Energy Health Insurance Plan
HDFC Family Health Insurance
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HDFC ERGO Energy Health Insurance Plan

HDFC ERGO Energy Health Insurance Plan helps to reduce the burden of medical expenses raised due to diabetes, the most common and deadly diseases of all. It is specially designed for people with diabetes and hypertension and offers you to live with these two successfully and peacefully.

Let us now explain this plan in detail for a better understanding.

Eligibility:

Type Of Disease

Type 1 and 2 Diabetes or Pre-Diabetes (Impaired Fasting Glucose/ Impaired Glucose Tolerance) or Hypertension.

Entry Age

18-65 years

Minimum Sum Insured

Rs.2 lakhs

Maximum Sum Insured

Rs.50 lakhs

Who Can Apply

Only one individual with any of the aforesaid diseases.

**Last Updated on 18-12-2020

Type of the plan:

Variants

Details

Silver Plan

The cost of wellness tests is excluded-

 a. Without Co-pay

b. With 20% Co-pay

Gold Plan

The cost of wellness tests is included-

a. Without Co-pay

b. With 20% Co-pay

**Last Updated on 18-12-2020

Coverage of HDFC ERGO Energy Health Insurance:

This dedicated plan covers most of the expenses that may arise due to diabetes and hypertension. Have a look at the below table for the details.

Parameters

Coverage

Day Care Treatment

Yes, up to 182 Days

Waiting Period

No (for diabetes and hypertension)

In-Patient Hospitalization

Yes

Pre-Hospitalization Coverage

30 days

Post-Hospitalization Coverage

60 days

Emergency Ambulance Coverage

Yes

Organ donor expenses

Yes

Wellness Program

  • Two complete medical checks administered during the policy year.
  • A personalized wellness web portal.
  • Personalized expert health coach.
  • Monthly newsletters to provide you with important information on healthcare and management.

Reward Points

  • Renewal premium discounts of up to 25% for management of health conditions.
  •  Reimbursement up to 25% of renewal premium against your medical expenses (like consultation charges, diagnostic expenses, medicines and drugs, and other miscellaneous charges not included under any medical insurance).

**Last Updated on 18-12-2020

What are the features and benefits of HDFC ERGO Energy Health Insurance?

The plan offers several benefits that are listed below-

Comprehensive Coverage - This plan offers day one coverage for all hospitalization arising out of diabetes and hypertension with no waiting period.

Pre and Post-Hospitalization - Your costs for diagnosis, investigation, and even post-hospitalization expenses are covered. All your pre-hospitalization expenses up to 30 days (before admission) and post-discharge expenses (till 60 days) are included.

Emergency Road Ambulance - If an emergency arises and you need to hurry to the hospital, your ambulance costs are compensated up to Rs.2000 per hospitalization.

Lifelong Renewability - Once you get connected with HDFC ERGO Energy Health Insurance Plan, there is no looking back. It can continue lifetime on break free renewals.

Organ Donor Expenses - The plan covers the medical and surgical expenses of the organ donor while having a major organ transplant.

Tax Saving - It offers tax benefits up to Rs.75,000 for the premiums paid under Section 80D of the Income Tax Act, 1961.

Personalized Health Guide - Under this plan, you can also get your personalized, highly trained health coach to guide, instruct, remind, and create your nutrition and fitness plan.

Wellness Portal - With this plan, you can avail of a personalized wellness web portal that tracks and stores all your medical records. It helps you to monitor your health condition along with the facility to purchase health products at special offers.

Easy Access to Valuable Information - After purchasing this plan, you can get easy access to the helpline number to answer all the queries, along with the monthly newsletters to provide you important information regarding healthcare and management.

HbA1C Benefit - Your costs of HbA1C tests are covered up to Rs.750 per policy year. Two complete medical check-ups (known as wellness tests) are also compensated up to Rs.2000 for Gold Plan on a cashless claim.

What are the exclusions of HDFC ERGO Energy Health Insurance?

The major exclusions are as follows-

  • Any pre-existing condition (other than diabetes or hypertension) will be covered after a waiting period of 2 years.
  • Expenses arising due to HIV or AIDS and related diseases.
  • External congenital diseases, cosmetic surgery, and weight control treatments.
  • Hospitalization due to war or due to a nuclear, chemical, or biological weapon and radiation of any kind.
  • Pregnancy or maternity-related expenses.
  • Self-inflicted injuries.
  • Expenses due to external aids, dental treatment, and appliances.
  • 2 years waiting period for specific diseases like cataract, joint replacement surgeries, hernia, surgery of hydrocele, etc.
  • Non-medical expenses.
  • Problems arising from taking any intoxicating substances.

How to buy HDFC ERGO Energy Health Insurance?

