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HDFC Ergo Health Insurance
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HDFC Ergo Health Insurance

HDFC Ergo Health Insurance plans are unique medical plans offered by HDFC ERGO. The motto behind HDFC ERGO health insurance plans is to offer medical insurance in a facilitating manner.

As medical care and hospitalization expenses are skyrocketing, any kind of medical expense leads to a huge dent in the savings of an individual. A medical plan that offers financial coverage for medical expenses is the way out for bearing these exorbitant yet urgent expenses.

HDFC ERGO health plans offer insurance coverage for meeting the expenses incurred by the policyholder over medical treatment and hospitalization.

Reasons to select HDFC ERGO Health Insurance Plans

HDFC ERGO health insurance plans are amongst the most popular health insurance plans. However, some of the reasons to choose HDFC ERGO health insurance plan are listed below:

  • HDFC ERGO medical insurance plans provide a variety of plans to meet the diverse needs of people
  • The health plans include policies for group health insurance, individual health insurance, critical illness insurance, and top-up plans for the policyholder
  • The plans are available at economical premium rates that make health cover accessible to many people
  • The insurer offers a convenient cashless health insurance facility to its policyholders through a network of over 9000 hospitals all over the country
  • The facilities offered by HDFC ergo mediclaim policy include coverage for pre-hospitalization and post-hospitalization charges, day-care procedures, domiciliary treatment, and cashless treatment cover for sickness and accidents
  • HDFC ERGO is the 4th largest company of the country offering General Insurance plans
  • The post-sale services of HDFC ERGO are impressive

What are the types of HDFC ERGO Health Insurance Plans?

The health plans offered by HDFC ERGO are of the following three types:

Top-up Health Insurance Plan:

A top-up Health Insurance plan is beneficial for an individual having an existing employee health cover or a basic health plan and looking for an additional sum assured at budget-friendly premium rates. HDFC ERGO super top-up is an example of this type of health insurance plan.

Base or Indemnity Health Insurance Plan:

An Indemnity plan or Base Health Insurance Plan makes a payment for the hospitalization expenses of the policyholder based on the medical treatment costs. Buying an Indemnity Health plan is recommended for all individuals.

Health Insurance Plans based on Lump-Sum Benefit:

In the event of the policyholder getting diagnosed with a potentially fatal disease, the treatment cost of the treatment drains the lifelong saving of the individual. In such a case, lump-sum benefit proves useful for the insured to cover the treatment expense rather than going for frequent claims at every expense of the treatment.

The difference in coverage under lump-sum and indemnity is shown in the table below.

Indemnity Cover

Lump-sum Cover

Costs incurred on the Hospital Room Rent

Physiotherapy / Rehabilitation

Doctor’s Fee

Costs involved in diagnostic tests and follow up of medical investigations.

Charges for an Operation Theatre

Expenses incurred on house modification and purchase of ergonomic furniture, diagnostic tests, and medical investigations.

Pre and Post Hospitalization

BP monitoring machines and Dietary supplements

Benefits of Buying HDFC ERGO Health insurance Plans

The HDFC ERGO Health Plans offer financial assistance in times of medical emergency. The benefits arising from purchasing a health plan from HDFC ERGO Health Insurance Company are mentioned below.

  • The customer support service of HDFC ERGO is available round the clock through their toll-free number and website
  • The company has a tie-up with a large number of hospitals across the country that offer cashless medical assistance to policyholders
  • The value-added or top-up service of HDFC ERGO enables customers to increase the value of their sum assured in cases where the policyholder has not raised any claim for years
  • The incurred claim ratio of HDFC ERGO Health Insurance plans was 62% for the year 2018-19
  • The sum insured offered under HDFC ERGO ranges between Rs 3-10 Lakh while the policy term of 1 or 2 years as selected by the policyholder
  • The policyholders are offered certain innovative benefits in the form of ‘Cumulative Bonus’ after each claim settlement

Tax Benefits from Buying HDFC Ergo Health Insurance Plan

Here are the tax benefits that you can avail from buying a HDFC ERGO health insurance policy:

  • Under section 80D of the Income Tax Act, 1961 an individual can claim tax benefit up to a limit of Rs 25,000.00 on the policy premium in a given financial year
  • The premium can be for a health plan for the spouse, self, or dependent children
  • In the event of a policyholder or the spouse being senior citizens, the tax benefit on the insurance premium can be claimed up to Rs 50,000
  • Policyholders can claim tax benefit on the expense incurred on health check-ups done annually
  • An amount up to Rs 5,000 can be claimed for tax benefit every financial year
  • Policyholders can claim tax benefit on the HDFC ERGO policy premium paid for parents or guardians up to a limit of Rs 25,000 every financial year
  • If either of the parents is a senior citizen, the tax benefit can be taken up to Rs 30,000

