HDFC Ergo Health Insurance : Buy Online Now

Know About HDFC Ergo Health Insurance

HDFC was incorporated on October 17, 1977. Mr. H. T. Parekh appointed as Chairman. HDFC was promoted as a development finance institution by the industrial credit and Investment Corporation of India Ltd. In the years 2021-2022, HDFC Ergo Net income is Rs. 500 Crore and its total assets are Rs. 32118 Crore.
The HDFC ERGO Health Insurance Company is a joint venture between HDFC and ERGO, where Ergo became a 49% skate holder in the company in 2015. In 2019, HDFC Health Insurance acquired Apollo Munich Health Insurance with 51.2% skate and later it merged into general insurance with the approval of the Insurance Regulatory Department Authority of India. As of now, HDFC Ergo General Insurance is the second-largest player in the health insurance industry. In 2021 A variety of non-life insurance products are offered by the HDFC Ergo general insurance, including health insurance, motor insurance, travel insurance, home insurance, and commercial insurance, and in the corporate sector it offers products like liability, marine, and property insurance, and in ruler sector, it offers product like rainfall index insurance, Pradhan mantri fasal Yojna, and cattle insurance policy. At present 9700+ employees are working with HDFC Ergo general insurance in 200+ branches across all over India. In 2021-2022 HDFC Ergo won a lot of awards for cyber insurance & optima secure health insurance by the BFSI leadership awards, Best Covid strategy implemented by ETBFSI Excellence Awards, the best insurance company in the private sector by the World HRD Congress, and many more awards are winning.

The HDFC ERGO Health Insurance Company provides financial protection and reduces all medical expenses. It saves you from all future financial losses arising due to Disease & Accident. It offers a lot of benefits with huge coverage. At present the company also covers COVID-19 after 15 days of policy purchase. You will get Tax benefit u/s 80D. There is a Free look period of 15 days to go through your policy and change your decision for a better understanding, let's take a closer look at this plan.

Network Hospital	13000+	Claim approval time	20 Min
Claim settlement ratio	100%	Claim type	In house claim settlement

Eligibility Criteria of HDFC Ergo Health Insurance

Entry age	91 days to 100 years
Family size	Covered up to 6 members
Plan type	Individual/Family floater
Tenure	1 Year, 2 Year & 3 Year
Cashless hospitalization	All over India

HDFC ERGO Top Health Insurance Plans

1. Optima Secure Plan - The HDFC ERGO Optima Secure Plan provides financial protection and reduces all medical expenses. It saves you from all future financial losses arising due to Disease & Accident. It offers a lot of benefits with vast coverage. This plan provides coverage starting from 5Lakh to 2 Crore sum insured. The Optima Secure Plan offers several benefits such as Lifelong renewal, In-patient treatment, Pre & Post Hospitalization, Restore benefit, Domiciliary treatment, Day care treatment, Road Ambulance, Air Ambulance, etc. rather than this Optima Secure Plan provides a lot of unique benefits which make the Plan different from others Plan such as Secure benefit (4X coverage), Super Secure benefit (5X coverage), Plus benefit, Home care treatment, Consumable benefit, Robotic surgery, Modern treatment, etc. The Optima Secure Plan focuses on the requirement of customers & their families. At present the company also covers COVID-19 after 15 days of policy purchase. You will get Tax benefit u/s 80D. There is a Free look period of 15 days to go through your policy and change your decision for a better understanding, let's take a closer look at this plan.
2. Optima Restore Plan - The HDFC ERGO Optima Restore Plan provides financial protection and reduces all medical expenses. It saves you from all future financial losses arising due to Disease & Accident. It offers a lot of benefits with vast coverage. This plan provides coverage starting from 3Lakh to 1 Crore sum insured. The Optima Restore Plan offers several benefits such as Lifelong renewal, In-patient treatment, Pre & Post Hospitalization, Restore benefit, Domiciliary treatment, Day care treatment, Road Ambulance, Air Ambulance, etc. rather than this Optima Secure Plan provides a lot of unique benefits which make the Plan different from others Plan such as Unlimited restoration, Robotic surgery, Modern treatment, etc. At present the company also covers COVID-19 after 15 days of policy purchase. You will get Tax benefit u/s 80D. There is a Free look period of 15 days to go through your policy and change your decision for a better understanding, let's take a closer look at this plan.
3. Health Suraksha Plan - The HDFC ERGO Health Suraksha Plan provides financial protection and reduces all medical expenses. It saves you from all future financial losses arising due to Disease & Accident. It offers a lot of benefits with vast coverage. This plan provides coverage starting from 3Lakh to 75Lakh sum insured. The Health Suraksha Plan offers several benefits such as Lifelong renewal, In-patient treatment, Pre & Post Hospitalization, Restore benefits, Domiciliary treatment, Day care treatment, Road Ambulance, Air Ambulance, etc. rather than this Health Suraksha Plan provides a lot of unique benefits which make the Plan different from others Plan such as Unlimited restoration, Robotic surgery, Modern treatment, Recovery benefit, Sum insured rebound, etc. At present the company also covers COVID-19 after 15 days of policy purchase. You will get Tax benefit u/s 80D. There is a Free look period of 15 days to go through your policy and change your decision for a better understanding, let's take a closer look at this plan.

