HDFC ERGO General Health Insurance

Medical emergencies can hit anytime, anywhere. Here come health insurance policies like HDFC RGO General Health Insurance into the picture that help an individual to be prepared to tide over medical contingencies with a protective financial shield.

HDFC Ergo General Health Insurance is one of the reliable insurers in India, offering a range of tailored health insurance plans to satisfy the diverse needs of Indian consumers. Their portfolio of health insurance plans has varied ingredients in all genres, providing comprehensive coverage for hospital care, backed by a robust service mechanism to aid the policyholder with a seamless experience during its entire life cycle. 

What is HDFC ERGO General Health Insurance? 

The bouquet of HDFC ERGO General Health Insurance is just the type of financial tool to do planning for the future worthy. The health insurance giant is a Joint Venture collaboration between HDFC Ltd., the premier Housing Finance Institution in India and ERGO International AG of Germany, the primary Insurance arm of Munich Re Group catering to both retail and corporate space in the country, with a wide range of general insurance business verticals spanning Motor, Health, Travel, Home and Personal Accident in addition to customized Marine, Property and Liability Insurance products. Today the insurer boasts a network of 120+ branches spread over 106+ cities in every corner of the country. 

Reasons to Choose HDFC ERGO General Health Insurance

It goes without saying that in the present times, incidence to lifestyle diseases has increased manifold. The menace is a fact of life due to the stress factors constantly haunting modern society, finding fertile ground due to unhealthy food habits, polluted environment, not to mention sedentary existence propelled by dependence on gadgets. While lifestyle diseases are gaining a vice-like grip on the vulnerable, healthcare costs are growing exponentially, driven both by inflation and the introduction of ever-advancing healthcare technology. In such a scenario, the best bet for financial protection from medical emergencies is effectively HDFC ERGO General Health Insurance Plans, that not only provide wide coverage but also dish out health insurance plans in every genre.

This is a suitable health insurance plan that accommodates the policyholder in an amazing 10000+ Network of Partner Hospitals providing cashless hospitalization. The commitment of HDFC ERGO Health Insurance towards simpler, dependable and affordable plans with equal emphasis on fulfilling all the promises with care, is reason enough for the discerning consumer to make it a worthy choice. 

*Paisawiki does not endorse, rate or recommend any particular insurer or insurance product offered by an insurer

HDFC ERGO General Health Insurance Features

As already enunciated, the range of plans at HDFC ERGO General Health Insurance provides the consumer with an eclectic choice. The coverage is extensive and comprehensive in their flagship health insurance plan under the title ‘my. Health Suraksha’, offering different ranges to suit every consumer taste. Some of the highlights of what all the health insurance plans are packed with are listed below.  

• Multiple Sum Insured: options in a range from Rs 3 lakh to Rs 75 lakh
• Entry and Renewal: No bar on the age of entry with lifetime renewal facility
• Policy Term: Long term options for up to 3 years
• Saving Options: In a range for Family, Loyalty, Long Term Policy etc.

* The insurer provides all savings as per the IRDAI approved insurance plan. Standard T&C apply.

• Inpatient Hospital Expenses: Illness or accidental injury needing hospitalization with medical expenses incurred thereon
• Pre and Post Hospitalization Expenses: Pre and post hospitalization expenses incurred for Consultation, Diagnostic Investigations and Medicines for the extended period of 60 and 180 days, respectively
• Daycare Procedures: Wide range of procedures are covered for treatment needing advanced medical techniques
• Mental Healthcare: Mental disorders being as important as any other illness or injury, warranting hospitalization receives equal weight for treatment
• Pre Policy Medical Checkup: A healthy consumer under 45 years of age is exempted from any medical checkup for buying HDFC ERGO Health Insurance Plan
• Cashless Home Healthcare: It is a unique feature where the doctor recommends home treatment with all medical expenses covered for the cashless experience
• Domiciliary Hospitalization: In cases where the insured cannot be shifted to a hospital or when there is no bed vacancy, coverage for all medical care and treatment is extended at home
• Organ Donor Expenses: Cover for expenses related to organ harvesting for transplant

Benefits of HDFC ERGO General Health Insurance:

Similar to the wide feature attributes in HDFC ERGO General Health Insurance Plans, there are also a host of attractive benefits awaiting the policyholder. Some of the major benefits worth highlighting are:

