HDFC ERGO Women's Critical Illness Essential Plan

HDFC Ergo Entry Age for all the Cancer Covers:

• Proposer
  • Minimum Entry Age – 18 Years
  • Maximum Entry Age – 65 Years
• Adult Dependent
  • Minimum Entry Age – 18 Years
  • Maximum Entry Age – 65 Years

Coverages for Critical Illnesses Include

Critical Illness/Surgical Procedure	Stage
Surgery of Aorta	Major
Kidney failure requiring regular dialysis	Major
Infective Endocarditis	Major
Major Organ/Bone Marrow Transplantation	Major
Primary (Idiopathic) Pulmonary Hypertension	Major
End Stage Liver Failure	Major
Dissecting Aortic Aneurysm	Major
Medullary Cystic Disease	Major
Cardiomyopathy	Major
Aplastic Anaemia	Major
Other serious coronary artery disease	Major
End Stage Lung Failure	Major
Eisenmenger’s Syndrome	Major
Fulminant Hepatitis	Major
Multiple Sclerosis with persisting symptoms	Major
Chronic Adrenal Insufficiency (Addison’s Disease)	Major
Permanent Paralysis of Limbs	Major
Progressive Scleroderma	Major
Benign Brain Tumour	Major
Chronic Relapsing Pancreatitis	Major
Parkinson’s Disease	Major
Elephantiasis	Major
Alzheimer’s Disease	Major
HIV due to blood transfusion and occupationally acquired HIV	Major
Motor Neurone Disease with permanent symptoms	Major
Terminal Illness	Major
Muscular Dystrophy	Major
Myelofibrosis	Major
Apallic Syndrome	Major
Pheochromocytoma	Major
Bacterial Meningitis	Major
Crohn’s Disease	Major
Creutzfeldt-Jakob Disease (CJD)	Major
Severe Ulcerative Colitis	Major
Encephalitis	Major
Deafness	Major
Major Head Trauma	Major
Loss of Speech	Major
Progressive Supranuclear Palsy	Major
Blindness	Major
Brain Surgery	Major

Survival Period

Claim under this Section is payable only if Insured Person survives 7days from the diagnosis and fulfilment of the definition of the Critical Illnesscovered.The Claim is payable only with confirmatory diagnosis of theconditions covered while the Insured Person is alive (A claim wouldnot be admitted if the diagnosis is made post mortem)

No of Claims and Benefits payable

Only one Claim is payable under each of the stages given belowduring lifetime of the Policy under this Section.

• Minor Stage - On the admissibility of Claim under Minor Stagecondition under the Policy, coverage for all other Minor stageConditions shall cease to exist. The Policy shall continue to CoverMajor Stage condition for Balance Sum Insured.
• Major Stage – On the admissibility of Claim under Major Stagecondition, coverage shall cease to exist.

General Exclusions applicable to Critical Illness Cover

• 48 months waiting period shall apply for all Pre-existingConditions declared and/or accepted at the time of applyingfirst policy with us
• Treatment directly or indirectly arising from or consequent upon 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 usurpedacts, nuclear weapons/materials, chemical and biologicalweapons, radiation of any kind.
• Any Insured Person committing or attempting to commit a breach of law with criminal intent, or intentional self-injury orattempted suicide while sane or insane.
• Participation or involvement of an Insured Person in naval,military or air force operation, racing, in a professional or semiprofessional nature
• From engaging in or participation in adventure sports including but not limited to winter sports, skydiving/parachuting, hang gliding, bungee jumping, scuba diving, mountain climbing (where ropes or guides are customarily used), riding or driving in races or rallies using a motorized vehicle or bicycle, caving or pot-holing, hunting or equestrian activities, skin diving or other underwater activity, rafting or canoeing involving white water rapids, yachting or boating outside coastal waters, participation in any Professional Sports, any bodily contact sport or any other hazardous or potentially dangerous sport for which the Insuredis untrained, unless specifically covered under the Policy;
• Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances such as intoxicating drugs andalcohol including smoking cessation programs and thetreatment of nicotine addiction or any other substance abusetreatment or services, or supplies

Disclaimer: “For the detailed list of exclusions under the policy, kindly refer to the same provided in your policy kit”

Claims documents for Critical Illness Cover

• Claim Form duly signed by the Insured Person
• Copy of Discharge Summary / Discharge Certificate
• First consultation letter from treating Medical Practitioner
• Medical certificate confirming diagnosis, and the treatment from Medical Practitioner
• Certificate from treating Medical Practitioner, specifying the duration and etiology
• OT Notes in case of Surgery
• Medical certificate from treating Medical Practitioner specifying the diagnosis and need for the surgery
• MLC/FIR copy/ certificate regarding abuse of Alcohol/intoxicating agent if applicable
• All pathological and radiological Investigation Reports We may require the Insured Person to undergomedical examination by Medical Practitioner authorized by Us to obtain an independent medical opinion forthe processing of the claim. Any cost towards such a medical examination will be borne by Us.
• NEFT details & cancelled cheque