Everything About HDFC ERGO Health Plans

Editorial Note: This content has been independently collected by the Forbes Advisor team and is offered on a non-advised basis. This content is not part of the comparison service provided by RunPath Regulatory Services. Forbes Advisor may earn a commission on sales made from partner links on this page, but that doesn’t affect our editors’ opinions or evaluations.

HDFC ERGO health insurance (formerly known as Apollo Munich health insurance) offers various health insurance plans providing coverage for pre- and post-hospitalization expenses, daily cash, daycare procedures, free health checkups, expert opinion, emergency ambulance, no room rent restriction, critical illness cover etc.

HDFC ERGO plans provide discount premium benefits such as family discount and loyalty discount in most of the policies. Both individual and family floater plans are available where the policyholder is eligible to choose a maximum of six adults and six children.

Pros

• Wide sum insured options and for every claim-free year, the insured earns 5% bonus.
• Presence in more than 13,000 network hospitals.
• Extra benefits such as home healthcare, day care treatments and recovery benefits.
• All Covid-19 treatments covered.
• Tax benefits up to INR 75,000 under Section 80D of Income Tax Act, 1961.
• No rent capping, which means the insured have the access to use any room in the hospital without any maximum limit.

Cons

Long waiting periods:

• iCan health plan has a 120-day waiting period, starting from the first day of the policy.
• Few illnesses & treatments are covered post two years of policy issuance.
• Declared pre-existing conditions are covered after the first three years of continual renewals.
• Accidental hospitalizations facility available in the first 30 days from the start date of policy.
• Pre-existing diseases are covered after four years of waiting period.

Aditya Birla Activ Health Insurance

INR 2 lakh to INR 2 crore

Early Bird Discount

5% discount from 4th to 7th policy year

On Aditya Birla’s secure website

Niva Bupa Health Insurance

Claims Settlement Ratio

Cashless Network of Hospitals

Features and Benefits

30 minute cashless claim processing, 24×7 dedicated relationship manager

• HDFC ERGO Health Insurance: Highlights
• Types of HDFC ERGO Plans
• What does HDFC ERGO Policy Cover?
• What does HDFC ERGO Policy Not Cover?
• What is The Claim Settlement Process of HDFC ERGO Insurance Policies?
• Whom to Connect With For HDFC ERGO Insurance Policies?

HDFC ERGO Health Insurance: Highlights

Following are the key figures provided by the company regarding their operations:

• Cashless Network Hospitals: 13,000+
• Number of Policyholders: 1.5 crores
• Tax Savings: Up to INR 75,000
• Claim Settlement Rate: 1 claim/minute
• Claim Settlement Ratio: 97%
• Renewability: Lifetime renewability

Types of HDFC ERGO Plans

Optima Secure

This plan has been recently launched by the company. It provides consumers the option of increasing the coverage four times at no additional cost. This plan also has other benefits such as no room rent capping, protect benefit, which provide coverage for cost of kits, procedure charges and cost of disposables used in the treatment. It comes with both the individual and family coverage option with the sum insured coverage ranging from INR 5 lakh to INR 2 crore.

Key Features:

• Provides a secure benefit, where the base cover gets doubled as soon as the buyer purchase the policy
• Offers the plus benefit where there is 100% increase in coverage after two years.
• Gives the insured the benefit of restore coverage, where anytime when the insured makes a claim of INR 10 lakh, whether partial or fully, gets 100% restored for any claims within the same year.
• Offer protect benefit coverage where disposable items such as PPE kits, gloves, masks, which come under non-medical expenses are covered. Also covers the cost of disposables, procedure charges and cost of kits.
• Provides second e-opinion for almost 50 illnesess, where the insured gets full coverage for any cost incurred in receiving virtual consultation from the doctor of a network hospital.

