HDFC ERGO Claim Settlement Ratio
  • Understand the CSR of HDFC ERGO
  • Benefits of HDFC ERGO CSR
  • claim settlement process of HDFC ERGO CSR
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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 your 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 time period, then the whole purpose of purchasing insurance goes to vain.

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:

Health Insurance Claim Settlement Ratio

What is 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 Beneficial to Policyholders?

Well, before buying any new product, we check its reliability and the brand's status. The same goes while 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.

Health Insurance Companies

HDFC ERGO Health Insurance Network Hospital List

HDFC Ergo entails a wide network of cashless Hospitals that impact millions of lives PAN India. A well connected network of over 13000+ cashless hospitals, HDFC Ergo ensures that you are medically secured, irrespective of the city you reside in.

HDFC ERGO Health Insurance Claim Settlement Ratio

As per IRDAI, HDFC ERGO Health Claim Ratio is 98.49%. Take a look at the below given table that will let you get an insight into the ability of HDFC ERGO Health Claim Settlement.

HDFC Health Insurance Claim Settlement Ratio 2021-22
Age Analysis of Number of Claims Paid (%) < 3 months 3 months to 6 months 6 months to < 1 year 1 year to < 3 year 3 years to < 5 years 5 years
Claims Settled 98.49 1.03 0.22 0.2 0.04 0.02

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 premium and pays out INR 8 crores 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 is 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 of 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

  • 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, 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 general insurance 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 call the customer care executive at +91 120 6234 6234 to enquire about the status of your claim.

You can also visit the nearest branch of HDFC ergo general insurance company to know the status of your claim.

HDFC Ergo Health Plans

HDFC Ergo Health Insurance offers a wide range of health insurance plans to fulfill the medical needs of individuals, families, and senior citizens.

Comprehensive

Get 4X coverage* without any extra cost under this comprehensive health plan for individuals and families.

Unique Features

  • No room rent capping
  • 100% SI restoration
  • E-opinion for 51 illnesses

Optima Secure Policy (Pros)

  • Secure Benefit
  • Plus Benefit
  • Automatic Restore Benefit
  • No room capping
  • Covid - 19 Cover

Optima Secure Policy (Cons)

  • Adventure Sports Injuries
  • Injuries Out of War
  • Death due to breach of law
  • Congenital Diseases
  • Alcoholism

Optima Secure Policy (Other Benefits)

  • Day Care Treatments
  • Road Ambulance Cover
  • Air Ambulance Cover
  • E-opinion
  • Organ Donor Cover

Optima Secure Policy (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - No Age Limit
  • SI - 5 L to 2 Cr
  • Waiting Period - 30 Days

Comprehensive

Provides comprehensive medical coverage to individuals and families with different budgets by offering SI options ranging from 5 Lakhs to 50 Lakhs.

Unique Features

  • Free health checkup
  • 2X multiplier benefit
  • 100% SI restoration

Optima Restore Policy (Pros)

  • Daily Hospital Cash
  • Ambulance Cover
  • Modern Treatment
  • Lifetime Renewal
  • Pre and Post Hospitalization

Optima Restore Policy (Cons)

  • No Dental Cover
  • No Maternity Cover
  • No Non-Allopathic treatment
  • Pre-Existing Diseases after 3 yrs
  • Alcoholism not covered

Optima Restore Policy (Other Benefits)

  • Sum Insured Enhancement
  • Tax Benefit
  • E-Opinion
  • 10% Family Discount
  • 7.5% discount on 2 years premiums

Optima Restore Policy (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - 65 years
  • SI - 3 L to 50 L
  • Waiting Period - 30 Days

Flexible

Offers 360 degrees protection to you and your family with multiple SI options of 3 to 75 Lakhs. Comes with EMI and lifelong entry option.

Unique Features

  • Fitness discounts during renewal
  • Room rent capping and co-pay
  • Loyalty discounts

my:health Suraksha (Pros)

  • Renewal Benefit
  • Wellness Benefit
  • Premium Payment Options
  • Reduced Premium Benefit
  • 1,2,3 Years policy Period Option

my:health Suraksha (Cons)

  • No Return Transportation Cost
  • Suicidal Injuries
  • No Non-Allopathic treatment
  • Adventure Sports Injuries
  • Alcoholism

my:health Suraksha (Other Benefits)

  • Pregnancy Complications Covered
  • Newborn Complications Covered
  • Loss of Job Covered
  • Post Diagnosis Support
  • 41 Critical Illness Covered

my:health Suraksha (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 3 L to 75 L
  • Waiting Period - 30 Days

Comprehensive

An individual and family health plan providing SI of up to 1 crore to prepare you to meet constantly increasing medical inflation.

