HDFC ERGO Health Insurance Plans

HDFC ERGO Health Insurance Mediclaim Insurance

HDFC ERGO Health Mediclaim Insurance

Coverage type
Coverage amount
Date of birth
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Key highlights of HDFC ERGO Health Insurance

HDFC ERGO Health Insurance is a joint venture between The Apollo Hospitals Group and Munich Health, world leaders in health insurance, a company which is part of the Munich Re Group, one of the largest Property & Casualty Reinsurers in the world. The company, headquartered in Gurgaon, is one of the largest standalone health insurers in India and offers a comprehensive range of Health, Personal Accident and Travel insurance solutions across its 40 branches across major metros in the country. They also have a strong distribution network of 25,000 individual agents and Bancassurance relationships with some of the leading Private and Public sector banks in the country. HDFC ERGO Health is also extremely active in the Corporate Health insurance space.

HDFC Ergo Health Insurance Review

HDFC Ergo Health Insurance
Sum insured
1 lac − 50 lacs options available
Tenure options
1 to 2 years
Claims Settlement Ratio **
89.50%
List of network hospitals
10,000+ hospitals
Number of policies issued *
1,063,052
Maximum family floater coverage
Self, Spouse + 5 dependent children
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

HDFC ERGO Health Mediclaim Insurance

  • Individual Plans
  • Family Plan Options
Optima Restore is one of the best selling plans of HDFC ERGO Health Insurance (AMHI) and it comes with 7 sum insured variants as depicted in the table below. The eligibility is as follows:
  • Entry age is 5 years onwards with maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
  • Any individual along with his spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on individual sum insured basis. There is a family discount of 10% if 2 or more family members are covered under the same policy
  • In an individual policy, a maximum of 4 adults and a maximum of 5 children can be included in a single policy.
  • The policy period options include period of 1 or 2 years(s). (We offer 7.5% discount if you opt for a 2 year policy)
The plan coves Pre & Post Hospitalisation, Day Care procedures, Organ Donor, Emergency Ambulance and Daily Cash benefit. There is also a Restore facility of 100% of the Sum insured, a Multiplier benefit for every claim free year apart from a Critical Illness Rider and Health Check up as part of the plan offering.
Optima Restore – Individual
Basic Sum insured per insured person per policy year (in ₹ INR) 3,00,000 5,00,000 10,00,000 15,00,000 20,00,000 / 25,00,000 / 50,00,000
In-patient Treatment Covered
Pre-Hospitalization Covered, upto 60 Days
Post-Hospitalization Covered, upto 180 Days
Day Care Treatment Covered
Domiciliary Treatment/Home Treatment Covered
Treatment for Organ Donor Covered
Daily cash for Choosing shared accommodation 800 per day, Maximum 4,800 1,000 per day, Maximum 4,800
Emergency Ambulance Upto Rs.2,000 per Hospitalisation
E-opinion in respect of critical illnesses Covered
Emergency Air Ambulance Cover Not Covered Covered upto 2,50,000 Lacs per hospitalization and maximum upto sum insured in an year
2) Restore Benefit Equal to 100% of basic sum insured
3) Multiplier Benefit Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%.In case of claim, bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy
4)Health Checkup Not covered Upto 1,500 Upto 2,000 Upto 4,000 Upto 5,000
5) Critical Advantage (Illness) Rider Offered (where base Sum Insured is 10 lacs & above)
Energy is another unique product from the AMHI stable and is a plan tailormade for Diabetes patients. It is essentially a wellness management program for individuals with Type 1 Diabetes, Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and/or Hypertension. It offers Day 1 coverage for all hospitalisation arising out of Diabetes and Hypertension (with no waiting period). The plan is also a combined package providing coverage for Inpatient hospitalisation expenses along with an availability of wellness solutions & health rewards for monitoring your health and earning rewards accordingly. The plan covers:
  • Individuals from the age of 18 years to 65 years for individuals with Type 1 Diabetes, Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT) and/or Hypertension.
  • There are 8 sum insured options from ₹2 lacs upto ₹50 lacs
  • The plan has 2 variants – Gold (cost of wellness test included) & Silver (cost of wellness test excluded), both available with/ without the co-payment option of 20%.
  • The policy will be issued for 1 year.
The plan coves Pre & Post Hospitalisation, 182 Day Care procedures, Organ Donor, Emergency Ambulance and Shared Accommodation benefit. There is also a Restore facility of 100% of the Sum insured, a Cumulative Bonus benefit for every claim free year
Energy - Diabetes Plan
BENEFIT COVERAGE
Basic Sum Insured Per Person Per Policy Year (figs in ₹ INR) 2,00,000 / 3,00,000 / 5,00,000 / 10,00,000 / 15,00,000 / 20,00,000 / 25,00,000 / 50,00,000
In Patient Hospitalization Covered
Pre-Hospitalization Covered, 30 Days
Post-Hospitalization Covered, 60 Days
Day Care Procedures 182 daycare procedures
Organ Donor Covered
Emergency Ambulance Upto 2,000 per Hospitalisation
Shared Accommodation Benefit Covered
Restore Benefit Covered
Cumulative Bonus 10% upto a maximum of 100%
HbA1c Checkup Benefit Covered
Wellness discount Upto 25% of Renewal Premium

Optima Restore Family Floater plan is designed specially to cover a family which can include your spouse, dependent children, parents and parents-in-law. The primary insured can choose from seven sum insured variants from ₹3 lacs, ₹5 lacs, ₹10 lacs, ₹15 lacs, ₹20 lacs, ₹25 lacs and ₹50 lacs. The plan also includes unique benefits such as Restore, Multiplier and Stay Active.

