Health Insurance Claim process

An important update regarding your health policy!

Please note that from 15th April 2023, hospitalization for claims on reimbursement basis needs to be notified minimum 48 hours prior for planned treatments and within 24 hours for Emergency hospitalizations. This would help us to pre-process your claim for a smooth experience. Please notify the claim by clicking here

Cashless planned

Step 1. Hospitalization

Who Will Do it : Policy Holder

What Should be done? click Here to locate nearest network hospital

Step 2. Avail Cashless Hospitalization & Submission of Documents

Who Will Do it : Policy Holder

What Should be done? Avail cashless at the network hospital by showing your health card and valid photo ID

Step 3. Preauthorization

Who Will Do it : Network Hospital

What Should be done? Hospital will send the cashless request to HDFC ERGO and coordinate with us for the Pre-authorisation form .

Step 4. At the time of Discharge & Settlement of claim

Who Will Do it : HDFC ERGO

What Should be done? HDFC ERGO/ TPA will scrutinize all the received documents and convey the final stand on the claim.

Step 5. Status Update

Who Will Do it : HDFC ERGO

What Should be done? You will receive an update through SMS/Emails at every stage of the claim on your registered mobile number or email id.

Step 6.Cashless authorisation & Approval of Claim

Who will do it: HDFC ERGO & Network Hospital

What should be done? Hospital shall send the final bill to HDFC ERGO for authorisation and HDFC ERGO shall scrutinize the same and give final authorization in case of approved transactions to the hospital. Any inadmissible expenses, copayments, deductions will have to be paid by you.

Document Check List

On receipt of complete documents, the claim would be processed in 2 hour from the time the last document is received.
( Please note In case of internal verification the final stand will be confirmed within 24 hours from the time the last document is received by HDFC ERGO/ TPA )

Step 1. Claim Registration

To register the reimbursement or supplementary claim and to upload the documents instantly click here (file size to be 8MB each documents). To Download the KYC /NEFT & Digital claim form links are mentioned here for your further reference. Click here KYC, NEFT, Digital Claim form. If your claim is already registered kindly click here to upload your documents instantly.

Step 2. Processing of Claim

Once you have shared the documents, HDFC ERGO doctors team will review all the documents. Post satisfactory receipt of all necessary documents the claim will be processed in 15 days from the time of last document is received as per Terms & Conditions by HDFC ERGO. You would also receive update with claim status through SMS / Emails at every stage of the claim. You can also track your claim status instantly here
click here

Step 3. Process for uploading Additional/Pending documents

In case of any additional information or documents are required, HDFC ERGO will sent an intimation through SMS & Email for the same and you can upload it through the link mentioned here. To upload the query /pending documents click here

Post satisfactory receipt of all necessary documents the claim will be processed in 15 days from the time of last document is received as per Terms & Conditions by HDFC ERGO.

Step 4. Settlement of claim

Upon satisfactory receipt of all necessary documents the claim will be settled by HDFC ERGO within 15 days from the time of last document is received and approved claim payment would be processed. The payment will be made to your bank account through NEFT.

(Please note in case of any internal verification the final stand will be confirmed within 30 days from the time of last document is received by HDFC ERGO/ TPA)

Document Check List

List of documents needed for registering claim

Duly filled and signed claim form with HDFC Ergo policy number.
Original discharge summary.
Original final bill with detailed breakup, payment receipt and original pharmacy invoices supported by prescriptions.
Original investigation reports (eg. bloodreports, X-Ray, etc).
Implant sticker/invoice, if used (eg. forstent in angioplasty, lens cataract, etc).
Past treatment documents, if any.
Incases of accident, Medico Legal Certificate(MLC) or FIR.
Incase of Proposer expired Nominee detailto be provided. Legal heir certificate is required if nominee is minor.
Other relevant documents, if any.
NEFT details for payment - Cancelled cheque in the name of the proposer or passbook copy attested by bank. Also, provide KYC (Know your customer) form along with the photocopy of any one of the following KYC documents for all claims amounting to Rs. 1 lakh and above. Passport, Driving License, Voter ID, etc for KYC Form click here.
Important points to remember - Click here.
Sample Claim Form - Click here.