HDFC Ergo Insurance Plans

HDFC ERGO Health Insurance

HDFC ERGO General Insurance Company Ltd. is a joint venture between HDFC Ltd., India’s premier Housing Finance Institution and ERGO International AG, the primary insurance entity of Munich Re Group.
HDFC Ergo offers their health insurance customers the option of availing quality treatment at more than 10,000+ leading hospitals across the country. With an incurred claims ratio of 62.00%, they also covered 96.05 lac lives during the same year 2018-19, as per the data provided by IRDAI.

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Key features of HDFC Ergo Health Insurance

The health of your family is always a top priority and giving them the best treatment is always your motive. With HDFC ERGO’s Family Health insurance, be rest assured of no sub-limits on the hospital room rents, hospital charges, ICU, nursing, and diagnostic procedures, etc. Cover your entire family under a single policy and avail the benefits of HDFC ERGO’s health insurance policy through our instant buy option.
  • Room Rent: Payable at Actuals upto Sum Insured
  • Co-pay: NIL for all treatment, Optional Co pay available between 10%-15%
  • Restoration: Sum Insured Rebound upto 100% of Sum Insured per year

HDFC ERGO Health Insurance Review

HDFC ERGO Health Insurance
HDFC ERGO Health Insurance sum insured
3 lacs − 75 lacs options available
Incurred Claims Ratio *
62.00%
HDFC ERGO Health Insurance tenure options
2 years
Claims Settlement Ratio **
85.97%
List of network hospitals
10,000+ hospitals
Number of policies issued *
1,066,395
Maximum family floater coverage
Self, Spouse + dependent (children (upto 25 yrs) + parents)
Number of lives covered *
96,05,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

Why Should One insure themselves through HDFC Ergo Health Insurance plans?

  • HDFC Ergo is one of India’s Fastest growing Private sector General Insurance companies overall and now aggressively ventured into the Health Insurance space through the acquisition of Apollo Munich Health Insurance
  • Insured more than 1 crore customers across all products in India as on June 2020
  • Cashless Hospitalization Across the Large Network With More Than 10,000+ Hospitals in India for their insured customers
  • Wide Range Of Health Insurance Products From Individual Plans to Family Floater Schemes with Sum Insureds ranging from ₹3 lacs to ₹75 lacs
  • HDFC Ergo has the iAAA rating for its "highest claim paying ability"
  • Supported by HDFC Banks’ wide bank branch network across India through their Bancassurance business
  • World class Customer Support through its 24X& service centre known for transparency and ease
HDFC Ergo Insurance is today one of the fastest growing insurance players in India with a lot of focus on both retail and group insurance products. Today the HDFC Ergo health insurance premium is one of the most competitive in the market across all their plans apart from being competitive in their benefit structure. They are also one of the players who have built a strong hospital network across India with a current strength of 10,000+. Most of the customer’s HDFC Ergo health insurance reviews have been positively influencing the growth of their business year on year. One can renew HDFC Ergo health insurance using the renewal link of their existing policies and if one needs to file a claim, all they need to do is to fill in the HDFC Ergo health insurance claim form available on the same website.

Policy wordings

How can one Buy a HDFC Ergo Health Insurance policy?

There are many distribution channels that distribute HDFC Ergo Health insurance products that include Agents, Banks and Brokers. One of the key distributors is the Web Aggregators which are online distributors of insurance and the advantage is that they offer a comparison of all insurance products to the customer, to allow them to compare the plans before opting for best HDFC ERGO health insurance plan that most suits his/her needs.
  • Step 1- Compare HDFC Ergo health insurance to review and compare policy benefits, coverage and premium details online
  • Step 2- Seek information and clarity on the charges, inclusions, exclusions, other terms and conditions under the policy
  • Step 3- Fill the HDFC Ergo online Health Insurance proposal form stating your personal details and health profile while ensuring the information given is complete and accurate
  • Step 4– If this is a Straight through proposal, the premium remitted online will be transferred directly to the insurance company, and the policy will be issued, dispatched and will reach you in 7 working days
  • Step 5– For Non Straight through cases, HDFC Ergo will process the application forwarded to them. Based on the information provided, one may be required to undergo pre-policy tests at designated diagnostic centers or they may just levy a loading based on the health report
  • Step 6- If the proposal is accepted, the same will be issued accordingly
  • Step 7- The Policy Schedule, Policy Wordings, Cashless Cards and Health Guide will be sent to the insured’s mailing address mentioned on the proposal form in the prescribed Turn around time.