Details of HDFC Ergo Health Insurance

Features	Optima secure plan	Optima restore plan	Health suraksha plan
Base sum insured	5L, 10L, 15L, 20L, 25L, 50L, 1Cr & 2Cr	3L, 5L, 10L, 15L, 20L, 25L, 50L & 1Cr	3L, 4L, 5L, 7.5L,10L, 15L, 20L, 25L, 50L & 75L
In-patient treatment	Covered up to sum insured
Room rent	Actual
ICU charges	Actual
Pre-hospitalization	60 Days
Post-hospitalization	180 Days
Day care treatment	All day care treatment covered
Organ donor	Covered up to sum insured
Domiciliary Hospitalization	Covered up to sum insured
Home care treatment	Covered up to sum insured	Not available	Covered up to sum insured
Restoration	100% of sum insured, multiple times
Plus benefit/No claim bonus	50% of sum insured maximum up to 100%, It will never reduce	50% of sum insured maximum up to 100%, Reduce when you take claim	10% of sum insured maximum up to 100%, Reduce when you take claim
Secure benefit	Covered up to 100%	Not available
Super secure benefit	Covered up to 200%	Not available
Consumable benefit	Covered up to sum insured	Optional rider	Not available
Robotic surgery	Covered up to sum insured
Modern treatment	Covered up to sum insured
Road ambulance	Actual amount covered	Covered up to INR 2000/Hospitalization	Maximum up to INR 15000
Air ambulance	Covered up to 5lakh	Covered up to 2.5lakh	Covered up to 5lakh
Health check-up	Available
Share accommodation	Up to 15lakh sum insured - INR 800/Day up to INR 4800. Above 15lakh sum insured - INR 1000/Day up to INR 6000.		Not available
Ayush treatment	Covered up to sum insured	Not available	Covered up to sum insured
Bariatric surgery	Covered up to sum insured
Second e-opinion	Once in a policy year
Recovery benefit	Not available		Maximum up to INR 25000
Sum insured rebound	Not available		Available
Live healthy benefit	Not available	Renewal discount maximum up to 8%	Renewal discount maximum up to 10%
Tax benefit u/s 80D	up to INR 75000

HDFC Ergo Health Insurance Premium Calculation

The health insurance premium is an amount you need to pay to the insurer to keep your health insurance active. In return, the insurer is liable to pay for hospital bills and healthcare expenses which is incurred by you in case of a medical emergency. The health insurance premium depends on factors like age, location & family size. Let’s look at some examples of health insurance premiums as mentioned below:

Family Size	Sum Insured	Premium
Individual	500000	10384
Self, spouse	500000	15,004
Self, spouse & 1 child	500000	18,402
Self, spouse & 2 child	500000	21,854
Senior citizens	500000	30,444

Unique Features of HDFC Ergo Health Insurance Plans

Consumable Benefit – All non-payable items are covered up to the sum insured.
Home Care Treatment – Get treated at home.
Secure Benefit – In Optima Secure Plan your base sum insured gets doubled immediately after purchasing the plan with no extra cost. For example - If you buy a policy for 10lakh the Company will give you 20lakh coverage from the same year onwards.
Super Secure Benefit – In Super Secure benefit your base sum insured gets tripled immediately after buying Optima Secure Plan by paying a 3-year premium in one shot. For example - If you buy a policy for 10lakh by paying a 3-year premium the Company will give you 30lakh coverage from the same year onwards.
Plus Benefit – Under plus benefit your sum insured will increase by 50% of the base sum insured maximum of up to 100% whether you take a claim or not. It will never reduce whether you take a claim or not. It will be your fixed bonus.
Recovery Benefit – The Company will pay a lump sum amount to the insured if he is hospitalized for more than 10 continuous days.
Sum Insured Rebound - Get an additional sum insured equivalent to the admissible claim amount up to a maximum of the basic sum insured.

