file a claim, download the application form for claim processing, and fill and attach all the required documents (listed in the claims form).
Submit the form with the documents to your respective insurance company’s branch.
Once your claim is processed, the reimbursement amount is transferred directly to your registered bank account.
Check HDFC Ergo Health Insurance Policy Claim Status
You can check the status of your claim through both online and offline mediums.
Procedure for Online
Go to the HDFC ERGO general insurance official website and click on the claim tab.
To get your claim status, enter the essential details asked by the portal.
You will receive an OTP on your registered mobile number and email ID.
Verify yourself using the OTP and click on ’Go’.
After this step, you will be able to see the status of your claim.
Procedure for Offline
You can call the customer care executive at +91 120 6234 6234 to enquire about the status of your claim.
HDFC ERGO’s impressive 99.16% claim settlement ratio for 2025, coupled with its transparent claim processes, underscores its commitment to policyholder satisfaction. By offering both cashless and reimbursement options, and providing easy online and offline claim tracking, HDFC ERGO ensures a seamless experience during medical emergencies, making it a reliable choice for your health insurance needs. Secure your peace of mind with HDFC ERGO. Get a free quote and take the first step towards a healthier, worry-free future with PolicyX.com!
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.
To cater to the different medical needs of an individual & their family,
HDFC ERGO Health Insurance offers
several Health Plans ranging from senior citizen plans to specialized plans for
autistic
children, to health insurance for cardiac patients, and many more.Take a look below
to HDFC ERGO Health Insurance plans
explore more:
HDFC ERGO Optima Restore Policy is the best-selling plan of HDFC ERGO since its launch. It offers comprehensive health cover to you and your family un...
Unique Features
Recovery benefit
SI restoration
Waiting period reduction
HDFC ERGO Optima Restore Plan (Pros)
Restore benefit
2X Multiplier benefit
Renewal discounts
HDFC ERGO Optima Restore Plan (Cons)
AYUSH not covered
OPD cover unavailable
Global health cover
HDFC ERGO Optima Restore Plan (Other
Benefits)
Recovery benefits
Organ donor cover
In-patient and out-patient hospitalization
HDFC ERGO Optima Restore Plan (Eligibility
Criteria)
HDFC ERGO Koti Suraksha is a health insurance plan that provides a sum insured of up to INR 1 crore. Koti Suraksha Plan by the HDFC ERGO Insurance Com...
Unique Features
High sum insured
Health and wellness plan
Emergency worldwide coverage
HDFC ERGO Koti Suraksha Plan (Pros)
Air ambulance
OPD cover
Domiciliary hospitalization
Emergency global coverage
HDFC ERGO Koti Suraksha Plan (Cons)
Vaccination not covered
Modern treatment unavailable
Maternity & newborn baby care unavailable
HDFC ERGO Koti Suraksha Plan (Other
Benefits)
In-patient hospitalization
Daycare procedures
Health check-up cover
HDFC ERGO Koti Suraksha Plan (Eligibility
Criteria)
HDFC Ergo super top-up plan is the best option by HDFC Ergo to ensure a cushion of ample cover to get the best medical treatment without any restricti...
Unique Features
Plan Specifications
Key Features & Benefits
Quick Buying And Claim Process
My Health Medisure Super Top Up (Pros)
Day care procedures
High sum insured
6 Hours response guarantee
My Health Medisure Super Top Up (Cons)
Adventure sport injuries
Self-inflicted injuries
War
My Health Medisure Super Top Up (Other
Benefits)
Deductibles offered
Covers family members
Versatile plan
My Health Medisure Super Top Up (Eligibility
Criteria)
HDFC ERGO Health Insurance's Health Wallet plan by HDFC ERGO Health Insurance is a comprehensive health insurance plan that not only ensures your heal...
Unique Features
Worldwide Emergency Care
Avail 6% interest on un-used SI
Cashless Homecare treatment
HDFC ERGO Health Wallet Family Floater (Pros)
Inpatient and outpatient cover
OPD cover
Domiciliary hospitalization
HDFC ERGO Health Wallet Family Floater (Cons)
Air ambulance
E-consultations
Health check-up
Modern treatment cover
HDFC ERGO Health Wallet Family Floater (Other
Benefits)
Global coverage
Daycare procedures
Health check-up
Vaccination charges
HDFC ERGO Health Wallet Family Floater (Eligibility
Criteria)
HDFC ERGO Health Insurance offers an Energy Diabetes plan which is ideal for those who are suffering from diabetes Type 1, diabetes mellitus Type 2, p...
Unique Features
Personalized health coach option
Get rewards to reduce your premiums
Diabetes-Hypertension without waiting period
HDFC ERGO Energy Diabetes Plan (Pros)
Personal health coach
Rewards for premium discount
Diabetes and Hypertesion cover
HDFC ERGO Energy Diabetes Plan (Cons)
ICU cover unavailable
AYUSH treatment
OPD not covered
Domiciliary treatment unavailable
HDFC ERGO Energy Diabetes Plan (Other
Benefits)
Organ donor cover
Ambulance services
Pre & post-hospitalization cover
HDFC ERGO Energy Diabetes Plan (Eligibility
Criteria)
HDFC ERGO Health Suraksha Plan is a comprehensive plan from the house of HDFC ERGO Insurance Company that aims at providing 360-degree protection agai...
Unique Features
Key Features
Eligibility & Age Restrictions
Types of My:Health Suraksha Smart Plans
My:Health Suraksha Smart Plan (Pros)
Air ambulance cover
Recovery benefit
Infertility cover
My:Health Suraksha Smart Plan (Cons)
Vaccination cover unavailable
Second medical opinion not available
Maternity cover
Newborn baby cover
My:Health Suraksha Smart Plan (Other
Benefits)
Family discount
Long-term policy discount
Loyalty discount
My:Health Suraksha Smart Plan (Eligibility
Criteria)
iCan Cancer Insurance is a cancer-specific plan offered by HDFC Health Insurance Company. The plan covers medical expenses incurred during the treatme...
