Health Suraksha Gold Insurance Plan

Health Suraksha Gold Insurance Plan

  • Sum insured upto 10 lakhs
  • Hassle-free claim settlement
  • Protection from critical diseases
  • Cashless treatment at 8,600+ hospitals
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Health Suraksha Gold Individual Plan

HDFC ERGO Health Suraksha Gold Insurance Plan is uniquely designed for who want to have never-ending benefits from their health insurance policy. HDFC ERGO is a General Insurance Company which was formed with the collaboration of famous Housing Finance Institution called HDFC and ERGO International AG insurance rooted in Germany.

The Health Suraksha Gold Insurance Plan caters to the needs of both individual and family. This HDFC ERGO Health Suraksha Gold is highly flexible and dynamic as it offers an extensive range of choices for different individuals as per their demands at highly affordable rates and unlimited benefits. Check more about the benefits and features of the plan to get a better understanding of the plan.

Highlights of the Plan

  1. The sum insured limit varies between Rs 3 Lac to Rs 10 Lac for the individuals
  2. Anyone above the age of 3 months is eligible to buy the policy.
  3. All the benefits and exclusive features of the plan are included in this coverage like cashless treatment, tax benefit, pre and post-hospitalization, no claim bonus, daycare treatment, facility of E-opinion etc
  4. Treatment at 8,600+ network hospitals without any cash.
  5. 100% settlement of claim laid down by the insured.
  6. Policyholder also get the options if availing add-on cover benefit in case of any critical illness, shortage of sum insured.

Eligibility Criteria for Individuals

  • The minimum Entry Age for the plan has no limit. Anyone can opt to buy the Health Suraksha Gold Insurance Plan no matter you are a child, adult, senior citizen or super senior citizen.
  • The minimum Exit Age is also under no restriction as anyone can exit at any point of time with respect to policy’s terms and conditions.
Individual Plan Coverage
Sum Assured 3 lac to 10 lac
Eligibility Child – 91 days, Adult – No Limit
Renewability Life Time Renewal
Daycare Procedure 144 Treatment
Plan tenure 1 – 2 Years

Coverage Provided

1. In-patient Hospitalization

This feature covers hospitalization expenses that can arise due to medical issues like an accident or illness. It basically covers the nursing expense, medicines, doctor fees, intensive care expense, surgeon fee, operation theatre charges, single private room accommodation, etc.

2. Pre-hospitalisation

It covers the expenses that happened before the hospitalization of the insured for inpatient treatment and provides coverage for 60 days prior to hospitalization. It may include medical tests, Medicines, vaccinations, Doctor’s practitioner fees etc

3. Post-hospitalisation

These are the medical expense to regain the lost stamina or capacity of the body after illness/injury has been treated in the hospital. This is also referred to as recuperation expenses and the time limit ranges from minimum 60 days to 90 days maximum after the hospitalization.

4. Room Rent

When you got hospitalized, you need room for which you have to pay some rent. In this plan, you can enjoy the benefit of no sub-limit on the room rent charges.

5. Emergency Ambulance

In certain medical emergencies, the insured may need the service of an ambulance which is covered by Health Suraksha Gold Insurance Plan as it pays as the ambulance charges up to 2000 (for a sum assured 3 Lac, 4 Lac, 5 Lac) and 3500 (for a sum assured 7.5 Lac, 10 Lac)

6. Domiciliary Hospitalisation

This kind of hospitalization is required when the insured is not in the condition to move to a hospital or nursing home due to extreme illness and want complete treatment at home. There are certain guidelines provided below under this feature-

  • The condition of the patient is so critical that he cannot be shifted to hospital
  • There is no availability of the accommodation in the hospital you are hunting for.

7. Day Care Treatments

Day Care Treatments are also called short term hospitalization treatment that can be covered within 24 hours and does not require extended hospitalization. There are 144 different daycare treatments that are included by the plan.

8. Organ Donor

If the insured have to face any organ transplantation which will involve the expense for the treatment of organ donor. This expense is covered by the insurance company.

9. Maternity Expenses

The maternity coverage may include pre and post natal expenses which under abidance of 4 years of a waiting period.