Features of HDFC ERGO Health Insurance Plans

The following are the key features of HDFC ERGO Medical Insurance plans:

  • The maximum number of family members that are covered under HDFC medical insurance plans is 4, which includes 2 adults and 2 children
  • The plans offered have a lifelong renewal feature that keeps the customers protected for the entire life
  • The policyholders earn a 5% bonus on the sum assured for every policy year without a claim
  • The HDFC ERGO Health Insurance Plans are free of the co-payment feature
  • The plans offer coverage for any pre-existing illness after completing 4 years of the policy term
  • The HDFC mediclaim plans offer coverage for the pre-hospitalization expenses for a period of 60 days and post-hospitalization expenses for 90 days for the related expense
  • The medical expense incurred on health check-ups is reimbursed to the policyholder after the successful completion of 4 years of the policy term without any claim
  • The plans offered by HDFC ERGO are free of any sub-limit on the room rent
  • The HDFC ERGO claim settlement ratio was 98% for the Y 2018-2019

What are the Various HDFC ERGO Health Insurance Plans?

HDFC ERGO offers a number of health insurance plans to suit different requirements of the buyer. They are:

My: Health Suraksha Plan

My: Health Suraksha plan is an all-inclusive HDFC mediclaim plan that offers coverage for the excessively high medical expenses. This plan comes with three variants namely, Silver Smart, Gold Smart, and Platinum Smart Plans.

The features of the HDFC ERGO My: Health Suraksha plan are mentioned below:

  • The sum assured can be selected from anywhere between Rs 3 Lakh to Rs 75 Lakh
  • The entry age for this plan is open to all customers opting for a lifetime renewal option
  • The coverage offered in the plan includes coverage for air ambulance, infertility, and recovery benefit
  • For customers opting for a three-year policy term, discounted premium rates are offered
  • Attractive features such as fitness discounts at the time of HDFC ERGO health insurance renewal and lucrative incentives for staying healthy are offered
  • Flexible premium payment frequency of quarterly, half-yearly, or annual mode is available
  • Customers can avail additional benefits by selecting capping on the room rent and co-pay
  • Some other discounts offered include long term policy, family, and loyalty discount

HDFC Ergo my: Health Suraksha Insurance - Silver Smart Plan

Following are the features of My: Health Suraksha Silver Smart Insurance Plan:

  • The plan offers health coverage for individuals, senior citizens, and families
  • Offer health cover between the range Rs 3 Lakh - Rs 5 Lakh
  • The plan does not offer any limit on the room rent expense
  • The plan offers a sum insured rebound in case the sum assured gets exhausted in some treatment
  • The policy offers a complimentary health check-up with every policy renewal
  • The plan offers a cashless treatment facility from home too
  • The policy covers 586-day care treatments
  • The policy provides coverage for an expense incurred on pre-hospitalization for 60 days
  • The post-hospitalization expense coverage is for 180 days
  • The policy offers coverage for treatment of mental illness
  • Coverage for the expense incurred on organ donors, road ambulance, and hospitalization charges such as blood tests, nursing charges, bed charges, consultation fees, and ICU
  • The plans offer coverage for the expense incurred on treatment taken through non-allopathic ways. This includes Ayurvedic, Yunnan, Sidha, and Homeopathy
  • The plan, however, does not offer coverage for the expense incurred on treatment for self-injuries, HIV/AIDS, cosmetic surgery, injuries caused by war, or from participation in adventure sports

HDFC Ergo my: Health Suraksha -Gold Smart Plan

Key features of my: Health Surkasha Gold Smart Policy:

