About HDFC ERGO General Insurance Company Limited
The HDFC ERGO General Insurance Company Ltd. is a joint venture between HDFC Ltd. and ERGO International AG. While the former is a reputed housing financing institution of India the later is a celebrated primary insurance unit of Munich Re Corp. The company has a huge umbrella covering Motor, Health, Travel, Personal Accident and Home for both personal and commercial sectors.
The aim of the company is to offer betterment in the insurance services and provide the utmost care to the clients of the company. The processes of the company are automated and speedy to offer hassle free aids in time of need.
The company has an employee base of 1900 experts over 108 branches covering 89 cities effectively. The company boasts of the achievement of "iAAA rating" which it has received for possessing the highest claim paying ability. The policies of the company are targeted towards the customer's health care and wellness and are paramount in the industry.
HDFC ERGO: Health Suraksha
The cost of health care and emergency medical care may make you run out of your pockets but with HDFC ERGO by your side you need not worry about this. The exclusive benefits offered by the company very effectually cover the costs of your medical requirements. By taking off the financial burden from you the company offers you to focus on the other emergency aspects of the illness of medical emergency.
The policy is applicable as when the policyholder falls for any sickness, injury or meets with any unfortunate mishappening. The cost of hospitalization, pre & post hospitalization, ambulance charges and all the medical expenses are covered under the policy.
With the contingency cost falling on you unplanned, you need a support system to stand against it. With HDFC ERGO Health Suraksha you need not worry about it much as the policy has all the necessary medical and health care aspects covered for you.
Highlights of HDFC ERGO Health Suraksha Plan:
- The plan is available on the individual as well as on a family floater basis.
- The rates of availing the plans are highly affordable.
- There are options to choose the policy either for one year or two year term.
- If you hit a claim free year you may avail a bonus as per the company's pre decided terms.
- On completion of 4 successful claims free year, you unlock the terms of free health checkups.
- More than 5000 hospitals in the network to avail cashless services.
- Income Tax Exemption under the Section 80D.
- Hospitalization, pre and post hospitalization costs, surgical and non-surgical expenses, nursing and boarding charges are covered under the policy.
- There are no caps on hospital expenses, room rents, doctor's fees or specific diseases.
What does the Policy Cover?
- In patients: All the costs incurred due to illness or any accidents are covered under the policy up to the sum insured. The cost of nursing, medical expenses, boarding and fees are included in this.
- Costs: The amount paid for intensive care unit, blood, oxygen, operation theatre charges, medicine, drugs and other consumables, diagnostic procedures and surgical appliances are covered under the plan.
- Pre-Hospitalization: Any medical expenses incurred 60 days prior to the hospitalization are taken care by under the plan on a reimbursement basis.
- Post Hospitalization: All the medical costs incurred in the period of 90 days after the discharge of the patient is covered under the policy on a reimbursement basis.
- Day Care: If the policyholder goes through any medical procedure which does not require any hospitalization of 24 hours, the cost of such procedures is well covered under the policy. The policyholder may avail 144 such sessions of day-care treatment on a reimbursement basis.
- Domiciliary Treatment: Any treatment taken at the residence of the patient on the advice of an attending medical practitioner, because of any reason of not being able to transfer him/her to the hospital is covered under the plan and the cost of the same is reimbursed.
- Organ Donor: On reimbursement basis, the cost of organ harvesting is inclusive in the plan.
- Emergency ambulance: The charges of the emergency ambulance are taken care under the policy.
- Cumulative Bonus: If you hit a claim free year you are benefitted by 5% increase in the total sum insured amount. The increase is limited up to 50% of the sum insured.
- AYUSH Benefit: This benefit covers the expenses incurred undergoing any Ayurvedic, Unani, Siddha or Homeopathy treatment.
- Health Checkups: After 4 continuous claim free years, you may avail medical checkups worth Rs. 5000 or 1% of the sum insured, whichever amount is lesser.
What is not included in the plan?
Following are the exclusion under the policy:
- HDFC ERGO Health Suraksha requires 30 day waiting period for claims.
- Any pre-existing health conditions are not covered until and unless the holder is covered for more than 48 months.
- No casualties of war and other armed conflicts are covered under the policy.
- Any injury caused because of self-harm or destruction is not included under the policy cover.
- Surgical or medical treatment for beautification like plastic surgery, botox, genital uplift or surgery, etc. is excluded under the policy.
- Any vaccination taken for preventive measures is not covered under the policy.
- Treatment cost for any condition arisen due to consumption of alcohol or drugs is not covered.
||HDFC ERGO Health Suraksha
||1 Year and 2 Years
||Individual and Family Floater
|Basic Sum Insured Range
||Rs. 3 to Rs. 10 Lacs
|In Patient Expenses
|Pre Hospitalization and Post Hospitalization
||30 Days and 60 Days respectively
|Pre- Policy Check
||If aged 45 years or more
|Free Health Check-ups
||After 4 years of claimless policy
||No limit on room rent/doctor's fees/specific diseases
||Exemption under section 80D
Health Claims can be broadly categorized in to two types:
- Cashless Claim
- Reimbursement Claim
For seamless processing of claims make sure to submit below details.
Provide NEFT details along with cancelled cheque
Provide KYC ( Know your customer ) form along with photocopy of any one of following KYC documents for all claims amounting to Rs 1/- lakh and above.
Step 1: Hospitalization : The policyholder or any dependent is admitted to the network hospital.
Step 2: Intimation : As soon as possible the in-house HDFC ERGO claims services administrator must be intimated about the admission.
Step 3: Discharge formalities : You may continue to avail the services of the Hospital and make sure you collect all the bills, discharge details, and every other related document from the hospital at the time of discharge.
Step 4: Claim initiation : You may download the claim form and submit it duly filled with attached supporting documents to the HDFC ERGO claim services team. The required documents are mentioned there on the claim form. The claim gets approved within 7 days or till the documentation gets completed.
Health Claims can be broadly categorized in to two types:
- Claim form duly filled and signed
- All the bills in the original copy. This must include the final bill from the hospital with signature and stamp of the authorized person. The bill number on the final bill is a must. Itemized bills and receipts should be attached for attestation.
- Discharge sheet or death certificate whichever applicable should be presented in the original copy.
- Investigation reports and doctor's prescription along with medical bills are mandatory.
- In the case of any follow-up treatment, the advice letter must be attached.