Paisawiki is a Part of Logo
Get insured from the comfort of your home No medicals required

Tell us about you

HDFC ERGO Family Health Insurance
250+ Plans 18 Insurance Companies
₹ 5 Lakh Coverage @ ₹ 10/day
7 Lakh+ Happy Customers

*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C Apply

HDFC ERGO Family Health Insurance 

The presence of a stressful environment leads to numerous health issues. Lifestyle disorders, health emergencies, hospitalization, and rising medical costs are one of the biggest challenges facing affordable health care. Therefore, health insurance is one of the essential requirements today.

HDFC ERGO family health insurance is the most cost-effective means of ensuring adequate and affordable policy coverage for the entire family.

What is HDFC ERGO Family Health Insurance?

HDFC ERGO Family Health Insurance allows cashless admission in hospitals and timely refund of medical expenses. Furthermore, the policy is extended to ambulance coverage and organ donation; treatment plan options are provided under AYUSH for the entire family.

Health insurance investment at a younger age results in a lower premium, and options for policy coverage. The variable sum assured options are available as required. The variety of plan options offered by HDFC ERGO Family Health Insurance result in highly customized policy choices for the sum insured and the family coverage.

Features of HDFC ERGO Family Health Insurance

The salient features of the policy include:

  • Waiting period – This is the period that the insured must wait before the policy takes effect. It is also known as the cooling period. This is to ensure that the insured does not take undue advantage of the insurance plan and leaves after the payout.

For HDFC ERGO Family Health Insurance policy, there are multiple waiting periods, depending on the nature of the ailment or injury –

Waiting period

Coverage

Day 1 to 30

Only accidents

Day 30 onwards

All illnesses, except pre-existing ailments and those under exclusions

24 months

Specific illness user coverage

36 months

Pre-existing illnesses

  • Convenience - One of the most critical aspects of health insurance is the medical examination. An unfavourable medical report can affect the health insurance policy to be invested, even resulting in rejection.

Some health insurance companies are extremely particular about requiring a medical check-up. However, HDFC ERGO Family Health Insurance policy is extremely customer-friendly. Consequently, the insured does not have to appear for a medical check-up before the age of 45 years, provided pre-existing illnesses are declared beforehand.

Another customer-friendly initiative of this insurance policy is the absence of any upper age limit with respect to investment. In other words, while the upper limit for buying a new policy is 65 years, investment in an existing policy is lifelong, and there is no maximum age limit for it.

  • Greater Coverage - HDFC ERGO Family Health Insurance plan provides variable coverage to individuals at all levels. The minimum sum insured is Rs 3 lakh, which can reach up to a maximum of Rs 75 lakh. Also, the existence of a top-up scheme proves extremely useful as a family floater plan, enabling savings on policy investment.  If the sum insured amount is Rs 10 lakh or more, policy options offer coverage against critical illnesses listed in the plan. Therefore, the insured and family are covered by the policy in totality rather than against certain illnesses alone.

Therefore, greater health insurance coverage ensures that rising medical costs are no longer an impediment for effective health care.

  • Holistic Approach to Health Care – The coverage provided by HDFC ERGO Family Health Insurance policy focuses not only on financing hospital charges, but also covering diagnostic tests performed for up to 60 days before admission, and recovery for up to 180 days’ post-discharge.

Additionally, the insurance policy focuses on health from a holistic approach. The available plan options cover organ donation for the donor, treatment of mental illnesses, and wellness services. Therefore, all aspects of health care are effectively covered.

Policy Benefits of HDFC Ergo Family Floater Plan

The policy benefits can be availed as:

  • Restore Benefit - The sum insured exhausted during the policy period is automatically reinstated.
  • AYUSH benefits – Treatment expenses of AYUSH available in recognised hospitals are covered as a plan benefit.
  • E-opinion Benefit – If a patient seeks a digital medical opinion, the charges are covered under the plan.
  • The insurer can claim a bonus of up to 50% for no policy claim. This can be availed as either increased sum insured or decreased premium payment.
  • Maternity care and critical illness admission are optional benefits.
  • HDFC ERGO Family Insurance permits investment from an existing older policy; the policy amount can be transferred without any loss in the claim amount or the waiting period.
  • This HDFC policy option allows an increase in the sum insured during renewal, subject to a medical test or a waiting period.
  • HDFC ERGO Family Health Insurance allows reimbursement of medical test expenses in case the policy amount is not claimed for four consecutive years.
  • A multi-year insurance plan (at least two years) can result in a considerable savings on premium up to 7.5%.
  • The HDFC ERGO Family Health Insurance mobile app helps customers to keep a track of developments related to the insurance policy.
  • Tax benefits are offered under Section 80(D) of the Income Tax Act, India (1961).