• Cashless Hospitalization: More than 10000 Partner Network Hospitals to choose from PAN India.
• Premium Installments: The policyholder can pay the annual premium in 3, 6 and 12 equal instalments.
• Flexi Benefits: To avail of savings in premium, the policyholder can opt for Room Rent Capping and Copayment.
• Air Ambulance: If imperative, air ambulance evacuation is covered.
• Sum Insured Rebound: Recharge of the sum insured after claim settlement to ensure that the next hospitalization is well covered. 
• Recovery Benefit: When hospital stay exceeds 10 days, financial loss beyond hospital expenses is covered as per provisions in the policy schedule.
• Tax Savings: Premium paid for health insurance is tax-deductible under Section 80D of the Income Tax Act, 1961. The current exemption amounts are Rs 25000 for persons who are below 60 years of age and Rs 50000 for Senior Citizen, i.e. above  60 years of age. *Tax benefit depends on changes in tax laws
• Free Health Checkup: As one renews the policy, he is rewarded with a free checkup to determine health status within 60 days
• Ayush Treatment: The cover enables the policyholder to avail of the benefits of alternative therapies.
• Ambulance Cover: By road evacuation of the insured to hospital for amounts specified in the policy schedule. 

Types of HDFC ERGO General Health Insurance

It is already understood that HDFC ERGO General Health Insurance Policies are offered in a wide range of options, but it is also important to appreciate that they belong to both Indemnity and Benefit class of health insurance plans. The health insurance plans in the bouquet are:

• Health Suraksha – Silver Smart Plan
• Health Suraksha – Gold Smart Plan
• Health Suraksha – Platinum Smart Plan
• Arogya Sanjeevani – HDFC ERGO
• Health Medisure – Super Top Up
• Health Women Suraksha
• Women Cancer Plus Plan
• Women Critical Illness Essential Plan
• Women Critical Illness Comprehensive Plan
• Critical Illness Insurance
• Personal Accident Insurance

HDFC ERGO General Health Insurance: Plan Comparison

Comparison of plans serves its purpose. As already discussed, multiple plans pose a problem of plenty which adds to selection woes by raising confusing signals. The solution to this predicament as a helping aid to the consumer; suitable comparison table is designed, defining the highlights to compare plans in a nutshell. It affords the scope for quick scan and reference, to be analyzed in detail from the Prospectus, Customer Information Sheet or the detailed description that follows. It is meant to culminate in an informed choice. Accordingly, the following grids are created with tabulation of relevant data.

Under the below table, major plans under the flagship my: health Suraksha of HDFC ERGO General Health Insurance consisting of parameters spread over different coverage items have been incorporated. It is intended to help the consumer gain quick insight into the plans, to study further for clarity. It is also a tool to generate suitable HDFC ERGO General Health Insurance Review, to help others to access.

This is a comparison grid of plans under the my: health Women Insurance Plan, where there are multiple options to choose from. 

HDFC Ergo General Health Insurance Exclusions

There is always a lot of emphasis on learning what is included in the health insurance plans, ignoring what is excluded. It can lead to disappointment at the point of claim settlement. It thus makes sense to be aware of the waiting periods and general exclusions, to obviate unnecessary claim settlement issues. The policy doesn’t provide coverage for the following:

• Self-imposed injuries and act of attempted suicide
• Treatment of external congenital disorders.
• War and war-like situations.
• Participation in defence operations
• Participation in adventure, extreme and hazardous sports.
• Treatment of venereal and diseases like HIV and AIDs.
• Cosmetic and aesthetic treatment.
• Treatment of obesity-related issues.

HDFC ERGO General Health Insurance: Plans Explained

HDFC ERGO General Health Insurance Policies are described below one by one. 

My: Health Suraksha – Silver Smart Plan

It has always been the endeavour at HDFC ERGO General Health Insurance to provide for a value for money comprehensive health insurance cover. The range of cover against soaring medical costs without compromising on the quality of healthcare is suitable for Individuals, family and senior citizens. A robust sum insured choice of Rs 3 lakh to Rs 5 lakh makes it eminently affordable. The salient features of Silver Smart Plan are:

• No room rent is capping to ensure healthcare comfort.
• Sum Insured Rebound ensures that the policyholder is never short of sum insured balance for future hospitalization during the policy term.
• Free health checkup every year to monitor the health status of the policyholder, ringing alarm bells when necessary.
• Cashless homecare is a unique concept where treatment continues in home comfort.

My. Health Suraksha – Gold Smart Plan

Simplified yet wholesome health insurance cover is the USP of this plan. Financial protection being the primary aim of this plan, it is recommended for its suitability to individuals, family and senior citizens in its wide coverage and other options. The reasons for this health insurance plan to be popular among a cross-section of consumers are:

• No room rent is capping to ensure choice in healthcare comfort.
• Sum Insured Rebound is a backup that replenishes the sum insured balance to ensure that the policyholder is never short of funds for future hospitalization during the policy term.
• Free health checkup every year to ascertain policyholder’s health status, ringing warning bells when warranted.
• Cashless homecare is a unique concept where the doctor prescribes treatment in home comfort without spending a single penny.