Features of HDFC ERGO Health Insurance Plans

Lifelong renewal - Renew your cover lifelong and stay covered forever.
No sub-limit on room rent - With this health plan you can get the room you like and the treatment you deserve without a hassle.
No geography-based sub-limits - No matter where you buy your policy you can get treated in any city or hospital you like in the country with no additional co-pays or sub-limits.
Hospitalization expenses - Cover medical expenses incurred at the time of hospitalization that include room rent, ICU expenses, nursing expenses, surgeon’s fees road ambulance charges, anesthesia fees, blood, oxygen, etc.
Pre-hospitalization – Optima Secure Plan covers medical expenses for 60 days of pre-hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred before hospitalization.
Post-hospitalization - Optima Secure Plan covers medical expenses for 180 days post-hospitalization. These cover tests, medicine purchases, and other medical expenses that have been incurred after discharge.
Day Care treatment - Daycare treatments are those surgery that take hospitalization less than 24 hours like Stone, Cataract, Dialysis, Chemotherapy, Radiotherapy etc.
Organ donor expenses - We will indemnify the Medical Expenses incurred for a living organ donor’s treatment as an Inpatient for the harvesting of the organ donated.
Domiciliary hospitalization - Secure all medical expenses during domiciliary hospitalization.
Restore benefit - With the Restore benefit of Optima Secure Plan if any claim, partial or totally is made during the policy period then 100% sum insured will be restored automatically multiple times without any additional cost.
Multiplier Benefit/No claim bonus – 50% of the sum insured maximum up to 100%.
Robotic surgery - All robotic surgeries such as Cholecystectomy, Gastric Bypass, Mediastinal Tumor, Atrial Septal Defect Repair, Coronary artery bypass, etc. are covered up to the sum insured.
Modern treatment - All modern treatments such as Oral chemotherapy, Stem cell therapy, Bronchial Thermoplasty, Genetic diseases or disorders, Deep Brain stimulation, etc. are covered up to the sum insured.
Road Ambulance - Road Ambulance covered up to the sum insured.
Air Ambulance - Air Ambulance covered up to 5 lakh.
Health Check-up – Optima Secure Plan provide preventive health check-up every year.
Share Accommodation - If you choose to share accommodation Up to Rs. 15lakh sum insured you will get INR 800/Day up to INR 4800 and above 15 lakh sum insured you will get INR 1000/Day up to INR 6000.
Ayush treatment – Optima Secure Plan covers In-patient hospitalization expenses even for alternate treatments method. Ayurveda, yoga, naturopathy, Unani, Siddha, and homeopathy.
Bariatric surgery - Bariatric surgery is covered up to the sum insured.
Second E-opinion - We will provide you with a second opinion from Network Provider or Medical Practitioner if an Insured Person is diagnosed with critical illnesses during the Policy Period.
Tax benefits - You can avail of tax benefits for the premium amount under Section 80 D of the Income Tax Act.
Free look period - Get a 15-day free look period to understand and change your decision.

Discounts Under HDFC Ergo Health Insurance Plans

Long-Term Discount – Pay for a 2 years policy term and get a 7.5% discount and a 10% discount on choosing 3 years policy term.
Family Discount - 10% on family discounts on 2 or more members who are covered under an individual policy.
Employee Discount – 5% discount on premium, if any Insured Person is a HDFC Group employee.
Loyalty Discount – 2.5% discount on premium, if any Insured Person has an active retail insurance Policy with a premium above INR 2,000 with the Company.
NRI Discount – Get a 40% discount on the premium, if an insured person residing overseas with a declaration that they are based abroad in entirety for the Policy Year.
My: health Active – a) Fitness discount on renewal: Get up to 10% discount on renewal, if the insured member achieves the average step count target on the mobile application provided by us in the specified time interval.
b) Health incentives - Maintain good health and avail 50% discount at renewal.
c) Wellness services - Health coach, specialized stress management program, diet consultation, discounts on OPD/pharma, and more.

Add on covers of HDFC Ergo Health Insurance Plans

Hospital Daily Cash Benefit – Company will pay an Insured, an additional fixed amount for each day’s hospitalization for a maximum of up to 30 days. One day is considered 24 continuous hours of hospitalization.
Personal Accident – In the event of the unfortunate demise of the insured within the policy period from the date of the Accident, the company will pay the Sum Insured. The Personal accident benefit will terminate after the Accidental Death benefit is paid for.
Deductible option – By choosing a Deductible option like INR 25000, INR 50000 & INR 1lakh you can reduce your premium.
Unlimited restore rider – You can claim 100% of the sum insured multiple times in the same time period.
Protector Rider –
a. Claim Protector – All non-payable items are covered up to the sum insured.
b. Multiplier Benefit/Cumulative Bonus Protector – Your No claim bonus will not reduce at renewal if your claim does not exceed the overall amount of INR 50,000.
c. Sum Insured Protector – Your basic sum insured will increase on the basis of the previous year's inflation rate.