Unique Features
Key Features
Eligibility & Exclusions
iCan Cancer Plan Sample Premiums
HDFC ERGO iCan Cancer Insurance Plan (Pros)
Cancer cover
In-patient hospitalization
Ambulance cover
HDFC ERGO iCan Cancer Insurance Plan (Cons)
Maternity cover
Newborn cover
Organ donor cover
Global coverage
HDFC ERGO iCan Cancer Insurance Plan (Other
Benefits)
COVID-19 cover
Pre and post-hospitalization
ICU charges
HDFC ERGO iCan Cancer Insurance Plan (Eligibility
Criteria)
Accidental deaths or injuries can be devastating, it can attack your physical, emotional, mental, and financial status to ruin your happy life moment...
Unique Features
Worldwide coverage
No pre-policy medicals
Lifelong renewability
HDFC ERGO Personal Accident Insurance (Pros)
Accidental Death
Permanent Total Disability
Broken Bones
Burns
HDFC ERGO Personal Accident Insurance (Cons)
Breach of law
Pregnancy or childbirth
Self-inflicted injury
HDFC ERGO Personal Accident Insurance (Other
Benefits)
Ambulance costs
Hospital cash
Lump sum payout benefit
Air ambulance cover
HDFC ERGO Personal Accident Insurance (Eligibility
Criteria)
HDFC ERGO My:Optima Secure health insurance plan offers value that you might require in future to fight against medical discrepancies. Providing you a...
Unique Features
3 plan variants
Double coverage
E-opinion on critical illnesses
HDFC ERGO Optima Secure Plan (Pros)
Hospital Cash Benefit
No Cost Instalment Option
Restore Benefit
Unlimited Restore
HDFC ERGO Optima Secure Plan (Cons)
Maternity cover NA
Newborn care unavailable
OPD cover unavailable
HDFC ERGO Optima Secure Plan (Other
Benefits)
Aggregate deductible discounts
Disposables & consumables cover
Worldwide cover
HDFC ERGO Optima Secure Plan (Eligibility
Criteria)
Are you sceptical about finding the best health insurance plan that protects you and your family under one roof? Read further to learn about the exclu...
Unique Features
India & Worldwide Coverage
High SI up to 2 Crores
Aggregate Deductible Discounts
HDFC ERGO Optima Secure Global Plan (Pros)
Pre and post-hospitalisation
Organ donor expenses
AYUSH treatment
HDFC ERGO Optima Secure Global Plan (Cons)
Modern treatment
Vaccination unavailable
Maternity and newborn baby cover
Cataract cover
HDFC ERGO Optima Secure Global Plan (Other
Benefits)
E-opinion for 51 critical illnesses
Add-on covers
Overseas travel secure
HDFC ERGO Optima Secure Global Plan (Eligibility
Criteria)
The Arogya Sanjeevani Policy from HDFC ERGO is a basic plan designed for individual or family floater coverage. It provides you with the precise medic...
Unique Features
3 plan variants
Double coverage
E-opinion on critical illnesses
HDFC ERGO Arogya Sanjeevani Policy (Pros)
Pre and post-hospitalization
Doctor consultation
AYUSH treatment
Preventive health check-ups
HDFC ERGO Arogya Sanjeevani Policy (Cons)
Maternity expenses
Daily hospital cash
Modern treatment
Organ donor cover
HDFC ERGO Arogya Sanjeevani Policy (Other
Benefits)
Family floater cover
SI upto 10 Lakhs
Lifelong renewability
HDFC ERGO Arogya Sanjeevani Policy (Eligibility
Criteria)
HDFC My: Health Women Suraksha is a comprehensive policy that is designed to cater to the evolving needs of health and well-being of today's women. T...
Unique Features
Cancer Cover
Assault And Burn Cover
41 Critical Illness Cover
My:Health Women Suraksha Policy (Pros)
Lifetime renewal
Wellness Incentives
Add-On Coverage
My:Health Women Suraksha Policy (Cons)
Obesity or weight control
Cosmetic surgeries
Maternity cover
Change of gender treatment
My:Health Women Suraksha Policy (Other
Benefits)
Post Diagnosis Support
Cancer Cover
Major Illness Cover
Surgical Procedure
Critical Illness Cover
My:Health Women Suraksha Policy (Eligibility
Criteria)
1. After how many days from discharge a person must file a reimbursement claim against HDFC ERGO health policy?
A person must file their reimbursement claim within 3 to 5 days from the date of their discharge.
2. What is the incurred Settlement Ratio for HDFC Ergo Health Insurance FY 2023-24?
87.70% is the incurred claim settlement ratio for HDFC Ergo health insurance
3. What is the difference between the Claim Settlement Ratio (CSR) and the Incurred Claim Ratio (ICR)?
CSR is the percentage of claims settled out of the total claims filed. ICR is the ratio of net claims paid to the total premium collected, indicating financial health.
4. How do I avail of cashless treatment with HDFC ERGO?
Get admitted to a network hospital, show your health card, and submit the pre-authorization form. HDFC ERGO will settle the bills directly with the hospital.
5. How can I check my HDFC ERGO claim status online?
Visit the official website, click on the claim tab, enter your details, verify with OTP, and check the status.
Simran is an insurance expert with more than 4 years of experience in the industry. An expert with previous experience in BFSI, Ed-tech, and insurance, she proactively helps her readers stay on par with all the latest Insurance industry developments.
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