  • The plan offers comprehensive coverage that suits senior citizens, families, and individuals
  • The sum insured for the plan ranges between Rs 7.5 Lakh to Rs 15 Lakh.
  • The plan is available at budget-friendly rates
  • The plan offers coverage for maternity expenses after a waiting period of 4 years.
  • The policy can be renewed for life long
  • Tax benefits under section 80D are applicable
  • The plan offers coverage for 60 days of pre-hospitalization expense and 180 days of the post-hospitalization expense
  • An expense incurred on domiciliary treatment is covered under the plan
  • The expense incurred on inpatient treatment including room rent, medicine cost, doctor’s fee, boarding expense, nursing expense, etc. is covered
  • The plans offer coverage for prenatal and postnatal expenses after the completion of 4 years of the waiting period
  • The free look period for the plan is 15 days
  • This plan can be bought by anyone above the age of 91 days
  • The policyholder gets a 55 bonus of the sum insured in the event of a claim-free year. The bonus that a policyholder can claim is 50% of the sum insured
  • The plan, however, does not offer coverage for the expense incurred on treatment for self-injuries, HIV/AIDS, cosmetic surgery, injuries caused by war, or from participation in adventure sports
  • The claim process for the plan is quick and hassle-free

HDFC ERGO Critical Illness Silver Policy

HDFC ERGO Critical Illness Silver Policy has the following key features:

  • This plan offers a lump sum benefit to the policyholder in case of being detected with a critical illness
  • The diseases covered under critical illness include heart attack, cancer, coronary bypass surgery, kidney failure, stroke, multiple sclerosis, major organ transplant, and paralysis
  • The plan offers coverage under two different variants
  • The coverage for this plan lies between Rs 1 Lakh - Rs 50 Lakh for policyholders between the age of 5 and 65 years
  • HDFC ERGO critical illness silver policy comes with lifetime renewal

HDFC ERGO Critical Illness Gold Policy

Key features of this plan are as follows:

  • The coverage for this plan lies between Rs 1 Lakh - Rs 50 Lakh for policyholders between the age of 5 and 65 years
  • A lump-sum payment equal to the policy sum assured is provided to the policyholder in case of getting detected with any of the 8 critical illnesses
  • This plan offers coverage for heart valve replacement, primary pulmonary arterial hypertension, and aorta graft surgery in addition to the illnesses covered by the silver plan

HDFC ERGO Critical Illness Platinum Policy

The following are the features of Critical Illness Platinum Policy by HDFC ERGO:

  • The coverage for this plan lies between Rs 1 Lakh - Rs 50 Lakh for policyholders between the age of 5 and 65 years
  • A lump-sum payment equal to the policy sum assured is provided to the policyholder in case of getting detected with any of the 15 critical illnesses
  • It covers diseases like heart attack, coronary artery bypass surgery, stroke, cancer, kidney failure, major organ transplant, paralysis, multiple sclerosis, primary pulmonary arterial hypertension, aorta graft surgery, heart valve replacement, Parkinson’s disease, Alzheimer’s disease, Benign brain tumour, and end stage live disease
  • The plan offers an option to choose the survival period of 15 days or 30 days
  • The additional diseases that are covered under this plan include Parkinson's disease, benign tumour, last stage liver illness, and Alzheimer's disease

Personal Accident Insurance Policy

Personal Accident Insurance Plan by HDFC ERGO health insurance comes packed with the following set of key features:

  • This HDFC mediclaim policy offers a lump sum amount in case of disability caused due to an accident or death
  • For individuals below 65 years of age, the plan offers coverage between Rs 2.5 Lakh - 15 Lakh for accidents occurring in any place in the world
  • The disability caused due to accident includes both temporary or permanent total disability, injuries including burns, and broken bone along with the ambulance cost
  • The plan offers coverage extends outside the country too
  • The plan offers coverage for ambulance costs
  • A daily hospital cash allowance is provided under this policy
  • The plan, however, does not offer coverage for the expense incurred on treatment for self-injuries, HIV/AIDS, cosmetic surgery, injuries caused by war, or from participation in adventure sports
  • The plan offers the option of lifelong renewability
  • Dependent parents up to the age of 70 years can be added to the policy at a reasonable rate
  • The policy offers discounts on the premium amount when purchasing a policy for a longer-term
  • The policy offers 24 hours service and a free look period (calculated from the date of receiving the documents)

Health Medisure Super Top-up Insurance

Health Medisure Super Top-up Insurance Plan comes along with the following features:

  • This HDFC Ergo Mediclaim policy is a top-up plan that can be taken along with any other existing health insurance plan
  • This policy plan offers several benefits with an added protection cover
  • The plan offers a high sum assured at a budget-friendly premium rate
  • Lifelong renew option
  • Till the insured reaches 55 years of age, no medical tests are done
  • The premium amount is fixed when the policyholder reaches 61 years of age
  • Assured response from the insurer within 6 hours in case of a cashless claim
  • A 5% discount on the policy premium on purchase of a 2-year health insurance policy
  • A 10% discount on the policy premium on adding 2-3 members of the family under an individual plan
  • The policy offers coverage for the expense incurred on pre-hospitalization, inpatient hospitalization, and posy hospitalization
  • The plan, however, does not offer coverage for the expense incurred on treatment for self-injuries, HIV/AIDS, cosmetic surgery, injuries caused by war, or from participation in adventure sports
  • The policy has a waiting period of 3 years for the plan to cover pre-existing ailments