Waiting Period of HDFC Ergo Health Insurance

Cover from day 1 - Only accidental.
Cover after 30 days - Dengue, malaria, fever, jaundice, typhoid, etc.
Cover after 2 years - Stone, hernia, piles, ulcer, fistula, gallbladder, hip & joint replacement, tonsils, ENT surgery, Gyno surgery, etc.
Cover after 3 years – Pre-existing disease such as hypertension, thyroid, asthma, diabetes, etc.

Renewal Process of HDFC Ergo health insurance plans

Life-long Renewal - Get a life-long renewal, regardless of your health status or previous claims made under your policy.
Sum Insured Enhancement - To protect yourself from rising medical expenses, you can enhance your sum insured or add more members of your family in your existing policy at the time of renewal.
Portability and Migration - You can port or migrate your policy at the time of renewal. Please reach out to us for any queries regarding migration and portability.

How to File a Claim Under HDFC Ergo Health Plan

You can file a claim in HDFC ERGO Health Insurance in two ways as mentioned below:

1. Cashless Claim

Intimation – Fill up the pre-authorization form at the network hospital for cashless approval.
Approval/ rejection – once the hospital intimate the company, the company send you the status update.
Hospitalization – hospitalization can be done on the basis of pre-authorization approval.
Claim settlement – at the time of Discharge Company will settle the claim directly with hospital.

2. Reimbursement

Hospitalization – you need to pay the bills initially and preserve the original invoices.
Register your claim – Post-hospital discharge send to the company all your invoice
And documents.
Verification – The company verifies your claim-related invoices and treatment documents.
Claim settlement – The company send the approved amount to your bank account.

Exclusions of HDFC ERGO Health Insurance Plans

Conflict & Disaster -Treatment for any Injury or Illness resulting directly or indirectly from nuclear, radiological emissions, war or war-like situations, or rebellion.
Breach of law – The company do not cover expenses for treatment directly arising from or consequent upon any insured person committing or attempting a breach of law with criminal intent.
Treatment for alcoholism & drug abuse – Treatment for alcoholism, drug or substance abuse or any addictive condition and consequence thereof remain uncovered.
Congenital external disease, defects, or anomalies – The company does not cover medical expenses incurred for congenital external disease defects or anomalies.
Maternity Expenses - Pregnancy, dental treatment, external aids, and appliances.
Investigation & Evaluation - Expenses related to any admission primarily for diagnostics and evaluation purposes only are excluded. Any diagnostic expenses which are not related or not incidental to the current diagnosis and treatment are excluded.
Unproven Treatments - Expenses related to any unproven treatment, services, and supplies for or in connection with any treatment. Unproven treatments are treatments, procedures or supplies that lack significant medical documentation to support their electiveness.
Unrecognized Physician or Hospital - Treatment or Medical Advice provided by a Medical Practitioner not recognized by the Medical Council of India or by Central Council of Indian Medicine or by Central Council of Homeopathy.
Costs that are not Reasonable and customary and treatments that are not medically Necessary.

FAQ

What you need to know about HDFC ERGO health insurance claims?

Intimation. For cashless approval, fill out the pre-auth form at the network hospital.
Approval or rejection. As soon as the hospital informs us, we will update you on the status.
The hospitalization process. Pre-auth approval is required for hospitalization.
Settlement of claims.

What is the deadline for claiming HDFC ERGO health insurance?

Find out to whom the claim documents need to be submitted by the health insurance company. Health insurance claims must be filed within 7 days of completing treatment or being discharged from the hospital.

Does HDFC Ergo cover OPD?

Aside from the many features HDFC Ergo offers, it also offers OPD coverage.

HDFC Ergo covers what diseases?

HDFC ERGO Coverage For Critical Illness Diseases

Stroke.
The disease of multiple sclerosis.
An epilepsy stroke.
Cancer
Transplantation of major organs.
Bypass surgery for the coronary arteries.
The paralysis.
Failure of the kidneys.

I have a HDFC Ergo. How do I claim medical bills?

You can complete the payment as part of your hospitalization process. Following your discharge, make sure you submit a claim along with all the relevant hospital documents to your insurer as soon as possible. Your bank account will be credited with the approved amount.

Does HDFC Ergo cover MRIs?

Pre Hospitalisation and post-hospitalisation expenses (up to 60 days) are generally covered by the policy.