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HDFC ERGO Individual 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 Individual Health Insurance

The HDFC ERGO Individual Health Plan offers affordable financial cover for all your medical needs in the future. You can avail this plan and let HDFC ERGO take care of your hospitalization and medical needs, relieving you of financial worries.

What is the HDFC ERGO Individual Health Insurance Plan?

HDFC ERGO Individual Health Insurance Plan offers financial assistance for medical coverage in times of planned or unplanned medical situations. It offers extensive insurance coverage for all medical expenses incurred as a result of hospitalization, sickness or any injury.

This health plan acts as a saviour in times of medical emergencies where you may be required to shell out your hard-earned money for meeting up with sudden medical expenses. HDFC ERGO provides a comprehensive cover at affordable premiums in a vast network of cashless claim hospitals nationwide for your convenience. Most of these plans for individual health insurance are offered in several variants, which are as follows:

Plan Variant

Sum insured

Tenure

Features

My: health Suraksha Silver Smart

3-5 lakh

1-3 years

  • No room rent cap
  • Sum insured rebound
  • Free health check-up
  • Cashless home healthcare

My: health Suraksha Gold Smart

7.5-10 lakh

1-3 years

  • Hospital room eligibility
  • 10%-100% No Claim Bonus
  • Critical Illness
  • Co-payment option

My: health Suraksha Platinum Smart

7.5-15 lakh

1-3 years

  • Pre-existing disease coverage after 3 years
  • Maternity coverage
  • No restriction for the age of entry

My: health Women Suraksha

1lakh-1 crore

1-3 years

  • 41 critical illness covered
  • Cover for job loss due to illness, pregnancy and newborn baby complications 

Features of the HDFC ERGO Individual Health Insurance Plan

HDFC ERGO provides individual health insurance with a host of attractive features and associated benefits. Several plan variants offer customized coverage with different sum insured amounts and other benefits. Some of its features are as follows:

  • of Members- The plan provides coverage for up to 4 members of your family. This cover includes insurance for up to 2 children and two adults.
  • Pre & Post Hospitalization Cover - The plan provides coverage for all kinds of Pre and post-hospitalization medical expenses. This cover applies to expenses incurred 60 days before hospitalization and 90-days post-hospitalization.
  • Different Plan Variants – Each of the Individual health insurance plan variants come with a different sum insured options. This gives you the flexibility to choose your coverage amount as per your medical needs, along with varying tenures of the plan. Also, for every claim-free year, you earn a 5% bonus.
  • No Sub-Limits on Room Rent– Medical costs for hospitalization are dependent on the type of room taken. HDRC ERGO does not provide any sub-limit on the room rent.
  • Health Check-ups– HDFC ERGO individual health insurance plans provide you with the feature of reimbursement of health check-up expenses after completing four claim-free years.
  • Pre-existing Diseases – There is a waiting period of 4 years for Pre-existing diseases.
  • Lifelong Renewal – The plans offer the feature of lifelong renewability. It saves you from the financial burden and stress caused by a medical emergency. As long as you keep on renewing the plan, you can avail the plan benefits. It keeps you well prepared to handle any situation.
  • Less Paperwork and Easy Documentation: When buying the policy online, it requires no or less paper work, making the process more convenient.

Benefits of the HDFC ERGO Individual Health Insurance Plan

There is no medical check-up required until 45 years of age

  • Cashless treatment in over 6000 network hospitals
  • 5% No Claim Bonus for every claim-free year
  • Simplified and hassle-free claims procedure
  • Long term policy discount available
  • Cashless home health care
  • E-opinion for critical illness is available where you can seek a second opinion on any critical illness treatment from a panel of specialist medical practitioners
  • More than 580 daycare procedures available for in-patient treatment
  • You can also avail of 10% savings benefit on premium when two or more family members are insured under the same policy. (*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply)
  • Tax benefits under Section 80D of the India Income Tax Act available. (*Tax benefits are subject to changes in the available tax laws)
  • 24/7 customer support for taking care of your insurance needs

Inclusion of the HDFC ERGO Individual Health Insurance Plan

The policy covers the insured for following expenses:

  • Cashless home health care
  • Hospitalization expenses due to injury, disease or accident
  • Pre and post hospitalization expenses for 60 days and 90 days, respectively.
  • More than 540 Day Care procedures
  • AYUSH treatment facility available
  • Organ donor expenses are covered for a major organ transplant
  • Mental illness treatment costs covered
  • Sum insured rebound
  • Maternity and newborn baby cover
  • Free health check-up every year
  • Ambulance cover for both road and air travel
  • Recovery benefits if an individual is hospitalized for more than ten days

Exclusions of the HDFC ERGO Individual Health Insurance Plan

Any claims arising out of the following situations are not covered under the plan.

  • Suicide attempts or self-inflicted injuries
  • Injuries or illness due to Adventure or extreme sports
  • Any claims arising due to wars or warlike situations, terrorism, etc.
  • Any accidents caused due to participation in defence activities of the army, navy or the air force.
  • HIV, AIDS or any STDs
  • Any obesity treatment or cosmetic surgery

Eligibility Criteria to Buy the HDFC ERGO Individual Health Insurance Plan

HDFC ERGO offers health insurance at no entry age restriction for applying to any of these individual health plans. Here age is not an eligibility criterion, whether you are young or a senior citizen.