Unique Features

  • Free preventive health checkup
  • Multiple wellness services
  • Up to 10% of fitness discount

Koti Suraksha Plan (Pros)

  • Renewal Benefit
  • Wellness Benefit
  • Premium Payment Options
  • Reduced Premium Benefit
  • 1,2,3 Years policy Period Option

Koti Suraksha Plan (Cons)

  • Infertility Treatment
  • No Unproven Treatments
  • No Dietary Supplements
  • No Maternity Treatments
  • No Cosmetic Surgery

Koti Suraksha Plan (Other Benefits)

  • 5% Non-Medical Expense Covered
  • Emergency Worldwide Coverage
  • Aggregate Deductible
  • Overseas Treatment
  • Sum Insurance Rebound

Koti Suraksha Plan (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 1 L to 5 Cr
  • Waiting Period - 30 Days

Disease-specific plan

Designed especially for people with pre-existing diabetes or hypertension. Get coverage for diabetes and hypertension from Day 1 without any waiting period.

Unique Features

  • Stay fit & earn reward points
  • 100% SI restoration
  • Health coach & wellness programs

Energy Diabetes Policy (Pros)

  • In- Patient Hospitalization
  • No Waiting Period for Diabetes
  • Restore Benefit
  • Cumulative Bonus
  • Pre and Post Hospitalization

Energy Diabetes Policy (Cons)

  • 2 Year Waiting Period
  • Abuse of Intoxicant Not Covered
  • War Operations Injury
  • Sexsually Tranmitted Diseases
  • Pregnancy Not Covered

Energy Diabetes Policy (Other Benefits)

  • Monthly Newsletter
  • Organ Donor Benefit
  • Earn Rewards for Staying Healthy
  • 25% Discount On Renewal
  • 2 Variant Options(Silver,Gold)

Energy Diabetes Policy (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 2 L to 50 L
  • Waiting Period - 2 Years

Disease-specific plan

Covers all types of cancer at all stages with lifelong renewability option. If diagnosed with IV stage cancer or relapse, this plan pays 100% of SI as a lump sum.

Unique Features

  • Coverage for modern treatments
  • Second opinions available
  • Coverage for follow-up care

HDFC iCan Cancer (Pros)

  • Ambulance Cover
  • Follow up care post treatment
  • Conventional Treatments
  • Hormonal Treatment
  • Stem Cell Transplantation

HDFC iCan Cancer (Cons)

  • No Non Allopathic treatments
  • No Prosthetic Devices
  • No Overseas Treatments
  • Pre-existing condition for Cancer

HDFC iCan Cancer (Other Benefits)

  • Sum Insured Enhancement
  • CritiCare Benefit
  • Family Care Benefit
  • Lifetime Renewal
  • MyCare Benefit

HDFC iCan Cancer (Eligibility Criteria)

  • Entry Age - 18 Years
  • Max Entry Age - 65 Years
  • SI - 5 L to 50 L
  • Waiting Period - 120 Days

Critical Illness

An ideal health plan for people with a pre-existing critical illness or a family history of critical illnesses. Get comprehensive coverage for 15 critical illnesses.

Unique Features

  • One-time lump sum payment
  • No medical checkup up to 45 years
  • Lifelong renewability

Critical Illness Policy (Pros)

  • In- Patient Hospitalization
  • High Cover at Low Premium
  • 1 or 2 Year Policy Period
  • End Stage Liver Failure
  • No Cover ceasing age

Critical Illness Policy (Cons)

  • 10 Lakh Fine on Wrong Claim
  • Tuberculosis Not Covered
  • PED after 48 months
  • Kaposi's sarcoma Not Covered
  • Lymphomas in brain Not Covered

Critical Illness Policy (Other Benefits)

  • 3 Variants (Silver, Gold, Platinum)
  • Two Year Policy Period
  • Guaranteed Renewal for Life
  • Loading on Renewal
  • Individual and Floater SI Options

Critical Illness Policy (Eligibility Criteria)

  • Entry Age - 5 Years
  • Max Entry Age - 65 Years
  • SI - 1 L to 50 L
  • Waiting Period - 90 Days

Bonus-oriented health plan

A flexible and comprehensive health plan, securing your today & tomorrow. With 'Reserve Benefit' features, this plan grows unused policy amount @6% interest rate.*

Unique Features

  • Automatic SI restoration
  • Multiplier benefit
  • Free preventive health checkup

Wallet Family Floater (Pros)

  • Reserve Benefit
  • 100 % Restore Benefit
  • Recovery Benefit
  • 50% Increase On SI on Renewal
  • World Wide Coverage

Wallet Family Floater (Cons)

  • External Congenital diseases
  • Drugs Treatments
  • Miscarraige Not Covered
  • Deductibles (Optional)
  • No Cosmetic Surgery

Wallet Family Floater (Other Benefits)

  • Ambulance Cover
  • 5 Year Policy Cover
  • Portability
  • 30 Days Grace Period
  • Sum Insured Enhancement

Wallet Family Floater (Eligibility Criteria)

  • Entry Age - 91 Days
  • Max Entry Age - 65 Years
  • SI - 3 L to 50 L
  • Waiting Period - 30 Days

Top-Up

Avail of extra cover to meet medical expenses without any limitations by purchasing this deductible-based top-up plan.

