HDFC Ergo Health Suraksha Policy

Brief Overview

Merged in August 2017, HDFC Ergo is a general insurance company that is a joint venture between HDFC and ERGO International, Germany. The company is already the third-largest General Insurer company in the private sector. Due to its high claim settlement record, the company was conferred with an ‘AAAA’ rating by the ICRA and has also won various awards since its establishment. 

Being one of the most trusted firms, HDFC ERGO provides multiple insurance products like motor, travel, home and health. In this article, we are going to discuss all about HDFC Ergo Health Suraksha Policy.

HDFC Ergo Health Suraksha Policy - Highlights

Designed to meet the medical care requirements of your family and you, HDFC Ergo Health Suraksha Policy is an affordable health insurance plan that would cover you against injuries and diseases. Before discussing the features of the plan in detail, let us take a quick look at the highlights of this plan:

• You have a choice to pick a sum insured of your choice, which ranges from INR 3 lakhs to INR 75 lakhs
• No maximum entry age, as the plan comes with a ‘lifetime renewal’ benefit
• Exclusive features like Fitness Discounts, Health Incentives that will reward you on staying healthy
• Special cover for air ambulance, infertility and recovery benefits
• You have the flexibility to choose a cap on room rent, co-payment
• Avail multiple discounts through offers like-Family Discount, Long Term Policy Discount, Loyalty Discount
• You do not need to undergo a medical test till you turn 45 and up to sum insured of INR 20 lakhs
• The Wellness Application is a unique feature of the policy and helps you keep a track record of your health and also get rewarded for the same
• Long-term policy tenure of 3 years
• A claim-free policy will entitle you to a cumulative bonus
• You can also avail a renewal benefit that entitles you a 5% rise in the yearly limit against every claim-free year
• Pick a health insurance premium paying instalment frequency that suits you the best

HDFC Ergo Health Suraksha Policy - Benefits 

1. Options to Choose Sum Insured
   The sum insured can range from INR 3 lakhs to INR 75 lakhs, making this health plan suitable for almost all kinds of budgets.
2. Medical Expenses
   The policy overs:
   • Room charges, Boarding and nursing
   • Consultation Charges
   • Medicines and consumables
   • Diagnostic procedures
   • ICU charges
   • Consultation fees
3. Wide Coverage
   Depending upon your personal requirements, you can either select the individual the Family floater health insurance option.
4. Cashless Claims
   With a hospital network of over 10,000, you can make cashless health insurance claims almost anywhere in the country.
5. Pre-hospitalisation
   The medical expenses that you incur 60 days prior to the hospitalisation will be covered, provided the expenditure is done for the same injury/illness.
6. Post-hospitalisation
   Expenditure on treatment does not end with hospitalisation. Under this plan, the expenses related to the same injury/illness will be covered for a period of 180 days from the date of discharge.
7. Recovery Benefit
   When you are admitted to a hospital for a period of 10 days or more, then your Suraksha policy would help you recover from the financial losses that your absence may have caused.
8. Sum Insured Rebound
   In case of a shortage in the sum insured, you can avail of an additional amount to treat the illness.
9. Lifetime Renewability
   HDFC Ergo Health Suraksha policy comes with the option of lifelong renewability. You can avail of the benefits for as long as you live.
10. Instalment Benefit
    Your health insurance can be all the more affordable as you can pay for the policy in easy instalments.
11. Day Care Treatment
    Certain treatments require less than 24 hours of hospitalisation. The medical expenses that are made for any of the 586 listed day-care treatments or at the day-care centre are covered under this policy.
12. Domiciliary Treatment
    Sometimes an insured person may be too sick to be taken to a hospital or there is an unavailability of a hospital bed, the expenses that are incurred for the medical treatment at home would be covered by the insurance company. It should be kept in mind that only with the prescription of a medical practitioner would the reimbursement be carried out.
13. Ambulance Cover
    • Road Ambulance- If an insured is to be transferred to the nearest hospital in an emergency, the road ambulance cost will be covered.
    • Air Ambulance- Transportation through an aeroplane or a helicopter will be covered in case of an emergency and when prescribed by a doctor. The transport will be from the first site of illness or injury to the nearest hospital.
14. Mental Healthcare
    Hospitalisation because of mental illness which is in accordance with the Mental Healthcare Act, 2017 will be covered in the following scenarios:
    • Hospitalisation in doctor-prescribed
    • The treatment is done in a Mental Health Environment
15. Health Check-ups
    When you go claim-free for a period of 4 years, the company will provide you with the cost of a health check-up.
16. Organ Donor Expenses
    Under the Transplantation of Human Organ (Amendment) Act, 2011, Transplantation of Human Organs and Tissues Rules, 2014 and other applicable laws and rules, the organ donor expenses are borne by the insurance company.
17. Discounts
    • Family Discount of 10% on the premium if 2 or more family members are covered under Individual Sum insured
    • Loyalty Discount of 2.5% when you purchase more than 1 product from them
18. Alternative Treatments
    Some people do not feel comfortable with allopathic treatments and for them, this policy can be a boon as the following treatments by a medical practitioner are covered:
    • Ayurvedic
    • Yoga
    • Unani
    • Siddha
    • Homoeopathy

HDFC Ergo Health Suraksha Policy - What is not covered?