HDFC Ergo Health Insurance review

  • Benefits
  • Claims procedure
  • Exclusions

Benefits under HDFC Ergo Health Insurance plans include:

Some of the benefits under the HDFC Ergo Health plans are below…
  • Cashless facility: HDFC Ergo processes all cashless claims across 10,000 + quality hospitals in their network across India
  • Hospitalisation expenses: Coverage for room rental expenses up to the sum insured for most of their plans. Pre and post hospitalisation expenses are covered up to the sum insured, 90 days prior and 180 days post hospitalisation depending on the plan opted for
  • Inpatient Treatment Covered expenses include: Hospital room rent, Boarding expenses and doctor fees, Operation Theatre and Intensive Care charges, Nursing expenses and Medicines that you consume during the hospital stay
  • Sum Insured rebound: This benefit recharges your exhausted health cover to treat the next hospitalization of a new illness or injury, the recharge is upto 100% of the Sum insured.
  • No Medical Test Upto 45 Years: If one is young, hale and hearty then get yourself a health insurance plan by HDFC ERGO without any medical check-ups.
  • Cashless Home Health care: If your Doctor recommends you can get yourself treated at home and avail cashless medical facilities then this feature would be of utmost help.
  • Day care procedures: Medical/Technology advancements have helped in conducting important surgeries and treatments in less than 24 hours, and this policy covers the listed day care procedures
  • AYUSH Benefits: Alternate therapies like Ayurveda, Unaani, Siddha and Homeopathy remain covered as the company covers hospitalization expenses for AYUSH treatment as well.
  • Organ Donor Expenses: Organ donation benefit covers the medical and surgical expenses of the organ donor when harvesting a major organ transplant.
  • Recovery benefit: If you stay in a hospital for more than 10 days at a stretch then we pay for other financial losses that might have happened due to your absence at home. It helps to take care of other expenses during your hospitalization.
  • Mental healthcare: We believe mental healthcare is just as important as hospitalization due to physical illness or injury; hence we cover hospitalization expenses incurred for treating mental illnesses.
  • Free Renewal Health Check-up: Get a free health check-up within 60 days after policy renewal done by HDFC ERGO at the time of renewing your policy with us.
  • No entry age restriction: If you are 18 years old and above you can buy our health insurance plan without any hesitation. We secure people of all age groups.
  • Health Check up: Policy provides health check-up as per the applicable plan as specified in the Product Benefits Table, once every 3 claim free years.
  • Lifelong Renewability: HDFC Ergo assures you renewability for life without any extra loadings based on the claims
  • Income Tax Exemption under section 80D if the Income Tax Act.

Claim Process

Assistance Contact Numbers : For Health Claims
Call at : 022 6234 6234 / 0120 6234 6234
Whats app at : 73045 24888
Email ID : Network Hospital Issues (Claims): nsp@hdfcergo.com
Authorisation issues (Claims): preauth@hdfcergo.com
Write at : HCS – Noida, 5th floor, Tower 1, Stellar IT Park, C-25, Sector-62, Noida, UP, India - 201301

Cashless Claims Process

Step 1 Get admitted to any one of HDFC Ergo network hospitals, currently they have 6000+ hospitals across the country…check out the hospital list.
(Note: Cashless Facility is only available at hospitals in the company’s cashless network)
Step 2 Use your HDFC Ergo Health Card or share your Policy number and Passport / PAN card / voter’s ID for identification purposes
Step 3 The Network Hospital will check your identity for validation and submit the pre-authorisation request form to HDFC Ergo as per the defined process/format
Step 4 HDFC Ergo will review and provide our confirmation to the Network Hospital regarding the coverage limits and admissibility for the treatment for which the insured has been admitted.
Step 5 HDFC Ergo will settle the claim (as per policy terms & conditions) with the hospital after completion of all formalities of documentation as per submission by the hospital.