My: Health Women Suraksha Plan:

HDFC ERGO my: Health Women Suraksha Plan has the following features:

  • The plan offers coverage in the form of 100% sum insured for all cancer pertaining only to women. These include cancer in Cervix, Breast, Uterus, Ovary, Fallopian Tubes, and Vagina
  • The plan offers coverage of 1/4th of the sum insured up to a maximum of Rs 10 Lakh for cancers in the early stages. These include cancer in the cervix, breast, and uteri
  • The plan offers 100% sum insured for treatment of major illnesses such as Lupus Nephritis, Lupus Erythematous, and Rheumatoid Arthritis
  • The plan offers coverage for severe osteoporosis, which is up to a maximum of Rs 10 Lakh
  • The plan offers a discount of 7.5% if the policy is bought for 2 years and 12.55 if the policy is bought for a 3-year tenure
  • A free health check-up is provided on every policy renewal
  • The tax benefits are available under section 80D of the Income-tax Act
  • The policyholder can select the sum insured from Rs 1 Lakh to Rs 1 Crore
  • The plan, however, has a waiting period of 90 days for all major illnesses, 1 year waiting period for filing claims of any complications of a newborn baby
  • The plan has a free look period of 15 days calculated from the day of receiving the documents
  • The plan, however, does not offer coverage for the expense incurred on treatment for self-injuries, HIV/AIDS, cosmetic surgery, injuries caused by war, or from participation in adventure sports

Women Critical Illness Comprehensive Plan

  • The plan offers coverage for 41 critical illness (as mentioned in the list), special surgeries, women-specific major and minor illnesses
  • Any women-specific illness or surgery that happens out of the country is also covered under the plan
  • The plan offers coverage for major changes in life such as pregnancy, loss of a job, complications of a newborn baby, and support after the diagnosis of a critical illness
  • The policy coverage continues even after a part of the sum insured is claimed for the treatment of a minor illness
  • The plan offers coverage for women-specific surgeries. These include Hysterectomy, Mastectomy, Radical Vulvectomy, Wertheim’s Operation, Breast Reconstructive Surgery, Total pelvic Exenteration, and repair of vaginal Fistula
  • The plan, however, does not offer coverage for the expense incurred on treatment for self-injuries, HIV/AIDS, cosmetic surgery, injuries caused by war, or from participation in adventure sports
  • The plan offers a discount of 7.5% if the policy is bought for 2 years and 12.55 if the policy is bought for a 3-year tenure
  • A free health check-up is provided on every policy renewal
  • The tax benefits are available under section 80D of the Income-tax Act
  • The plan has a free look period of 15 days calculated from the day of receiving the document

What is the Add-on covers offered under HDFC ERGO Health Insurance Plan?

The following add on covers are available under HDFC ERGO Health plans:

Critical Illness Cover:

HDFC cancer care and other critical illnesses such as multiple sclerosis, brain tumour, heart stroke are covered under this add on cover.

Personal Accident Cover:

This cover offers coverage for any kind of medical treatment as a result of an accident including accidental death. Under this cover, the insurer offers a lump sum payment to the insured in the event of a critical illness. This payment is made to the insured irrespective of the expense borne during the treatment.

Top Up Cover:

These are the additional coverage offered by the insurer that the insured can buy in addition to the existing health plan.

Documents needed to buy an HDFC ERGO Health Insurance Plans

The documents required to purchase an HDFC ERGO Health insurance plan are listed below:

ID Proof:

Either of the following documents can be submitted as proof of identity. These include pan, Driving License, passport, Aadhaar, and voter card.

Address Proof:

Any of the following documents can be submitted as proof of address. These include passport, driving license, Voter card, Aadhaar, utility bill, or rental agreement.

Application Form:

The application form for purchasing the health plan must be duly filled and submitted.