10. Newborn Baby

Expenses covered for the newly born baby for up to 90 days after the birth of the baby. The expenses may include important vaccinations, treatment of baby etc

11. Convalescence Benefit

This benefit is to ensure extra financial safety to the insurer at the times of prolonged stay, let's say for 8 to 10 days. So, this feature helps in providing the lump sum payment to cover the income loss due to a long stay at hospitals.

12. Non-Allopathic Treatment

Under this insurance company pays the expenses under treatment done through Ayurveda, Unani and Homeopathy. This kind of treatment is also called AYUSH treatment.

13. No Claim Bonus

No claim bonus is offered every year on the renewal of the policy. The insured who hasn’t applied for any claim in a year or for cumulative years are beneficiaries of the bonus. The bonus amount depends upon the number of claim free years. The maximum percentage of bonus is determined as 50% of the sum insured. This bonus can give a jump in the amount of the sum insured.

14.Health Checkups

The insured can receive the benefit of health checkups for which you become eligible after 4 years of claim free years. You may get reimbursement as 1% of the sum assured or Rs 5000 whichever is more.

15. E-Opinion

This feature assists the insured to get the second opinion by a medical practitioner if he suffered from critical illness in the future within the policy period.

Benefits of Health Suraksha Gold Plan

  • Tax Benefit- Policyholder get the benefit of tax deduction with regard to Section 80 D of Income Tax Act.
  • Discount – If a policyholder includes two or more family members in the policy, then he is subjected to receive 10% discount. If a person buys a 2-year policy, then he will also a 10% discount.
  • Cashless Treatment - HDFC ERGO provide cashless treatment at 8600+ network hospitals. The number may vary according to your city.
  • Lifelong Renewability – Policyholder get the option to renew the existing policy.
  • Claim Settlement – The plan provides smoooth and less time-consuming claim settlement with least documentation.

Exclusions of the Plan

  • If you have any pre-existing diseases, then you must wait for 4 years to get the coverage.
  • The cost incurred in the dental, pregnancy, abortion, miscarriage, childbirth or external aids etc.
  • Contagious diseases like AIDS/HIV(sexually transmitted) is not covered.
  • Any mental disorders, genetic disorders, cosmetic surgeries, weight loss treatments.
  • Any hospitalization expenses resulted from the war, nuclear/chemical weapon, radioactivity etc.
  • Medical problems arising due to excessive intake of drug, alcohol, or hallucinogenic stuff are excluded.
  • Claims occurring in the first 30 days of the policy purchase date will not be settled or entertained by the insurer.

Sample Illustration

To illustrate how the plan works, here is a short example of a man named Dharmesh who wants to invest in HDFC ERGO Health Suraksha Gold Plan. Let us see how it works.

Dharmesh is a 37-year-old married man who works in an MNC located in Noida. His income is between 5-7 Lacs per annum an. He wants to include his wife (who is 35 years) and 7-year child into his health insurance. He compared various insurance companies and selected HDFC ERGO to buy their Health Suraksha Gold Insurance Plan.

Also, he has no smoking habit neither any other infectious diseases but still he wants to secure his future from financial problems by taking insurance. The sum insured was 10Lac along with the payment of Rs 24,707 per year as premium. Dharmesh faced a medical urgency for which he needs immediate hospitalization and funds too. So, he simply claims the expenses from the insurer and get compensation for the inpatient expenses, pre and post hospitalization expenses.

The salary of Dharmesh is tax payable. As he is paying premiums for his health insurance, so he will get a tax deduction up to 25000 in total tax payable on salary. This will automatically enrich his saving per year.

*The amount of premium may vary according to the age of an individual in taking the plan.

About the Company

HDFC ERGO General insurance company has been existing in the insurance sector for 17 years of establishment and has gained much momentum among the competitors. The company has the highest claim settlement ratio which is why customers display a remarkable amount of interest in buying the HDFC ERGO policies.

The company has been rated iAAA by the ICRA. Apart from health insurance services, the company also provide car insurance, bike insurance, travel insurance, personal accident insurance, crop insurance, weather insurance etc.

Frequently Asked Questions (FAQs)

1. What is the eligibility criteria for entering into the Health Suraksha Gold plan?

In order to enter into the plan, an individual must be above 90 days or 3 months of age which is the minimum age. Whereas the maximum has no limitations.