Reimbursement Claims Process

Step 1 In case of hospitalization notify HDFC Ergo within 24-48 hours of your admission in our network or non network hospital. After getting admitted settle bills directly to the hospital.
Step 2 On discharge, please ensure you collect all relevant documents, invoices, medical reports and discharge certificate from the Hospital in originals.
Step 3 Send these documents and the completely filled and signed claim form to us along with your valid ID proof and age proof. The claim form is available on the company website and in your policy document kit as well.
Step 4 We review your claim request and the supporting documents provided along with the claim form. Accordingly based on policy terms & conditions, HDFC Ergo will approve, query or reject the same.
Step 5 Subject to the claim being approved, HDFC Ergo will settle the claim (as per policy terms & conditions) and reimburse the approved amount to the insured.

List of documents needed for registering claim

  • Duly filled and signed claim form with HDFC Ergo policy number Claim Form
  • Original discharge summary
  • Original final bill with detailed breakup,payment receipt and,original pharmacy invoices supported by prescriptions
  • Original investigation reports (eg. blood reports, X-Ray, etc)
  • Implant sticker/invoice, if used (eg. for stent in angioplasty, lens cataract, etc.)
  • Past treatment documents, if any
  • In cases of accident, Medico Legal Certificate (MLC) or FIR
  • Other relevant documents, if any
  • NEFT details for payment: Cancelled cheque in the name of the proposer or passbook copy attested by bank 6) For all claims amounting to 1 lakh and above: KYC form along with photocopy of any one KYC document (eg. aadhar card, passport, driving license, voter ID, etc)
  • For all claims amounting to 1 lakh and above: KYC form along with photocopy of any one KYC document (eg. aadhar card, passport, driving license, voter ID, etc) KYC Form

Exclusions of HDFC Ergo health insurance

Some of the permanent exclusions under the HDFC Ergo Health Insurance Plans are below, kindly review the policy wordings which are available with your policy kit for the entire list of exclusions under your opted plan. HDFC Ergo will not make any payment for any claim in respect of any Insured Person directly or indirectly for, caused by, arising from or in any way attributable to any of the following unless expressly stated to the contrary in this Policy:
  • War or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind
  • Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self-injury or attempted suicide or suicide while mentally sound or unsound
  • Any Insured Person’s participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing of a professional or semi-professional nature
  • The abuse or the consequences of the abuse of tobacco, intoxicants or hallucinogenic substances such as drugs and alcohol, including smoking cessation programs and the treatment of nicotine addiction or alcohol addiction programs, any other substance abuse treatment or services, or supplies.
  • Treatment of Obesity and any weight control program
  • Sleep-apnoea, Parkinson and Alzheimer’s disease, general debility or exhaustion ("run-down condition”)
  • Congenital external diseases, defects or anomalies,
  • Stem cell harvesting, or growth hormone therapy. Venereal disease, sexually transmitted disease or Illness
  • Pregnancy (including voluntary termination), miscarriage except as a result of an Accident or Illness), maternity or birth (including caesarean section) except in the case of ectopic pregnancy
  • Treatment to treat infertility any fertility, sub-fertility or assisted conception procedure Dental Treatment and surgery of any kind, unless requiring Hospitalization
  • Circumcisions (unless necessitated by Illness or Injury an forming part of treatment); treatment for correction of vision due to refractive error, aesthetic or change-of-life treatments of any description such as sex transformation operations
  • Plastic surgery or cosmetic surgery or treatments to change appearance unless necessary as a part of Medically Necessary Treatment certified by the attending Medical Practitioner for reconstruction following an Accident, cancer or burns.
  • Experimental, investigational or Unproven treatments, devices and pharmacological regimens
  • Preventive care, any physical, psychiatric or psychological examinations or testing if doesn’t required Hospitalization; enteral feedings (infusion formulas via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements, unless certified to be required by the attending
  • Non-Medical expenses such as charges for admission, discharge, registration, Items of personal comfort and convenience including but not limited to television (wherever specifically charged for) , charges for access to telephone and telephone calls (wherever specifically charged for), foodstuffs (except patient‘s diet), cosmetics, hygiene articles, body care products and bath additive, barber or beauty service, guest service as well as similar incidental services and supplies, and medical supplies including elastic stockings, diabetic test strips, Charges related to a Hospital stay not expressly mentioned as being covered, including but not limited to, administration, documentation and filing.
  • Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed; treatments rendered by a Medical Practitioner who is a member of an Insured Person’s family, or stays with him
  • The provision or fitting of hearing aids, spectacles or contact lenses
  • Expenses for Artificial limbs, crutches or any other external appliance and/or device used for diagnosis or treatment (except when used intra-operatively).
  • Any Claim arising due to Non-disclosure of Pre-existing Illness or Material fact as sought to be declared on the Proposal form