Follow the below-mentioned steps to buy this plan easily and smoothly.

  • Visit the official website of HDFC ERGO and click on 'Health Insurance'.
  • Scroll down and search for 'Energy Health Plan'. Click on 'Buy Now'.
  • Enter the required details and click on 'Calculate Premium'.
  • Check the premium details and click on 'Buy Now.
  • Fill in the mandatory fields and pay the premium online.
  • The policy document will be shared on your registered email id.

If you aren't a fan of online buying, you can buy this plan from the nearest branch of HDFC ERGO.

In case you don't get a suitable response from HDFC, you can also buy this plan from PolicyX.com. Here is the process for the same.

  • Scroll to the top of this page and find 'Get Quotes from Top Insurers'.
  • Fill in the details and click on 'Continue'.
  • Enter further details and tap on 'Proceed'.
  • Out of all the quotes, choose the 'Energy Health' plan, and check its premium details.
  • Pay the premium and the policy will be sent to your registered email id.

What's the claim procedure of HDFC ERGO Energy Health Insurance?

The claim process can be of two types - 1. Cashless claim and 2. Reimbursement claim. Both the claim processes are discussed here with proper steps. Have a look.

Cashless Claim:

Hospitalisation - You have to get admitted to one of the authorized network hospitals of HDFC ERGO.

Provide proper documents to the hospital - Show your health card, valid photo ID, and other documents (if required) to the hospital.

Preauthorization - The hospital will send the cashless request to HDFC ERGO and coordinate with the company for the pre-authorization form.

Scrutiny - HDFC ERGO will do its investigation on the received documents and reflect on the claim stating its final stand.

Status update - You will be kept notified through SMS or mail on your registered mobile number or email-ID about each stage of the claim.

Authorization and approval - On approval, you can take the treatment, and the bills will be settled by HDFC ERGO. Any inadmissible expenses, copayments, and deductions will have to be paid by you.

Reimbursement Claim:

Hospitalisation- You can get admitted to any hospital according to your convenience. The amount will be settled directly by you, not the hospital.

Claim Registration - After discharge, download the claim form from HDFC's official website. To make your claim procedure quicker, it would be advisable to submit the soft copies of your bills and documents on the claim registration module. Once you have shared the documents, the team will initiate the processing of your claim.

Else, you may send soft copies of your claim documents along with the claim form to healthclaims[at]hdfcergo[dot]com.

Approval of Claim - HDFC ERGO will review and scrutinize all the documents. If additional documents are required, you will be informed by the insurer. After you meet their satisfaction level, the claim will be settled by the company.

Status Update - You will be kept notified through SMS or mail on your registered mobile number or email-ID about each stage of the claim.

Claim Settlement - After the completion of the procedure, the amount of the claim will be transferred through NEFT.

Note: On receipt of complete documents, the claim would be processed within 7 days from the time the last document is received.

Required Documents:

For filing your claim and getting it approved, you need the following documents.

  • Duly filled and signed claim form.
  • Original discharge summary.
  • Original final bill with detailed breakup payment receipt and original pharmacy invoices supported by prescriptions.
  • Original investigation reports (eg. blood reports, X-Ray, etc).
  • Implant sticker/invoice, if used (eg. for a stent in angioplasty, lens cataract, etc.).
  • Past treatment documents (if any).
  • In cases of accident, Medico-Legal Certificate (MLC) or FIR.
  • NEFT details for payment: Cancelled cheque in the name of the proposer or passbook copy attested by the bank.
  • For all claims amounting to 1 lakh and above: KYC form along with a photocopy of any one KYC document (eg. Aadhar card, passport, driving license, voter ID, etc.).
  • Other relevant documents requested by the company.

Note: For safety, it would be advisable to keep the documents both in original form and photocopied form.

FAQs:

1. Will I get life-long renewability with HDFC ERGO Energy Health Insurance Plan?

Yes, they provide life-long renewability unless the policyholder behaves improperly.

2. What is the Grace Period of this plan?

The insured will get a 30 days grace period to renew his / her policy.

3. Can I cancel my policy at any time?

The company offers 15 days from the date of receipt of the policy document to review the terms and conditions of this policy. In case of any objections, you have the option of cancelling the policy and you shall be refunded the premium paid by you after adjusting the amount spent on any stamp duty charges, medical check-up, and proportionate risk premium.

4. Can I enhance the amount of sum insured?

Yes, you can enhance the sum insured at the time of renewal. Just make sure that no claim has been made under the policy.

5. Can I port my policy?

Yes, any insured person has the option to choose another indemnity health insurance policy available with HDFC ERGO at the time of renewal and all the benefits of the previous policy will be carried forward if you have paid the premium without any break.

Last updated on 18-12-2020