HDFC Ergo Maxima Health Insurance, India Mediclaim Insurance

Key features of Maxima Health

This policy covers persons in the age group 91 days onwards. The maximum entry age is 65 years.

There is no maximum cover ceasing age in this policy.

The policy will be issued for a period of 1 year

This policy can be issued to an individual and/or family. The family coverage in on floater basis and the coverage will be available for two members & two adults + upto 2 children.

The premium under floater coverage will be charged on the age of the eldest insured member

The family includes spouse, dependent children and dependent parents.

HDFC ERGO Health Insurance Review

HDFC ERGO Health Insurance sum insured
3 lacs − 75 lacs options available

Incurred Claims Ratio *
62.00%

HDFC ERGO 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

HDFC ERGO Maxima Health benefits

What’s Included?
Benefits
Exclusions

What’s Included under HDFC ERGO Maxima Health Insurance?

Day Care Procedures
Pre-hospitalisation Cover
Post-hospitalisation Cover
Hospitalisation Expenses
Road Ambulance Cover
Organ Donor Expenses
Newborn baby
Maternity Expenses
Daily Cash for choosing shared accommodation
Domiciliary Treatment
Daily Cash for accompanying an Insured Child

Benefits of HDFC ERGO Maxima Health Insurance

Out-patient Consultations - Out-patient consultations by a general Medical Practitioner(s) or a specialist Medical Practitioner(s).
In-patient Treatment - Covers hospitalisation expenses for period more than 24 hrs.
Pre-Hospitalisation - Medical Expenses incurred in 30 days before the hospitalisation, can be increased to 60 days if claim is intimated 5 days before hospitalisation.
Post-Hospitalisation - Medical Expenses incurred in 60 days after the hospitalisation, can be increased to 90 days if claim is intimated 5 days before hospitalisation.
Day-Care procedures - Medical Expenses for 140 listed Day care procedures.
Domiciliary Treatment - Medical Expenses incurred for availing medical treatment at home which would otherwise have required hospitalisation.
Daily Cash for choosing shared accommodation - Day by day money sum whenever hospitalized in Shared convenience in Network Hospital and hospitalization surpasses 48 hrs.
Organ Donor - Medical Expenses for an organ donor’s treatment for organ transplantation
Emergency Ambulance - Upto Rs. 2,000 for each hospitalization for using emergency vehicle administration for moving Insured Person to medical clinic if there should arise an occurrence of a crisis
Daily Cash for accompanying an insured child - Day by day money sum for 1 going with grown-up whenever guaranteed youngster matured 12 years or less is hospitalized and hospitalization surpasses 72 hrs.
Maternity Expenses - Medical Expenses for maternity including pre-natal and post-natal expenses after a waiting period of 4 years.

HDFC ERGO Maxima Health exclusions

War or similar situations
Breach of law: Expenses for treatment directly arising from or consequent upon any Insured Person committing or attempting to commit a breach of law with criminal intent.
Intentional self injury or attempted suicide while sane or insane.
Hazardous or Adventure sports
Treatment for alcoholism, drug or substance abuse or any addictive condition and consequences
Cosmetic or plastic surgery
Change of gender treatments
Critical Illness - Any Critical Illness within 90 days of the commencement of the policy