Inclusions of an HDFC ERGO Health Insurance Policy

The following benefits are a part of the inclusion of an HDFC ERGO Health Insurance plan

  • Maternity Benefits offered after Completion of the waiting period
  • Ambulance assistance in case of an emergency
  • 1% of the sum assured reimbursed for the medical check-ups
  • Coverage for 60 days of pre-hospitalization expense and 90 days post- hospitalization
  • Coverage for the expense incurred on a newly born baby, up to 90 days from birth, for any inpatient treatment
  • If the hospitalization treatment extends for more than 10 days consecutively, convalescence befits are included

Exclusions of HDFC ERGO Health Insurance Policy

The following ailments are excluded from the coverage of HDFC ERGO Health Insurance plans.

  • Any pre-existing illness. (Applicable only in the case of a policy is 4 years old)
  • Participating in criminal activity by breaking the law
  • Getting affected by HIV/AIDs
  • Health diseases caused as a result of war or some armed conflict
  • Injury or illness caused as a result of radioactivity, war, terrorist activities, suicide attempts, suicide, or any other act of self-harm
  • Claims for Illness caused due to drugs or alcohol misuse
  • Cosmetic surgery not done as a part of a treatment
  • Immunization and vaccinations that are taken as a precaution

What is the Claim process of HDFC ERGO Health Plan?

The claim process for HDFC ERGO Mediclaim is divided into two broad categories. One is the Cashless Treatment claim and the other is Reimbursement Claim. Both of these processes are explained below.

Cashless Treatment Claim

In this case, the insured takes treatment for illness from any of the network hospitals spread across the country. The medical bills for the treatment are settled by the HDFC ERGO Insurance Company subject to the illness being covered under the plan.

Steps involved in filing a Planned/ Emergency Cashless Hospitalization Claim

  • Visit the nearest hospital from the network of hospitals to get treatment
  • Inform HDFC ERGO at least two days before getting admitted to the hospital regarding the planned hospitalization. This can be done by calling at their toll- free numbers
  • The insured must submit the photo ID proof and health card at the time of getting admission and fill an authorization form that is signed by the doctor attending the insured
  • The duly filled and signed authorization form is sent by the network hospital to the HDFC ERGO Insurance company along with other relevant details
  • HDFC ERGO then contacts the bank to the claim payment status
  • Once the claim has been approved, medical bills for the covered illness are settled and paid by HDFC ERGO. The treatment that is not a part of the coverage is to be settled by the insured/ patient/ cardholder
  • The original hospital bills are signed and maintained by the policyholder, while a copy of the bills is maintained with the Hospital

Reimbursement Claim:

Under this claim process, the treatment expense is settled by the insured and the hospital bills are sent to HDFC ERGO Insurance Company for reimbursement of the treatment expense. The following steps must be followed at the time of filing a reimbursement claim.

Steps involved in filing reimbursement Claim are:

  • The policyholder must inform the company about getting hospitalized for any medical treatment
  • This can be done by calling at their customer support numbers
  • Once the treatment is over, the policyholders must settle all the hospital bills and maintain the original bills and hospital reports
  • Fill the appropriate claim settlement form and send it to their branch office with other relevant documents for reimbursement of the expense incurred
  • The claim amount is reimbursed to the insured’s account if the claim is approved
  • If the claim is rejected, the rejection reason is shared by the company

Claims Process of HDFC ERGO Health Insurance:

The efficient and quick settlement of claims of the HDFC mediclaim policy requires certain points to be followed.

  • The claim must be registered within a week of getting discharged from the hospital
  • A proper intimation must be sent to the insurer at the time of getting treatment
  • The duly filled claim form and relevant proofs, certificates, and documents must be submitted at the branch office of the HDFC ERGO Insurance company
  • The medical reports, certificates must be submitted with the doctor's signature

Documents Required at the Time of Filling Claim

  • Proof of identity, address, and age of the insured
  • Bank details with a copy of the cancelled cheque for NEFT
  • Discharge Summary (original)
  • Duly filled claim form
  • Final detailed bill provided by the hospital with the original invoices of the pharmacy, and payment receipt.
  • Original test reports of a blood test or X-Ray, etc.
  • Any previous treatment records
  • Invoice of an implant (in case of lens cataract or stent, etc.)

How to Renew an HDFC ERGO Mediclaim Policy?

The policy renewal of the HDFC Ergo Health Insurance policy is done in the following steps.

  • Visit the website of HDFC ERGO and click on the ‘ Instant Renewal’ option
  • Enter the relevant details of the policy including policy number
  • Policy details get generated with the policy renewal premium amount
  • Using any of the payment modes, make the payment and the policy gets renewed

HDFC Ergo Health Insurance FAQ’s

Written By: Paisawiki - Updated: 10 July 2020

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