My: Health Suraksha – Platinum Smart Plan

It is specifically designed for the discerning consumer with the sum insured options up to Rs 75 lakh. It ensures that the policyholder is never found to be underinsured with adequate financial protection shield, capable of absorbing growing medical expenses in the best hospitals anywhere in the country. It is ideally suited for Individuals, Family and Senior Citizens, who are averse to compromise in healthcare quality for themselves as well the members of the family. Some of the policy features include:

• The best of hospitalization comfort is ensured with the provision of no room rent capping.
• Sum Insured Rebound ensures that the sum insured is replenished after claim settlement so that the policyholder does not fall short of financial cover during the policy term.
• Free health check-up at renewal ensures that the policyholder is always healthy and can initiate measures immediately if anything is amiss.
• Cashless homecare is a unique concept which comes into play when the doctor prescribes treatment in home comfort without spending a single penny.

Arogya Sanjeevani – HDFC ERGO

Choosing a suitable health insurance plan has always been daunting, considering the glut of general insurers in the country coupled with multiple plans designed by each one of them, without any uniformity in the coverage. IRDAI designed a template with standard cover features, available pan India through Arogya Sanjeevani Plan to be rolled out by every insurer. Accordingly, it is up for sale from 1st April 2020 onwards.  Salient features of the plan are:

• Sum Insured: From Rs 1 lakh to Rs 5 lakh
• Policy Term: 1 year
• Entry Age Eligibility: 18 to 65 years with lifelong renewability
• Pre Hospitalization:30 days
• Post Hospitalization: 60 days
• Room Rent: 1% of the SI subject to maximum Rs 5000
• ICU: 5% of the SI subject to Rs 10000
• Copayment: At a flat rate of 5% across entire coverage
• Road Ambulance: Maximum of Rs 2000
• Daycare Procedures: Covered as per policy schedule
• Cataract Procedure: Limited to 25% of SI maximum Rs 40000
• Dental Surgery: If deemed medically necessary
• Waiting Period: 48 months of continuous renewal for PED, Joint Replacement, Osteoarthritis and Osteoporosis
• Pre Policy medical test is compulsory

My. Health Medisure – Super Top Up

 It is a plan that helps to increase financial cover substantially without digging a hole in the pocket. With rising medical cost and exponential inflation, suitable upward revision in sum insured has become a necessity. Super Top-up is the solution to this predicament. Some of the key highlights of this plan are: 

• All members of the extended family can be insured.
• Post 61 years of age, the premium is fixed with no escalation. Thus, old age is rewarded with hefty health insurance cover.
• No health check-up is conducted for policyholders up to 55 years of age.
• Attractive savings options for choosing longer tenure and more than 2 members in the family are insured. *Standard T & C apply.

My: Health Women Suraksha

It caters specifically to those women who look for health insurance cover for the future financial protection of medical contingencies. The basic aim is to provide comprehensive cover for women-specific medical issues, which do not find ample attention in normal health insurance plans. Financial coverage is a generous Rs 1 lakh to Rs 1 Crore. There are 3 plans in this category in which the waiting periods are:

Waiting Period

• 90 Days: All Major Illness and Procedures.
• 180 Days: All Minor Illness and Procedures
• 1 year: Pregnancy and Newborn complications

Survival Period

• 7 days: On all illnesses and procedures, including maternity issues.
• 30 days: From the date of delivery of the baby, subject to complications identified within 30 days.

Women Cancer Plus Plan

Cancer is a dreaded disease which is a constant drain on one’s mental as well as financial health, not to mention physical. Women are prone to certain cancer like Breast and Uterus, which needs adequate protection provided by Cancer Plus Plan. The inclusions are:

• All major cancers
• Major Illnesses
• Carcinoma in situ.
• Minor Illnesses

Women Critical Illness Essential Plan

With advancing age, women become prone to many ailments specific to them. They can stay protected from cover for Cancer, Major Illnesses, Heart ailments and other Major Surgeries under a single plan. Inclusions are:

• All major cancers
• Major Illnesses
• Carcinoma in situ.
• Minor Illnesses
• Surgical procedures
• Heart ailments and procedures

Women Critical Illness Comprehensive Plan

 As the name suggests, apart from the cover for Cancer, Major Illnesses, Heart ailments and other Major Surgeries, 41 listed Critical Illnesses are available in a single plan. Inclusions are:

• All major cancers
• Major Illnesses
• Carcinoma in situ.
• Minor Illnesses
• Surgical procedures
• Heart ailments and procedures
• Critical Illness
• Worldwide coverage

Critical Illness Insurance

A plan with wide coverage and the low premium is ideally suited for handling financial worries when planned in advance. A list of 15 critical illnesses including Cancer and Stroke in 2 plan options, prevents a dent in savings in medical contingencies. Inclusions in this plan are:

• Silver and Platinum Plan options to choose from
• Sum insurance paid in a lump sum in a single transaction
• Policy term options for 1 and 2 years
• No medical check-up until 45 years of age
• Initial waiting period of 90 days and Survival waiting period of 30 days 

