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Features, Advantages, Types, and Claim Settlement Process of HDFC ERGO Health Insurance

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Published on Feb 19, 2019. EST READ TIME: 3 minutes

Chronic health conditions are increasing among people of all ages, and so are healthcare costs. In this scenario, the best you can do is take good care of your overall well-being and keep health insurance policies handy for yourself and your loved ones. The right health insurance plans can cover a major part of your medical bills and prevent financial setbacks during expensive medical procedures.

If you are looking to buy health insurance, HDFC ERGO is a good option. The insurance company is a reputed name in the industry and is known for providing a range of health insurance policies to suit different customer preferences and pockets. Let’s take a look at HDFC ERGO health insurance benefits in detail.

HDFC ERGO Health Insurance – Features

1. Comprehensive coverage

The insurance provider offers a range of health insurance plans with comprehensive coverage. These health plans can cover your hospital bills and help you cope with the rising healthcare costs.

The best HDFC ERGO health insurance policies cover the following expenses of the policyholders:

• Hospital bills

• Pre- and post-hospitalisation expenses

• Ambulance charges

• Home healthcare

• Mental healthcare

• Day care expenses

• Organ donor expenses

• AYUSH benefits

• Recovery benefit

• Multiplier benefit

• Free renewal health check-up

• Sum insured rebound

2. Waiting period

HDFC ERGO health insurance policies come with an initial waiting period of 30 days. However, the waiting period for pre-existing conditions, maternity benefits, bariatric surgery and some other conditions can range between 1-4 years.

3. Critical illness coverage

The insurance company also offers critical illness coverage as an add-on. You can pay an additional premium and take this add-on to cover 15 life-threatening conditions, including cancer, heart conditions, stroke, paralysis and kidney failure.

HDFC ERGO Health Insurance – Benefits

The following are the benefits of HDFC ERGO health insurance:

1. High claim settlement ratio

HDFC ERGO boasts a high claim settlement ratio of 97%. This means that, to date, the insurance provider has settled 97% of the total claims received from policyholders. A high claim settlement ratio shows that the company is a trustworthy one when it comes to quick claim settlement.

2. Free preventive health check-ups

The insurance provider offers free annual medical examinations at the time of policy renewal. This can help in the early diagnosis of a health condition and its timely treatment.

3. Short waiting period

Basic health insurance policies come with a short waiting period of 30 days.

4. Timely customer service

The insurance company is known for offering timely and quality customer support. It boasts over 1.5 crore happy customers.

5. Cashless treatment

The insurance company has more than 12000 network hospitals across the country where policyholders can avail of cashless treatment. So, in case of a medical emergency, you can avail of the finest treatment at a network hospital without worrying about the bills. The insurance provider will cover all your hospital bills except for the non-covered expenses and mandatory deductibles.

6. Tax benefits

Under Section 80D of the Income Tax Act, you can enjoy tax benefits of up to INR 25,000 for the premium paid towards your healthcare plan. A senior citizen can enjoy a maximum tax benefit of INR 50,000 every year for the premium paid towards his/her health insurance policy.

7. No room rent sub-limit

There is no room rent sub-limit for HDFC ERGO health insurance policies.

8. Lifelong renewability

The insurance provider offers plans with lifelong renewability. So, timely renewal of your healthcare plan will keep it valid and save you from the hassles of buying a new health insurance policy every few years.

9. No-claim bonus

The insurance provider offers a no-claim bonus for every claim-free year. For example, if you take the HDFC ERGO Health Suraksha plan, you can earn a cumulative no-claim bonus of 5% on the sum insured for every claim-free year.

Types of health insurance plans by HDFC ERGO

HDFC ERGO offers a range of health insurance plans for individuals and families. Here are the different types of health plans by HDFC ERGO:

Type 1: Indemnity health insurance plans

These are basic healthcare plans with both cashless and reimbursement claim settlement options. HDFC ERGO offers the following indemnity health plans for individuals and families:

1. Optima Secure

• Double coverage to policyholders from day 1:

For example, If you choose a base cover of INR 5 lakh, it will get doubled instantly and increase to INR 10 lakh without any extra cost.

• Increase in the base coverage:

When you renew your health plan, the base cover will increase by 50% in the 1st year and 100% in the 2nd year.

• 100% restoration of the base coverage:

If you make a partial or total claim on your health insurance policy, the insurance provider will restore the used amount. You can use the restored amount for subsequent claims in the same policy period.

• No cost instalment:

You can avail of this benefit by paying health insurance premiums using your debit or credit card.

2. Optima Restore

• Restoration benefit:

The insurer restores 100% of the cover as soon as you make the first claim.

• No claim bonus: Policyholders can earn up to 100% of the sum insured as no claim bonus. Every claim-free year will increase the basic sum insured by 50%. However, the sum insured cannot be more than 100% of the base cover at any point.

• Complimentary health check-ups: Policyholders can avail of complimentary health check-ups at the time of policy renewal for up to INR 10,000.

• Pre- and post-hospitalisation expenses: The policy covers 60 days of pre-hospitalisation expenses and 180 days of post-hospitalisation expenses.

• Daily hospital cash: The policy includes daily cash of INR 1000 per day, which cannot be more than INR 6000 per hospitalisation.

3. My:Health Suraksha

• Sum insured rebound: If you use up the existing sum insured of your health plan, the insurer will restore the used amount up to the base sum insured.

• Free health check-ups: You can opt for free health check-ups at the time of policy renewal.