2. What are the additional benefits offered by the plan?

The first thing you need to know is that you have to pay an extra premium to avail additional benefits or add-on covers offered. The add-on covers include-

  1. Critical illness cover- The diseases which are fatal to health are Critical illness like cancer, massive heart stroke, brain tumor, sclerosis etc. This covers 10-15 ailments normally but this can go up to 38 ailments in case of a comprehensive package.
  2. Top Up cover: This upgrades the basic value of the sum insured over a period of time. To illustrate, if you have faced multiple diseases and accidents during a year which has brought down your sum insured limit to zero. Then, this rider or add-on will assist you in combating the future financial needs during medical emergencies.
  3. Personal Accident Cover- If the policyholder met with an accident due to which it caused severe injuries or even death in some cases. In such situation this add-on cover can offer compensation for the consequences of the accident.

3. What is the time period of Health Suraksha Gold Plan?

The usual time period of this policy plan is one to two years in accordance with the choice of an individual. If the policyholder wants to continue the policy, he/she can easily renew the policy by notifying the insurer.

4. Do this policy offer any tax benefit or tax exemptions?

Yes, this plan offers tax benefit up to Rs 25000 under Section 80D of Income. While if you pay a premium for your parents who come in the category of senior citizen, you can avail Rs 30,000 as a tax benefit.

5. What are the documents required for the plan?

To buy the policy, an individual to submit an application form or proposal form with complete information about your medical history along with address proof. Moreover, a medical examination can be required in case the policyholder is equal to 55 years or more.

6. What are the minimum and maximum sum insured options available in the plan?

In case of an individual, the sum insured is 3 Lac, 4 Lac, 5 Lac, 7.5 Lac, and 10 Lac. The premium may vary according to the age and medical conditions of the individual.

7. Can we cancel the policy in case we don’t like policy’s terms and conditions?

Yes, the policyholder is given the option of Free-Look Period in which he/she is given a time period of 15 to review all the mentioned terms and conditions. If the policyholder has any disagreement with any clause, he/she can terminate the policy. The premium paid towards the policy will be refunded to the policyholder’s bank account with a deduction of expenses incurred in medical checkups, stamp duty charges, and risk-adjusted premium.

8. What is the value of E-opinion in the plan?

As the storm comes without any notification, so do the illness which can take the life of an individual without any notice if not taken precaution. The E-opinion holds value when a policyholder suffers any Critical illness during the policy term and need second advise from a medical expert.

In E-Opinion, the insurer will take the responsibility of arranging the second opinion from a medical expert selected by the insured from the company’s panel. The second opinion will be formed on the basis of information and documentation submitted by the insured to the expert.

9. What is the process of claim settlement in HDFC ERGO Health Suraksha Gold Plan?

To settle your claims, follow the few easy steps:

  1. First, register your claim within the 7 days of discharge from the hospital. After 7 days no claims will be accepted.
  2. Submit your duly attested insurance claim in supplement with other mandatory documents in between the time period of 15 days of the occurrence of the incident.
  3. If you didn’t supplement proper documents, you will be granted a letter of deficiency within 7 days of submission of documents.
  4. Finally, when your claims are approved by the insurer you will receive insurance claim settlement statement within 30 days after you have all the documents along with permissible payment.

10. How to file the claim under HDFC ERGO?

Generally, claims are of two types as listed below-

  • Cashless Claim: In the policy plan, policyholders have the advantage of cashless treatment at 8600+ hospitals covered in the plan. When the policyholders get treated in any of the hospitals, the insurer will directly compensate the cashless claim with the network hospital.
  • Reimbursement Claim: There is also an option of getting reimbursement in case the policyholder get treatment from a hospital not listed in the network hospitals of the policy.

If you want a hassle-free settlement of the claim, submit the documents below.

  • NEFT details in the form of claim along with a canceled cheque.
  • Photocopy of any one of the KYC documents like Adhaar card, Passport, Driving License, Voter ID etc in order to claim an amount of Rs 1 Lac or more.

11. If the primary applicant passes away, what happens to the policy?

If in any condition the policyholder is no longer, then the second member included in the policy can continue the existing policy.

12. What to do if the cashless hospitalization is rejected by the network hospitals?

For this, you have to check your policy whether your condition for which you are seeking cashless treatment is mentioned in the policy papers. It is recommended to pay the expenses first and then seek for the reimbursement of the claim.

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