Certain services that are not included in a health insurance cover are called exclusions. The exclusions of HDFC Ergo Health Suraksha Policy are given below:

1. Waiting Period
   Any treatment (except injuries that require hospitalisation) that you, the policyholder, undertakes during the waiting period will not be covered.
   • General Waiting Period- 30 days
   • Illness and Procedures - 24 months
   • Pre-Existing Conditions- 36 months
   • Parent and Child Care Cover-Booster- 48 months
2. Self-inflicted injuries are not covered
3. Treatment that is required because of any kind of intoxication use or misuse will not be covered
4. Expenses on dental treatments except when hospitalisation is required
5. Treatments for infertility, sterility,  birth control, surrogate or vicarious pregnancy will not be covered (unless opted for)
6. Accidents encountered while participating in adventure sports or defence operations
7. Treatments related to sexually transmitted diseases, obesity or cosmetic surgery
8. Injury/death in war is not covered

These are some of the most common exclusions applied by most health insurance companies. It is recommended that you carefully consider the exclusion policy of your insurance company.

HDFC Ergo Health Suraksha Policy - Other Details

1. Free Look period
   A 15-day period starting from the date of purchase is given to you when you buy the policy. Within this time, you can evaluate the terms and conditions. In case the policy is not as per your requirements and you have not made any claims, you can return it. A refund will be initiated on your request. The cost of pre-acceptance of medical screening, stamp duty charges and proportionate risk premium will be subtracted from the premium that you have paid.
2. Termination of Policy
   • If you wish to terminate the policy you would have to submit a written request for the same. in case you have not made any claims yet, the refund will be on the following basis:

• If you are found to have acted in a fraudulent manner, the company can terminate the policy
• If the policyholder expires, the policy will end

1. Tax Benefits
   The premium that you pay towards health insurance is exempted under Section 80D of the Income Tax Act. However, you would not be able to avail of this benefit if you pay the amount using cash. You can enjoy tax benefits of up to INR 25,000 or INR 50,000(in case you are above 60 years)under this plan.
2. Grace Period
   Once the policy expires, a 30-day grace period is given to you to renew the policy. After the grace period is over, your policy will lapse. 
   Note that you would not be able to avail of any benefits during the grace period.
3. Co-payment
   Under co-payment, you would have to bear a fixed percentage of the admissible claim amount. The option of co-payment does not lower the sum-insured in any way. Once this option is selected, you cannot withdraw it.

HDFC Ergo Health Suraksha Policy - Renewal Health Plan

Depending on the policy tenure that you have picked for yourself, you would be required to pay for the same. To renew your policy you can follow any of the given options:

1. Online Renewal
   On the official website, www.hdfcergo.com visit ‘Online Renewal’ and renew the policy instantly
2. Speak to a customer care executive and renew your policy. Call on 022-6234 6234 OR 0120-6234 6234
3. Email your renewal request to care@hdfcergo.com
4. Send a Cheque or a Demand Draft in the name of HDFC General Insurance at this address: D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai - 400 078.

At the time of renewal, remember –

• The policy will end when the policy tenure is over
• The company is not obligated to notify you about the approaching expiry date
• If renewed within the grace period, the policy cover may be considered continuous in terms of continuity benefits, such as the waiting period
• The policy premium may be revised, with the approval of IRDA

HDFC Ergo Health Suraksha Policy - Eligibility

HDFC Ergo Health Suraksha Policy - Claim Process

HDFC Ergo is known for its super-quick claims. However, you as a policyholder must be mindful of your responsibilities and adhere to the guidelines issued by the company. Following the company policy will help in making the claim process easy and quick. 

When you wish to make a claim, there are two ways to proceed-

Cashless Claims
To make a cashless claim, you must keep in mind that you need to get the treatment done at a network hospital. A network hospital is a hospital or a healthcare centre that has a tie-up with the hospital. The cost of treatment is paid by the insurance company directly and you need not pay for the hospitalisation.

However, this doesn’t mean that you do not have to pay anything. Depending on the variant selected by you, you will have to pay your share under co-payment and for services not covered in the plan. 

For a planned treatment, you have to obtain pre-authorisation for a Cashless facility at least 48 hours before treatment. Once the pre-authorised is received, the treatment must be carried out within a given number of days. 
In case of emergency treatment,  for pre-authorising the cashless facility, the company must be informed within 24 hours after hospitalisation or treatment

Reimbursement Claims
Sometimes going to a network hospital may not be possible, due to lack of time or because of unavailability of a certain kind of treatment. In such a case, you can visit a non-network hospital for treatment and make the payments up-front. After the treatment is over,  you can request for reimbursement. 
However, you would have to ensure that you inform the insurance company within 48 hours of hospitalisation. You would have to fill in and submit the claim form along with other essential documents. The list of documents that would be required when making a claim is  given below:

Documents Required: 

• Health Card issued by Company, along with KYC papers
• Duly filled and signed Claim Form
• Original Payment Receipts
• All diagnostic and pathological Reports
• Original discharge summary, with the date of admission and discharge, history
• Invoice of transplants, if applicable
• Nature of Illness and the Treatment required
• Detail of Individual Medical services
• Doctor’s prescriptions - medicines or/and diagnostic tests
• Copy of Death Certificate (for death claim)
• Copy of FIR (First Information Report, in case of an accident

HDFC Ergo Health Insurance - Customer Care Details 

HDFC Ergo Health Insurance provides the following ways of contacting the company for your queries or complaints.

HDFC Ergo Health Suraksha Policy - Review

HDFC Ergo Health Suraksha Policy is a comprehensive health insurance plan that offers its customers a wide coverage at an affordable price. This health insurance policy offers cover for hospitalisation, hospitalisation at home and also for mental care. Along with allopathic treatments, AYUSH cover is also available, making it a suitable plan for a big number of people.

As the plan includes both cashless and reimbursement claim options, you can focus on the treatment rather than worrying about the expenses. HDFC Ergo follows a 30-minute TAT (turn-around-time) to process cashless claims. With a sum insured that ranges from INR 3 lakhs to INR 75 lakhs, you can choose a variant that you find most suitable. Along with the benefits of the plan, you also get the insurance benefits from one of India’s most popular insurance companies.