• Cashless home healthcare: The insurer offers cashless home healthcare, so you need not worry about filing a reimbursement claim.

• Cumulative bonus: The policy offers a cumulative bonus for every claim-free year.

4. My:Health Koti Suraksha

• Wide coverage: This health plan has a sum insured of up to 1 crore and covers the costs of surgeries, critical illness treatments, and more.

• Unlimited daycare procedures: This health plan also covers unlimited daycare procedures, such as cataract surgeries, angiography, and radiotherapy.

• Multiple discounts: The health plan offers family, long-term and fitness discounts to policyholders.

• Cumulative bonus: You can earn a bonus of 10% of the sum insured for every claim-free year. This bonus can go up to 100% of the sum insured.

Type 2: Super Top-up Health Insurance Plan:

• High coverage: The plan offers high coverage and is ideal for covering huge medical bills.

• No health check-ups:Policyholders below 55 years of age need not undergo a health check-up before taking the super top-up plan.

• Fixed premiums: The premiums remain constant for people aged 61 and above.

• Aggregate deductible: This health plan works on an aggregate deductible.

• Policy inclusions: The policy covers hospitalisation expenses, pre- and post-hospitalisation costs, daycare procedures, and other related medical expenses of the policyholders.

Type 3: Fixed Benefit Health Plans:

The two main types of fixed-benefit health insurance plans are:

1. Critical Illness Insurance

• Policy coverage: The plan covers up to 15 critical illnesses, such as cancer, heart conditions, stroke, multiple sclerosis, and kidney ailments.

2. Lump sum payout: If diagnosed with a critical illness, the policyholder receives a lump sum amount from the insurance company. They can use this money for their treatment and other personal expenses.

3. No medical check-ups: Policyholders below 45 years of age can take a plan without medical check-ups.

• Lifetime renewability: The plan comes with lifetime renewability and stays active till the time you file a claim. Once you file a claim and receive a lump sum from the insurance, the insurance policy will cease to exist.

2. iCan Cancer Insurance

• Covers all types and stages of cancer

• Wide coverage: The policy covers all cancer treatments, such as chemotherapy, stem cell transplantation, and other advanced options. This insurance policy also takes care of outpatient treatment costs.

• Other coverage: The plan also covers pre- and post-hospitalisation bills, emergency ambulance costs, second opinion costs, family care benefits if the policyholder gets diagnosed with stage IV cancer and more.

• CritiCare benefits: If a policyholder is diagnosed with cancer of specified severity, they will receive an additional payout of 60% from HDFC ERGO.

• Lump sum payout: If a policyholder gets diagnosed with cancer, they receive a lump sum from the insurance company for their treatment and other expenses.

• Lifelong renewals: Since cancer can recur anytime, the policy offers a lifelong renewability option. The policy can be renewed even after claims.

• Cashless treatment: The health plan also covers cashless treatment of policyholders at network hospitals.

• Waiting period: The policy has a waiting period of 4 months or 120 days.

These are the main types of health insurance policies offered by HDFC ERGO insurance companies. The insurance provider has health plans for individuals, families and senior citizens, so you can check the options and select the best one for yourself and your loved ones.

HDFC ERGO Health Insurance - Claim Settlement Process

Along with the HDFC Ergo health insurance benefits, knowing about the claim settlement process is crucial. The claim settlement process of HDFC ERGO health insurance plans is quick and hassle-free. If you have an HDFC ERGO health policy, you can make a claim in one of the following ways:

1. Cashless claim

If you opt for a medical procedure at a network hospital, you can file a cashless claim by following the steps below:

• If you are planning to undergo a medical procedure, inform the insurance company about it 5 days before hospitalisation. If it is a medical emergency, inform the insurer as soon as possible, preferably within 24 hours of admission.

• Take a pre-authorisation form from the insurance desk at the hospital. You can alternatively visit the website of the TPA and download the form online.

• Fill the form correctly and submit it at the insurance desk.

• The TPA will check your form and start the claim settlement process.

• They will process the form and sanction the maximum treatment amount. The same will be conveyed to you through an email.

• The insurance company will settle your medical bills directly with the hospital. This will complete the claim settlement process.

2. Reimbursement claim

If you choose a non-network hospital for your treatment, the following are the steps to file a reimbursement claim with HDFC ERGO.

• Inform the insurer about your hospitalisation or medical procedure before the treatment (for planned surgeries) or within 24 hours of it.

• Obtain the required documents from the hospital to support your claim. These include:

- Doctor’s prescription or medical certificate recommending hospitalisation

- Doctor’s consultation slip and prescription

- Original copy of the discharge summary

- Prescriptions for medicines, original pharmacy bills and diagnosis reports

- Original copies of receipts from the hospital

- Ambulance receipt and FIR copy, if applicable

• Take a claim form from the insurance company or download it online. Fill out the form correctly, sign it and submit it to the insurer. You must also submit original copies of all the required documents with the claim form.

• The insurance company will verify the documents and process your claim.

• The approved claim amount will be reimbursed to your bank account.

Conclusion

Understanding what are the benefits of health insurance will enable you to opt for the right policy. HDFC ERGO health insurance plans offer wide coverage to policyholders and make things easier during medical emergencies. You can opt for the finest treatment at a reputed hospital without worrying about the bills. So, if you are looking to buy health insurance policies, HDFC ERGO is a good option.

Disclaimer : The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before concluding the sales

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