Optima Restore- Family Plan

This is a family floater health insurance plan, which restores the sum insured instantly on partial or complete utilization of the health cover. It also offers a two times multiplier benefit, which means, 50% increase in basic sum insured only for every claim free year. This addition in the sum insured amount is subject to a maximum limit of 100%. Let’s have a look at the features that optima restore family plan provides:

Key Features:

• 100% basic sum insured is restored immediately after the first claim partial or complete utilization of the health cover.
• Provides 2X multiplier benefit where the insured receives 50% growth in basic sum insured for each claim free year, subject to a maximum limit of 100%.
• Preventive health check-ups up to INR 10,000 at the time of renewal.
• Provides daily cash of up to INR 1,000 every day and maximum of INR 6,000 per hospitalization on opting a shared accommodation in any of the networked hospitals.
• Offers family discount of 10% if two or more members are covered under this plan.

My: Health Suraksha

This policy comes in three different variants such as silver smart, gold smart and platinum smart plans. It gives the option of multiple sum insured amount ranging from INR 3 lakh to INR 75 lakh.This plan offers the coverage option for individuals,family and senior citizens. Let’s have a look at some of the prominent features of this plan:

Key Features:

• Offers the sum insured options ranging from INR 3 lakh to INR 75 lakh.
• The policyholder would get the advantage of exclusive covers like air ambulance, recovery benefit and infertility cover.
• Provides flexible benefits like opting for room rent capping and co-pay clauses.
• Offers sum insured rebound benefit, which allows the insured to get additional sum insured, that is equivalent to the claim amount paid under basic sum insured.
• The policyholder has the option of choosing a long term policy option up to three years at an affordable premium rate.
• The policyholder has the option to pay yearly premium in three, six and twelve equal installments.

My: Health Medisure Super Top-up Plan

In case the policyholder requires a bigger sum insured amount, he or she always has the option to top it up with medisure super top-up plan. This plan ensures no health check-ups up to the age of 55 years. My:health medisure super top up plan also provides full coverage up to the sum insured without any sort of sub-limits.

My: Health Women Suraksha

This policy is a comprehensive plan for women centric critical illness. It offers protection against minor ailments, major illnesses, surgeries and critical illnesses related to women.

Key Features:

• Wide range of sum insured is available in this plan ranging from INR 3 lakh to INR 24 lakh.
• Covers women specific cardiac ailments, cancer where the insured will get the coverage for almost 40 critical ailments.
• Covers major and minor illnesses where 100% sum insured is offered in treating these diseases.
• Includes coverage for loss of job, pregnancy and newborn complication cover.
• The policyholder will also get coverage for surgical procedures.
• Offers up to INR 10,000 for a second opinion, if the policyholder is not satisfied with first diagnosis.
• Minimum and maximum entry age to be covered is 18 and 45 years respectively for basic covers.

Types of Plans Listed Under My:Health Women Suraksha Insurance:

• Women Cancer Plan
• Women Cardiac Plan
• Women Cancer Plus Plan
• Women Critical Illness Essential Plan
• Women Critical Illness Comprehensive Plan

Critical Illness Insurance

HDFC ERGO critical illness insurance policy allows the insured to get the coverage to handle medical costs related to critical illnesses and lifestyle diseases such as cancer, heart attack, brain disorders, kidney failure etc. This single policy covers 15 critical illnesses and these plans are available with an easy option to buy for one and two years.

Key Features:

• Coverage of a wide range of 15 critical illnesses in one single plan.
• Lump sum payment of sum insured amount in a single transaction.
• This policy is available for one or two years and with the option of quick renewals.
• No requirement of medical check-up up to the age 45 years.
• Critical illness cover offers the tax benefits up to INR 50,000.

iCan Cancer Insurance

iCan is a health insurance plan which covers the diagnosis and treatment of cancer. This plan provides coverage to all types of cancer at all the stages with the option of lifelong renewability. If there is a diagnosis of fourth stage of cancer or a relapse kind of situation, then it pays the full coverage of the sum insured as a lump sum payment.