One can opt for extended coverage of health insurance for Individual plans. The entry age to become a policyholder for adults is from 18 to 65 years. This age can be extended to 70 years based on the plan and insurer.

Even children can avail health insurance from 90 days to 18 years.

However, the earlier one applies for enrollment to a plan, better it is from the premium perspectives.

Claim Process of the HDFC ERGO Individual Health Insurance Plan

A claim to an individual health insurance policy can be made in two ways:

  • Cashless basis
  • Reimbursement basis

HDFC ERGO Health Insurance provides a well-defined claim processing system under both methods.

Cashless Claims Procedure

For cashless claims, you must seek treatment or hospitalization in any of the hospitals on the network prescribed by HDFC ERGO. You need to fill the prescribed form at the hospital reception after showing your insurance card. You first need to seek an authorization as per the procedures laid down. Here are the steps that you need to follow for the cashless claim procedure:

  • Fill the pre-authorization form available at the hospital's insurance/TPA Desk
  • Submit the completed form via email or fax
  • HDFC ERGO’s claim management team will verify your information with the hospital and send their approval in the form of an Authorization letter
  • In some cases, they may reject the authorization if the information is insufficient or cannot be verified. Then you need to file for a reimbursement claim

Reimbursement Claim

In case of claims on a reimbursement basis, you should notify HDFC ERGO health insurance team. The policyholder has to ensure the collection and submission of all documents like hospital discharge summary, prescriptions and medical bills for reimbursement.

An individual policyholder needs to follow the following steps to submit a Reimbursement claim:

  • Complete the necessary claims form
  • Collect the necessary documents like discharge summary, doctors’ prescriptions, medical bills, etc.
  • Submit the claims form along with required documents to the HDFC ERGO Claims processing team as per the policy terms and conditions
  • Once the documents are verified and examined by the team, and everything is found to be correct, the Claims Management team will send a letter of approval.
  • In case of missing or incorrect information, the claim can be rejected, and the team will communicate with a letter of rejection.

In any kind of claim processing, you need to inform HDFC ERGO on a timely basis.

In case of emergency hospitalization, you need to inform the provider in 24 hours of admission. In the case of planned hospitalization, you need to notify the company 48 hours before hospitalization.

Claim intimation can be made via toll-free number 1800-2000-700.

You can also fax 1800-2000-600 or emailed to healthclaims[at]hdfcergo[dot]com.

How to Buy the HDFC ERGO Individual Health Insurance Plan?

You can either buy a health insurance policy online from HDFC ERGO or call their toll-free number to buy the policy.

You can also buy insurance from Paisawiki at paisawiki.com. You get to avail of a complete package of services ranging from plan comparison and selecting plan options online, purchasing a policy, claims assistance and renewal options as well.

You should select your policy type and click on buy now to fill the details. Once confirmed, you can make a secure online payment.

Renewal Process of the HDFC ERGO Individual Health Insurance plan

You need to renew your expired health insurance policy to enjoy continued benefits from HDFC ERGO Health Insurance. This should be done within 30 days from the expiry date of the plan.

You can use any of these two ways to renew your policy:

The online process of renewal is convenient and fast. You can also renew the policy through third party websites like paisawiki.com. To renew the policy with Paisawiki, let’s follow the below steps:

  • Visit the official website at paisawiki.com
  • Select the ‘Instant Renewal’ option
  • You need to enter your policy details and policy number
  • The premium will be auto-generated for renewal
  • You can make the payment for the renewed premium amount via debit/credit/net banking, and your policy will be renewed

With the new InstaRenew feature, which is a 3 step process, you can easily renew your policy online here.  You just need to enter your DOB, policy number and mobile number, and click on “Proceed” to go ahead with the renewal process and make the necessary payment.

FAQs

  • What do you need to keep in mind before buying any individual health insurance plan?

    Ans: Before going ahead with finalizing a particular individual health insurance policy, you need to keep in mind certain factors like the number of people to be insured, any dependents, your financial situation, policy tenure, any pre-existing diseases and waiting period, and availability of add-on riders.

  • Why should you buy HDFC ERGO Individual Health Insurance Plan?

    Ans: HDFC ERGO Individual Health Insurance plans are customized as per customer needs. The company has an AAA rating from the ICRA, which means that HDFC ERGO insurance has a high CSR or Claim Settlement Ratio. They offer affordable coverage with excellent post-sales service. They also have a vast network of over 10,000 hospitals in India.

  • Is the cashless facility available in hospitals online?

    Ans: Yes, you can find a couple of hospitals across India that offer cashless facilities online under HDFC ERGO’s network. You need to visit the company’s official website and click under ‘Cashless facility hospital locator’ to find the list of those hospitals.

  • Does HDFC ERGO health insurance provide any mobile app feature for its customers?

    Ans: Yes, HDFC ERGO Mobile App allows you to get an insurance quote via the app. You can download this app from the Play Store on your mobile phone. It will help you to look for network hospitals or cashless hospitals instantly for making a claim. You can also track your claim status via the app on your mobile. Your policy document listing will also be available through your app.

Written By: Paisawiki - Updated: 03 March 2021

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