Health Insurance Products

Key Features:
  • Cashless claims at 4800+ network hospitals.
  • One policy covers entire family.
  • No sub limit.

Key Features:
  • This policy covers persons in the age group 91 days onwards. There is no maximum entry age.
  • Children below 5 years would be covered provided both the parents are covered under our policy.
Key Features:
  • Covers 8 critical illness.
  • Provides a lump sum benefit on first diagnosis.
  • No health check-up.
Key Features:
  • Offers Lump Sum Benefit on first diagnosis any of 15 critical Illnesses
  • Sum Insured available from ₹100,000 to ₹50,00,000
  • Option to choose survival period of 15 days/ 30 days
Key Features:
  • Insured’s Parents and Parents-in-law can be covered under the same policy on Individual Sum Insured basis or under a Separate Policy on Floater basis


Key Features:
  • Minimum age at entry will be 3 months for children and 18 years for adults.
  • Entry and renewals are available for Lifetime
  • Children between the age of 3 months (91 days) and 18 years will be covered only if either of the parent is covered.
Key Features:
  • Lifelong renewability.
  • Grace period of 30 days at renewal.
  • Free look period of 15 days at the policy inception.

Key Features:
  • Multiple sum insured options ranging from Rs. 1 Lakh to Rs. 5 Lakhs available under this policy
  • Comprehensive policy covering Hospitalization expenses with life time renewal
Key Features:
  • HDFC ERGO Women Cancer Plus Plan - cover you against cancer along with major illnesses.

Key Features:
  • Women's health is as important as any other member of your family, secure it today and stay protected from cancer, major diseases, heart disease and other major surgeries under one single plan with HDFC ERGO
Key Features:
  • Your wellbeing is as critical as that of any other member of your family, secure it today and stay safe from various ailments under a single plan with HDFC ERGO.

Key Features:
  • Person age between 18 yrs to 65 years



HDFC Ergo Health Insurance FAQ’s

Looking at the healthcare inflation cost coupled with the lifestyle disease epidemic, health insurance is needed to help you pay for health care in the event of an unexpected illness or injuries. HDFC Ergo Health Insurance covers medical uncertainties and ensures quality medical treatment at the time of need.

The earlier the better, typically, when you are in your early 20's and you have just started earning Health insurance also helps in financial planning and offers wider coverage at a lower premium.

Your own health insurance means an all round cover that secures your medical needs. After a period when you are no more eligible to stay covered under your parent's policy, your own health insurance helps you at times of need.

Your ideal sum insured or total coverage would highly depend on factors such as your current age, lifestyle, medical history, income and place of residence. Looking at the medical inflation, most of our customers prefer a health insurance policy with a sum insured of 5 lacs and above.

Health Insurance covers not just major illnesses arising due to infection and accidents which can affect anyone at any point of time in life. Hence HDFC Ergo Health Insurance is equally important for a fitness expert or an athlete.