Unique Features

  • Constant premiums post 61 years
  • No medical checkup up to 55 years
  • 5% discount on 2-year policy term

My:health Medisure Super Top-up (Pros)

  • In- Patient Hospitalization
  • High Cover at Low Premium
  • Post 61 Year No Premium Hike
  • Day Care Procedure
  • Pre and Post Hospitalization

My:health Medisure Super Top-up (Cons)

  • Treatment Of Obesity
  • Self Inflicted Injury
  • War Operations Injury
  • Sexsually Tranmitted Diseases
  • No Cosmetic Surgery

My:health Medisure Super Top-up (Other Benefits)

  • Free Look Period
  • Two Year Policy Period
  • Guaranteed Renewal for Life
  • Loading on Renewal
  • Individual and Floater Options

My:health Medisure Super Top-up (Eligibility Criteria)

  • Entry Age - 18 years
  • Max Entry Age - 65 Years
  • SI - 1 L to 10 L
  • Waiting Period - 30 Days

Women-oriented health

Women-oriented health plan providing comprehensive medical insurance with major illnesses cover, and cancer cover all under a single plan but different variants.

Unique Features

  • Maternity complications
  • SI options from 3L - 1 Cr
  • Free preventive health checkup

My:health Women Suraksha (Pros)

  • AYUSH Benefit
  • Alternative Treatment
  • Organ Donor Benefit
  • Domiciliary Hospitalization
  • Pre and Post Hospitalization

My:health Women Suraksha (Cons)

  • Adventure Sports Injuries
  • No Sexsually Transmitted diseases
  • No Cosmetic Surgery
  • Alcoholism issues not covered
  • No Self Inflicted Injuries

My:health Women Suraksha (Other Benefits)

  • Parent and Child care Cover
  • Child Care Benefit
  • Vaccination
  • Air Ambulance
  • Health Coach

My:health Women Suraksha (Eligibility Criteria)

  • Entry Age - 18 years
  • Max Entry Age - Lifetime Entry
  • SI - 1 L to 1 Cr
  • Waiting Period - 30 Days

Read Reviews & Ratings

Customer Review Image

Aadhya Kapoor

Agra

October 4, 2023

I trust Policyx.com for insurance advice, and HDFC Ergo Health Insurance was the right choice for my family.

Customer Review Image

Yashika Khanna

Pune

October 4, 2023

Policyx.com s partnership with HDFC Ergo Health Insurance is a winning combination for anyone seeking quality coverage.

Customer Review Image

Vrinda Chauhan

Patna

October 4, 2023

HDFC Ergo Health Insurance, suggested by Policyx.com, offers comprehensive coverage at a reasonable price.

Customer Review Image

Vidyut Sharma

Rajkot

October 4, 2023

Policyx.com s expertise in insurance guided me towards HDFC Ergo Health Insurance, a wise investment.

Customer Review Image

Vidisha Gupta

Pune

October 4, 2023

I couldn t have chosen a better health insurance provider than HDFC Ergo, and Policyx.com led me to them.

Customer Review Image

Veer Singh

Patna

October 4, 2023

Policyx.com s services, combined with HDFC Ergo Health Insurance, have ensured our health and well-being.

Customer Review Image

Varsha Verma

Agra

October 4, 2023

Thanks to Policyx.com, I made an informed decision by choosing HDFC Ergo Health Insurance for my family.

Customer Review Image

Vaishali Sahu

Raipur

October 4, 2023

Policyx.com is where I found HDFC Ergo Health Insurance, and I ve been a satisfied customer ever since.

View All HDFC Ergo Health Insurance Reviews

Naval Goel

Reviewed By: Naval Goel

Naval Goel is the CEO & founder of PolicyX.com. Naval has an expertise in the insurance sector and has professional experience of more than a decade in the Industry and has worked in companies like AIG, New York doing valuation of insurance subsidiaries. He is also an Associate Member of the Indian Institute of Insurance, Pune. He has been authorized by IRDAI to act as a Principal Officer of PolicyX.com Insurance Web Aggregator.