*Tax benefit is subject to changes in tax laws

*Savings are to be availed as per the IRDAI approval. Standard T&C apply 

Inclusions under HDFC ERGO Family Health Insurance

The list of inclusions includes:

  • Hospitalization coverage includes accommodation, nursing charges, intensive care, visitation charges, medical equipment, blood requirement, oxygen administration, anaesthesia, drug treatment, and clinical diagnosis. Policy options cover ambulance charges, as well as, emergency air ambulance.
  • The insurance plan covers 144 medical procedures that do not require hospitalization. Such procedures will be reimbursed accordingly.
  • Plan options cover domiciliary hospitalization in case hospital beds are unavailable.

Exclusions of HDFC ERGO Family Insurance 

HDFC ERGO Family Insurance plan excludes the following in its coverage list:

  • A pre-existing illness before policy completion of 3 years.
  • Any insurance claim made under 30 days of the plan purchase
  • Alcohol or drug overdose
  • Injuries arising due to self-inflicted damage, adventure sports, criminal intent, cosmetic surgery, or laser treatment
  • Damage due to war, nuclear radiation, explosion, armed conflict, terrorist activity
  • Treatment for any sexually transmitted infections, including HIV and AIDS
  • Preventive health measures, such as vaccination and/or inoculation
  • Any unlawful activity violating the terms and conditions of the policy

Eligibility Criteria to Buy HDFC ERGO Family Health Insurance

Eligibility criteria to apply for the plan are -

  • Age limits for entry –

Age

Child

Adult

Minimum

91 days

18 years

Maximum

25 years

65 years

  • Depending on the family size, there are variants of HDFC ERGO Family Health Insurance.
  • Two adults with no children – self and spouse
  • Two adults and a single child
  • Two adults and two children
  • Parents (or parents-in-law), self, spouse, and two children

The family includes parents, in-laws, nephews, niece, self, spouse, and kids. In a single insurance policy, a maximum of 5 children and/or 4 adults can be covered.

  • Policy tenure – 30 days, 2 years, 3 years, or 4 years
  • Sum insured

Minimum

Maximum

3 lakh

75 lakh 

  • Waiting Period

Minimum

Maximum

Till 30 days

(Excepts accidents)

3 years (pre-existing illnesses)

  • The policy works on the principle of lifetime renewability.
  • Cumulative bonus of 50% is offered on the sum insured for every claim-free year. It is available once during the renewal period.
  • Shared hospital accommodation is eligible for coverage under HDFC ERGO Family Health Insurance. The daily allowance is subject to the sum insured amount.

Claim Process of the HDFC ERGO Family Health Insurance

HDFC ERGO Family Insurance policy claim is divided into two categories – cashless and reimbursement.

Cashless Claim

This can be availed of only at hospitals tied up with the health insurance provider. The hospitalized insured is not required to pay for the healthcare expenses under this type of claim. However, it is required to inform the health insurance provider regarding hospitalization for the initiation of the claim process.

Policy details required to be provided in the cashless claim form:

  • Contact information
  • Policy ID
  • Insured name
  • Details of hospitalization (including date and time)
  • Nature of ill-health or injury

The claim is required to be authorized either by the health insurance authority or third-party personnel through a pre-authorization application. The insured has to submit the insurance health card along with a photo identity for this purpose.

In case of incomplete details, the policy claim can be rejected. Consequently, the insurer can pay for the treatment and file a claim later.

Reimbursement Claim

In case the insured is admitted to a non-network hospital, the insurance claim registered is under the reimbursement claim. Here the insured pays for the hospitalisation expenses and registers a claim later. It is advisable to keep a record of payment made. Furthermore, original documentation of the bills and health reports should be submitted.

The claim form should be duly filled and submitted with the necessary documentation at the time of discharge. The reimbursement claim is processed within 30 days after the receipt of the claim application. The claimed amount is settled according after a proper verification done by the insurance company.

Documents Required for Claim HDFC Ergo Family Floater Plan

Cashless Claim - The original hospital bills, test reports, and other documentation are sent to the health insurance provider for coverage.  Expenses not covered will be required to be financed by the insured.

Reimbursement Claim – The insured is required to submit the following documents:

  • Duly-filled claim form
  • KYC documents of the insured
  • Duly signed hospitalization report by the medical practitioner
  • Original medical documents for reimbursement – hospital bills, diagnostic reports, treatment prescription
  • Discharge report issued by the hospital
  • Report and prescription of post-discharge treatment (as required)
  • Police FIR for claiming hospitalization coverage due to an accident
  • For authentication, all hospital reports should be issued on a letterhead document with the sign and seal of the concerned medical authority.

How to Buy HDFC ERGO Family Health Insurance plan?

Buying HDFC ERGO Family Health Insurance plan online involves three steps –

  1. Calculation of Premium Amount

On the Paisawiki website, select the appropriate insurance plan offering affordable monthly coverage and covering the required expenses.

Provide details of the family members to be covered under HDFC ERGO Family Health Insurance.

In terms of the sum insured, two forms of family health insurance coverage are provided – individual (separate for each family member) and family floater (common for the entire family). Accordingly, the appropriate mode of family coverage is chosen.