Absolutely! With employee health cover the major drawbacks come in picture when you leave your job that's when your policy goes out of action and exposes you to health risks. Your new employer may or may not cover you sufficiently. Also, having your own policy means a better buying decision and complete control to buy a cover which suits your requirement from time to time.

Yes! We do cover you subject to no adverse medical conditions due to same.

You can raise a claim via their mobile application my:health active. At HDFC ERGO, 90% reimbursement claims are settled within 3 days and around 90% are cashless claims are pre-authorized within 20 minutes.

Under cashless hospitalization, the insured person does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by us for treatment that the insured person is eligible to receive under the terms of his/her policy. This is for your convenience. However, it is important to note here that prior approval is required from us before admission into the hospital. In some cases, you may have to pay for all or part of the treatment if it is not fully covered under the terms of the policy. However, in case of emergency hospitalization, you can obtain approval post-admission. Please note that the cashless facility is available only at our Network Hospitals.

HDFC Ergo has an extensive network of 10,000+ network hospitals across India growing steadily over the years. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can find the hospital closest to them by reviewing the list of network hospitals at HDFC Ergo health insurance

There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.

A pre - existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within 36/48 months prior to 1st health insurance policy issued by Us under which the insured person was covered.

Most of the Health Insurance Policies offered by the General Insurance companies in India have waiting periods during which certain pre existing diseases are excluded in the coverage. They are excluded for certain predefined period (number of years) before they are covered i.e. The Policy holder is expected to have continuous cover for the predefined period before the pre existing diseases are covered under the policy. Portability will ensure that these accrued benefits are transferred (without any dilution) to the new insurer at the time of renewal and porting and the consumer do not lose on these accrued benefits while opting to switch the insurer using Health Insurance Portability. The Policy holder can port the following accrued credits: General waiting period Waiting periods pertaining to the coverage of pre - existing diseases / conditions Any time bound exclusions

It refers to payment of the Medical Expenses incurred by the insured, immediately 90 days before and 180 days after Hospitalization.

It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.

Pre - acceptance Health check is not mandatory for people who are less than 45 years old and without any history of illness. Insured’s with following condition, acceptance of proposal is subject to a satisfactory medical examination as per HDFC Ergo’s requirements.

Premium for Family Floater Policy is calculated basis the age of the oldest member of the family to be insured.

Individual plan has to be separate for every individual. Floater covers all in family (max. 2 Adults and Children upto 25 years and Dependent parents) and provides one sum insured to all, hence there is saving of premium.

There is No maximum exit age for HDFC Ergo medical insurance.

Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.

The duration only after which a claim can be made is called the waiting period.

The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!

Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs

A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.

The following KYC documents are required from the insured person/proposer in cases of reimbursement-
  • If claim amount is below 1 lakh- Photo Id proof & address proof
  • If claim amount is above 1 lakh- Photo Id proof, address proof and a recent photograph
List of necessary claim documents to be submitted for reimbursement are as following:
  • Claim form duly signed
  • Copy of photo id of patient
  • Hospital discharge summary
  • Operation theatre notes
  • Hospital main bill
  • Hospital break up bill
  • Investigation reports
  • Original investigation reports, X ray, MRI, CT films, HPE, ECG
  • Doctors reference slip for investigation
  • Pharmacy bills
  • MLC/ FIR report, post mortem report if applicable and conducted

A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.

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HDFC ERGO health insurance useful links

How to buy online?

You can buy insurance online by using a credit/debit card, direct funds transfer using NEFT or RTGS or by using a cheque

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Network hospitals

HDFC ERGO Network hospitals list. Cashless & Hassle-free direct claim settlement with us at 10,000+ Hospitals

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Health insurance benefits

Insurance customers can quickly compare the details of benefits offered under Indian mediclaim insurance policies.

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Portability

Portability Information for Mediclaim Insurance in India.


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Health insurance FAQ

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  • Address

    InstantCover Insurance Web Aggregator Private limited
    710, 6th B Cross, 16th Main Road, Koramangala 3rd Block, Bangalore - 560 034.

  • +91-(80)-41744345
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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2022
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