HDFC ERGO Health Suraksha Policy offers cashless claims in over 13,000 network hospitals in the country. An individual can opt or a policy coverage starting from INR 300,000/- and increasing it by multiples of INR 100,000/- up to INR 500,000/-, In addition to what is quickly becoming a standard health insurance package offering in-patient treatment, pre and post hospitalisation expenses, the policy also offers coverage of 144 listed day-care procedures, domiciliary treatment and inpatient hospitalisation expenses up to the sum insured even for Ayurvedic,Unani, Siddha & Homeopathy treatment.
Scope of Coverage
In-patient Hospitalisation Expenses: In the event of illness or accident, expenses related to hospitalisation for the same are covered subject to certain exclusions explained later in the blog.
Pre-hospitalisation Expense: Specified medical expenses relating to the procedures/illnesses for which the insured person is hospitalised will be covered up to a prior period of 60 days, and 5% of the insured amount.
Post-hospitalisation Expense: Specified medical expenses relating to the procedure/illness for which the insured person is hospitalised will be covered up to a period of 90 days after discharge and 10% of the insured amount.
Domiciliary Treatment: Medical expenses for domiciliary treatment is covered if hospitalisation was advised by the attending physician, but could not be undertaken due to the non-availability of a hospital bed or if for some exigency, the person covered could not be transferred to the hospital.
Organ Donor Treatment: In case the insured requires an organ transplant, the expenses of the donor are also covered under this policy.
Alternative Medicine Hospitalisation Treatment: This policy also offers coverage of in-patient treatment in non-allopathic hospitals of the Unani, Ayurvedic, Homeopathic and Siddha streams of medicine, subject to their recognition by the Government of India.
Ambulance Expenses: The policy offers reimbursement of ambulance expenses in case of emergencies up to INR 2000/-
Cashless Coverage: The HDFC ERGO Health Suraksha plan offers a network of over 13,000 hospitals from which treatment may be obtained on a cashless basis. In order to take advantage of cashless coverage, notice of 48 hours is required for a planned treatment. In case of emergencies, HDFC ERGO needs to be informed within 24 hours.
Reimbursement against Claims: In case of treatment in non-network hospitals, reimbursements are provided after the claim is registered in the manner prescribed by HDFC ERGO health insurance. This includes a duly filled claim form, bills and investigation reports in original, copy of the policy document, etc. Claims should be submitted within seven days of the insured’s discharge from the hospital.
The total amount covered however, against pre and post hospitalisation, along with hospitalisation costs and treatment of an organ donor will only be the total of the sum insured.
Exclusions
As with most health insurance policies, the HDFC ERGO Health Suraksha Policy, comes with some exclusions. This includes a waiting period of 30 days before you can make any claim against the policy, except in the case of accidents. There is a 2-year period for certain specific illnesses/treatments such as internal tumours, cysts, surgery on tonsils and sinus related. Pre-existing conditions invite a 4-year waiting period.
The policy also has some permanent exclusions.
- Hospitalisation due to war
- Injuries due to adventure sports
- Attempted suicide or self-inflicted injury
- Claims related to use of drugs and alcohol
- No cover for sexually transmitted diseases
- Plastic/cosmetic surgery also forms part of the exclusions unless it was carried out due to a medically necessary treatment.
There are several other diseases which come under the exclusion clause, such as psychiatric and mental disorders, Parkinson and Alzheimer’s disease, external congenital diseases, defects or anomalies, genetic disorders, stem cell implantation or surgery, AIDS, pregnancy, miscarriage (except as a result of an accident or illness), dental treatment, etc., unless requiring hospitalisation, etc.
Other Features
Family Floater Feature: This policy can be availed of as a family floater policy, i.e. two, three or more members of the same family may be covered under a single policy umbrella.
Cumulative Bonus: This policy offers a bonus of 5% of the basic sum insured for every claim free year, i.e. the insured amount increases by 5% every year, up to a maximum of 50% of the basic sum insured. In case of a claim, however, there is a corresponding deduction in the sum insured. However, in order to be eligible for this, the policy must be renewed in time.
Health Check-up: If the policyholder completes 4 continuous years without making any claim, she or he will be entitled to a health check-up subject to a maximum load of INR 5000/- or 1% of the sum insured for that policy year. However, if covered under the family floater policy, the free health check up cannot be availed by any member if any single member covered under the policy raises a claim during the preceding four years.
Renewal of Policy: This policy may be renewed up to 65 years of age.
Termination of Policy: HDFC ERGO Health Suraksha Policy may be terminated early (within six months) there is no claim against it during the policy year. If terminated within a month of issuance, 75% of the premium amount is returned to the insured; within 3 months, allows return of 50%, and 25% up to 6 months.
Conclusion
With a network of over 13,000 hospitals, cashless coverage, coverage of 144 day-care procedures, the HDFC ERGO Health Suraksha Policy is a health insurance policy that is worth consideration. Be sure to check the exclusions carefully and evaluate as to whether you or the members included under the policy are likely to need coverage for those conditions. If so, you could consider a critical illness add-on policy as this may make the total of both premiums more affordable than buying a single policy that covers all the conditions you may consider yourself or the insured persons to be at risk from.