The premium calculator provides insurance premium amount to be paid.

  1. Furnishing Details

- Provide the mobile number that will be registered with HDFC ERGO Family Health Insurance.

- Select your gender and enter your name. Provide details of the number of adults and/or children to be covered. Enter the ages of the eldest member of the family and the eldest child.

- Enter the city of residence.

- A list of plans will appear. Click on ‘View Features’ to study the plan details.

- Information is provided regarding the cover, claim settlement, monthly insurance premium, plan features, highlights, claim process, and hospitals covered. Plan comparison helps in selecting the required plan.

- Click on “Proceed to Buy”.

- The next screen displays the full details of the insurance plan selected, along with the family coverage. This is to ensure that the customer is apprised of the transaction before finalizing the payment. Accordingly, two brochures are made available for download – policy wording (terms and conditions) and the selected plan. Policy options are provided on a multi-year basis. - After the finalization of the details, click on “Proceed”.

- A window appears requiring the ages of the spouse and the second child (if present), and additional members (if being covered). Kindly provide the details and click on “Done”.

- The previous page with the full plan details re-appears with the updated details of the family members to be covered. If all details are correct, click on “Proceed”.

- The next page is divided into five sections. Each section is to be filled up carefully

  • Insured details – Names of each insured family member, date of birth, height, weight, and occupation
  • Address and Communication
  • Basic Medical History
  • Nominee and Other Details
  • Declaration

- Confirm the details entered and upload the required documents. Proceed for payment as per the plan selected.

- Alternately, the proposal form of the selected health insurance plan can be downloaded from the insurance provider website. The duly filled form can be submitted at the nearest HDFC ERGO Family Health Insurance office with the documents and the premium payment.

  1. Payment of Policy

With online policy purchase, the premium payment is required to be made digitally.

Offline purchase of the policy can be carried out by visiting any branch office of HDFC ERGO Family Health Insurance.

Documents Required to Buy HDFC Ergo Family Floater Plan 

The following documents are required to be submitted while purchasing the insurance policy. They are uploaded online or submitted at the branch office. These form the KYC of the insured customer and the family members being covered –

  • Identity proof – PAN card, Aadhar card, driving license, birth certificate, passport, voter I-card
  • Age proof – Birth certificate, passport, PAN card, driving license
  • Address proof – Aadhar card, driving license, passport, ration card, bills
  • Passport-sized photograph

Furthermore, the insured may be required to furnish additional documents –

  • Income proof as documentary evidence of premium payment guarantee.
  • Medical reports/tests in the event of pre-existing illnesses. However, this is left to the discretion of the health insurance provider.

Renewal Process of HDFC ERGO Family Health Insurance policy

HDFC ERGO Family Health Insurance provides for lifetime renewability. This is an extremely quick and hassle-free procedure. Renewal of policy provides options for the increase in the sum insured amount. The policy can be easily renewed through Paisawiki.com as well.

  • Kindly visit Paisawiki.com
  • Click on "Renewal" followed by "Health Renewal".
  • Enter plan details such as policy ID, mobile number, and date of birth.
  • The plan details are displayed containing the family members being covered.
  • Click on "Plan Renewal". Changes can be made to the rider benefits, the number of family members covered, and the sum assured.
  • Choose the required option, indicating the change made.
  • Accordingly, provide the additional details. The new premium amount will be displayed.
  • Pay the required amount. This renews the health insurance policy. 

FAQs About HDFC ERGO Family Health Insurance policy

Written By: Paisawiki - Updated: 18 November 2020

Top Articles

Best Health Insurance Plans in India

Best Health Insurance Plans in India

Best Health Insurance Plans in India 2020 Drafting a sound financial plan is challenging to an individual for reasons more than one. The primary aim of the plan is to cater for financial cover for life goals and long term wealth creation in the fo...
Best Health Insurance Plan For Senior Citizens

Best Health Insurance Plan For Senior Citizens

Best Health Insurance Plan For Senior Citizens When it comes to a health insurance plan it is more than a necessity in today’s times. As we know and will even agree that any eventuality does not come with prior notice or information. In any cas...
Best Health Insurance Companies in India 2020

Best Health Insurance Companies in India 2020

Best Health Insurance Companies in India 2020 Agent: Sir, what type of health policy do you want? Buyer: Yaar kuch bhi de de, sare to same he hote hai almost. Agent: No sir, there are multiple types as per the requirement. Buyer: Achcha, policy...
Best Maternity Insurance Plans in India

Best Maternity Insurance Plans in India

Best Maternity Insurance Plans in India Health insurance with maternity cover and childcare benefits provide for the expenses incurred before, after, and during the delivery process of a child. Expecting parents are often bombarded with expenses ...
Best Dental Insurance Plans in India

Best Dental Insurance Plans in India

Best Dental Insurance Plans in India One of the scariest aspects of everyday life is going to see a dentist. A simple toothache can turn a happy day into a painful experience. And we can’t ignore the expenses associated that can’t assume to be...