Personal Accident Insurance

The uncertainty of accidents leaves many individuals in a state of despair caused by immense physical and emotional stress, not to mention the debilitating financial drain on resources. HDFC ERGO Personal Accident Insurance is the right plan to protect the policyholder from all these hazards. The features of this plan are:

• Eligibility from 18 years to 70 years
• Worldwide coverage
• Lifelong renewability
• Accidental Death
• Permanent Total Disability
• Burns
• Broken bones
• Ambulance
• Daily Hospital Cash

Waiting Periods

The plan comes with the following waiting period:

• First 30 days: It is a mandatory exclusion applied across the board for hospitalization, other than for accidental reasons.
• First 24 months: Applicable to listed illnesses and treatment as defined in the policy schedule.
• First 36 months: Applicable to pre-existing diseases and treatment, declared at inception as defined in the policy schedule.

Eligibility Criteria to Buy HDFC Ergo General Health Insurance

The eligibility criteria defined in major plans are as follows:

How to Buy HDFC ERGO General Health Insurance?

The obvious outcome of all the descriptions of HDFC ERGO Health Insurance leads to only one conclusion - How to buy the chosen plan? By far the most popular option is buying it online, in user-friendly aggregator portal of Paisawiki.com or the official portal of HDFC ERGO. The process is a simple, three-step function. HDFC ERGO Health Insurance is also happy to extend assistance for online purchase if the consumer calls the toll free number at 1800- 2666-400. 

Step 1- Calculate Premiums:

• One has to visit the portal home page at paisawki.com and first compare plans to arrive at an informed decision. There are ample buttons spread over the page or in “Know more”: sections prompting to “Buy Now”.
• Enter the sum insured rage and select the Button to open a fresh page.
• There are two sections on the The first section seeks inputs regarding insurance options, individuals or family and date of birth of each.
• The second section seeks contact details like name, cell number, state, city, PIN Code and email address to complete premium calculation input.
• Tick accepting the terms and conditions and click on “Calculate Premium”.

Step 2- Fill Details:

• This is the completion of the proposal form in all respects to receive the quote.
• Once the quote is received and accepted, navigate to the last step.

Step 3- Make Payments:

• This is where the deal is sealed.
• The secure gateway displays the available options.
• The successful payment completes the process for the proposal to be accepted.
• The policy document is ready, subject to any other compliances. 

Documents Required HDFC ERGO General Health Insurance

Documentation is intrinsic to any health insurance plan. However, with the digital platform gaining ascendancy in all spheres of life; does not preclude HDFC ERGO General Health Insurance from its purview. Suffice to say, documentation is sparse and is confined to bare essentials only.

Documents required at Purchase:

• Valid photo Identity Card
• Valid Date of Birth proof
• Valid address proof
• Income proof

Documents required for Claims:

• Duly Completed and signed Claim Form
• Health Card of the insured
• Discharge Summary from the Hospital
• Hospital medical case papers
• Doctor’s Certificate, Requisition Slips and Notes
• Original Diagnostic and Investigation Reports with those in digital format also
• Hospital Bills and Breakup in original, duly authenticated.
• Bank account details of the claimant
• Death Certificate where required
• Post Mortem Report if applicable
• Police FIR or MLC if applicable
• Any other document deemed necessary

HDFC ERGO General Health Insurance Claim Process

Health insurance from HDFC Ergo can be claimed for cashless and reimbursement settlement. The process slightly differs from each other.

• Cashless Claim: This claim can be availed only at a network hospital. The insured has to inform the insurer 72 hours before the hospitalisation in case of a planned treatment, and 24 hours before in case of an emergency hospitalisation. A pre-authorisation form has to be filled at the TPA desk in the hospital, and submitted along with the IF proof. The insurer, will convey its decision after a couple of hours. Once it is confirmed, the insured can take cashless facilities at the hospital, where the bills are settled directly by the insurer.
• Reimbursement Claim: In case a cashless claim is rejected, the insured has to pay the hospital bills on his/her own and file a reimbursement claim later. A claim form duly filled has to be submitted along with the required claim documents. The bills and reports are to be submitted as well. After verifying the claim and documents, the insurer settles the claim accordingly. The claimed amount gets transferred to the insured’s account through NEFT. 

HDFC ERGO General Health Insurance Renewal

The renewal process most preferred is online. The official portal has a dedicated option for payment of renewal premium. If not, one can also do it through paisawiki.com. Very similar to the online purchase, the online renewal process can be done in 3 simple steps.

• Step 1: Visit the portal at paisawiki.com and invoke instant renewal. Enter the Policy Number and click "Proceed."
• Step 2: View Policy Details and enter other sought data to generate a renewal premium.
• Step 3: Make Payments and preserve the Renewal Acknowledgement for future use.

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