Key Features:

• Option of lifelong renewability of iCan health plan even after receiving claims.
• Coverage available for all kinds and all stages of cancer.
• Cashless cancer treatments in more than 13,000 network hospitals.
• Offers coverage for traditional and advanced treatments and also covers in-patient and outpatient treatments expenses.
• Provides coverage up to INR 2,000 as reimbursement per hospitalization for ambulance service.
• The policyholder is entitled to receive 100% of the sum insured as lump sum payment on the diagnosis of stage four cancer, or in the case of relapse.
• Lump sum benefit of 60% of sum insured on the base, if the insured is diagnosed with cancer of any kind of severity.
• Waiting period is of 120-day, which starts from the first date of the policy.

HDFC ERGO My Health Koti Suraksha

This is a standard health plan that provides coverage for various health costs such as hospitalization costs, critical illness treatments, major surgeries costs, daycare procedures, among others. The sum insured amount of this plan is up to INR 1 crore.

Key Features:

• Coverage includes pre-hospitalization expenses of 60 days pre-admission and post-discharge expenses up to 180 days.
• Coverage for medical operations, treatments and surgeries that require less than one day of hospitalization.
• Coverage related to AYUSH and Covid-19 treatment.
• Free health check-up within 60 days of policy renewal.
• Access to health coaching services such as nutrition, fitness and psychological counseling.
• Offers discounts on OPD consultations, pharmacy bills and diagnostic costs.

What does HDFC ERGO Policy Cover?

• Coverage for hospitalization expenses such as room rent, ICU, surgery, doctor consultation and many more.
• Covers hospitalization expenses arising out of treating mental illness.
• Covers pre-hospitalization cost up to 60 days before the date of admission and post-hospitalization cost up to 180 days post discharge from the hospital.
• Offers the benefit of sum insured rebound, where the insured gets an additional cover when the base sum insured amount and cumulative bonus gets exhausted.
• Day care treatment
• Home healthcare
• AYUSH benefits
• Preventive health check-up at the time of renewal.

What does HDFC ERGO Policy Not Cover?

• Adventures and self-imposed injuries
• Accidental injury caused in defense operations
• Treatment of any kind of cosmetic surgery
• Dental treatment and surgery
• Treatment of obesity
• Hospitalization due to alcohol and drug abuse

What is The Claim Settlement Process of HDFC ERGO Insurance Policies?

Cashless Hospitalization: HDFC ERGO claims to settle the cashless claims in 20 minutes with the process mentioned below:

• In case of emergencies, claim intimation is required within 24 hours of the emergency hospitalization.
• In case of planned hospitalization, claim intimation is required within 72 hours of the hospitalization.
• Post the intimation, HDFC ergo shall send the status update to the policyholder.
• Lastly, at the time of discharge from the hospital, the insurer settles the claim directly with the hospital.

Reimbursement Claims: HDFC ERGO claims to settle the reimbursement claim in six working hours with the process mentioned below:

• In case of reimbursement of claims, intimate the company within 48 hours of hospitalization or before getting discharge from the hospital, whichever is earlier.
• At the time of hospitalization, the policyholder needs to pay the bills initially and preserve all the original invoices.
• Post the discharge formalities, the policyholder is supposed to share all the original invoices and treatment related documents.
• Once the invoices and bills are verified from the insurer, they send the approved claim amount directly to the insured’s registered bank account.

Documents Required for Claim Reimbursement

• Duly filled claim form with signature of applicant.
• Valid identity proof such as Aadhaar card, Voter ID, passport, PAN Card, and driving license.
• Prescription by a medical practitioner recommending hospitalization, tests and medicines.
• Original pharmacy bills, case papers and ambulance receipt.
• Insurance policy stating the name, address, illness and other details of the insured.

Whom to Connect With For HDFC ERGO Insurance Policies?

As we have already mentioned the online process of buying a policy, you can also buy or renew your policy by directly connecting with the company. Following are the details of their respective customer care:

1 2 Helpline Number 022-6242 6242 E-mail travelclaims@hdfcergo.com Registered Office 1st Floor, HDFC House, Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400020 WhatsApp Service 8169 500 500

Forbes Advisor adheres to strict editorial integrity standards. To the best of our knowledge, all content is accurate as of the date posted, though offers contained herein may no longer be available. The opinions expressed are the author’s alone and have not been provided, approved, or otherwise endorsed by our partners.