With Restore benefit even if any family member uses the sum insured partially or fully, instantly an additional 100% of the sum insured will be added to the insured’s policy, and the restored sum insured would be available to everyone covered under the plan. It is applicable once during a policy year. Similarly the Multiplier benefit rewards the insured with a 100% increase in sum insured for every two claim free years. The Stay Active benefit rewards customers who lead an active lifestyle, the benefit allows a customer to enjoy premium discounts simply by exercising.

The plan also covers Pre & Post Hospitalisation, Domiciliary Expenses, Day Care Treatments, Organ Donor, Daily Cash, E-Opinion (which is a second opinion), Emergency Ambulance Expenses (including Air Ambulance), Health Check-up and Critical Advantage Rider. Other criteria include:
  • Coverage is offered from the age of 5 years till maximum entry age of 65 years. A dependent child can be covered from the 91st day (if either parents are covered under this policy).
  • The Primary Insured you’re their family members namely spouse, dependent children, dependent parents / parents in law are eligible for buying this cover on floater sum insured basis.
  • The policy period options include period of 1 or 2 years(s).
Optima Restore Family Floater
Basic Sum insured per insured person per policy year( figs in ₹ INR)) 3,00,000 5,00,000 10,00,000 15,00,000 20,00,000 / 25,00,000 / 50,00,000
1) Inpatient treatment Covered
Pre-hospitalisation Covered, upto 60 days
Post hospitalisation Covered upto 180 days
Day Care procedures All Day Care Treatment Covered
Domiciliary treatment Covered
Organ donor Covered
Daily cash for Choosing shared accommodation 800 per day, Maximum 4,800 1,000 per day, Maximum 4,800
Emergency Ambulance upto 2,000 per hospitalisation
E-opinion in respect of critical illnesses Covered
Emergency Air Ambulance Cover Not Covered Covered upto 2.5 Lacs per hospitalization and maximum upto sum insured in an year
2) Restore Benefit Equal to 100% of basic sum insured
3) Multiplier Benefit Bonus of 50% of the Basic Sum Insured for every claim free year, maximum upto 100%.In case of claim, bonus will be reduced by 50% of the basic sum insured. However this reduction will not reduce the Sum Insured below the basic Sum Insured of the policy
4) Health Checkup Not covered Upto 2,500 Upto 5,000 Upto 8,000 Upto 10,000
5) Critical Advantage Rider Offered (where base Sum Insured is 10 lacs & above)

Frequently Asked Questions (FAQ’s)

Medical examinations may be required in some cases, based on the sum insured and the age of the individual.

Yes, the insurer will pay the admissible amount for the medical expenses incurred subject to the terms and conditions (sum insured) of the policy. The insured might have to pay for the non-medical and expenses not covered under the policy, directly to the hospital prior to being discharged.

HDFC ERGO Health has a hospital network of more than 4650 hospitals pan India where the insured can be treated.

HDFC ERGO Health is one of the leading Health insurers and currently enjoys a 20% market share among the Stand Alone Health insurers in the Indian market. Their advantages include:
  • More than 5.2 million customers from inception till date
  • Cashless Access to over 4650+ hospitals across the country and access to the best 10,000+ doctors in India.
  • Given the illustrious parents’ experience in the health space, they have the expertise required in the health insurance industry.
  • One of the fastest claims settlement in the industry with over
    • 95% of the claims settled within 30 days with average claim settlement duration of 15 days for clear cases
    • Cashless Authorisation is less than 2 hours of claims intimation
    • 100% Lifelong Renewal
    • Superior Customer Service with
    • More than 80% renewal rate with existing customers
    • High Level of 85% satisfied customers with claims and policy servicing
  • Wide Range of Sum Insured Options / Products
    • Sum insured from ₹ 1lac to ₹ 50 lacs
    • 16 products with 80 variants across all categories
  • More than just insurance – HDFC ERGO Health insurance provides Health & Wellness Portal + Stay Active Benefit
The insured can register a claim on any policy at the AMHI Customer Service Centre or any of the offices of HDFC ERGO Health by letter/phone/email or in person. They will need to provide the following information while registering the claim:
  • Name of the Insured
  • Policy number
  • Date and time of problem
  • Nature of problem
  • Location of problem
For any help or information regarding Claims on AMHI policy, please
  • Call on : 1800-102-0333
  • Email at customerservice@apollomunichinsurance.com
  • Courier your query directly to their CPC office
    HDFC ERGO Health Insurance Co. Ltd.,
    iLABS Centre, 2nd & 3rd Floor,
    Plot No 404 - 405,
    Udyog Vihar, Phase – III,
    Gurgaon-122016, Haryana

HDFC Ergo health insurance products

Key Features:
  • Restore Benefit: Equal to the Sum insured. Extra Sum insured will be reinstated only after the basic Sum insured amount has been exhausted. This does not involve additional cost.
  • Multiplier Benefit: 50% of the initial basic Sum insured for every year without claims and Maximum is 100%. If there are claims, only the bonus is reduced by 50%, not the initial Sum insured.
Key Features:
  • Energy by HDFC ERGO Health Insurance is particularly designed for diabetes patients. It also serves the needs of patients dealing with hypertension.


Brochure

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Policy wordings

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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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