HDFC Ergo Health Insurance

Network Hospitals:
Claim Settlement
Ratio: 90%
PED Coverage
Covered after 3 Year
Save Tax Under
Section 80D

About Niva Bupa Health

HDFC ERGO operates as a joint venture between HDFC Ltd and ERGO, the primary insurance entity of Germany's Munich Re Group. It stands as the third-largest private general insurer, commanding a market share of 6.2%. The company provides an extensive range of insurance products in both the retail and corporate sectors.

In the retail space, HDFC ERGO offers insurance options such as Motor, Health, Travel, Home, Personal Accident, and Cyber Insurance. Additionally, it caters to corporate clients with specialized policies including Property, Marine, and Liability Insurance. With a network of 203 branches spanning 170 cities and a wide distribution network, HDFC ERGO ensures accessibility to its services.

The company is dedicated to meeting the specific insurance needs of its corporate customers, particularly in the areas of Property, Marine, and Liability insurance. HDFC General Insurance has received recognition for its financial reporting excellence, earning the ICAI Award for Excellence in Financial Reporting in the fiscal years 2014-15 and 2015-16. ICRA has assigned HDFC ERGO an 'iAAA' rating, highlighting its exceptional claim-paying ability.

Furthermore, the company's commitment to superior customer service earned it the 2016 Best Customer Experience Award of the Year in the financial sector, presented by KamiKaze.

HDFC Ergo Health Insurance Plans Summary

Discover the wide range of health insurance plans offered by HDFC Ergo Health Insurance. Look at the list below:

The HDFC Ergo My Health Suraksha Plan is a comprehensive health insurance option available for individuals and families. It covers various medical expenses, including inpatient hospitalization, pre-hospitalization, post-hospitalization, day care procedures, domiciliary treatment, organ donor expenses, emergency ambulance services, AYUSH treatments, and health check-ups. The policy can be obtained for a duration of 1 or 2 years, with the option of lifetime renewability. Additionally, if you don't make any claims during the policy period, you can enjoy a cumulative bonus as a reward.

The HDFC Ergo Critical Illness Insurance Plan is designed to provide coverage for critical illnesses. It includes up to 15 critical illnesses such as heart attack, stroke, cancer, paralysis, and kidney failure. The plan offers two variants and does not require medical check-ups for individuals up to the age of 45. It also comes with the benefit of lifetime renewability.

The HDFC Ergo My Health Medisure Super Top-up Plan serves as a supplementary coverage option in case your existing plan falls short of covering all your medical expenses. This plan ensures that you receive the best medical treatment by bridging the gaps in your existing sum insured. It covers inpatient hospitalization, pre-hospitalization, post-hospitalization, and day care procedures.

The HDFC Ergo My Health Women Suraksha Plan offers three variants: Women Cancer Plus Plan, Women CI Essential Plan, and Women CI Comprehensive Plan. It provides coverage for cancer, major illnesses, preventive health check-ups, wellness and health coaching, surgical procedures, cardiac ailments, pregnancy, and newborn complications (up to 25% of the sum insured, with a maximum of Rs. 5 lakh). The plan also includes a unique feature of loss of job benefits, offering 50% of monthly salary for up to 6 months.

The HDFC Ergo My Health Medisure Classic Insurance Plan covers inpatient hospitalization, pre-hospitalization, and post-hospitalization expenses. It also provides coverage for day care procedures, maternity expenses, newborn baby coverage, ayurvedic treatment, and pre-existing diseases after a waiting period of 3 years. There is no age restriction for enrollment in this plan, and it offers complete coverage for children up to the age of 23 years.

Network Hospital

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Why Choose HDFC Ergo Health Insurance?

HDFC Ergo Health Insurance provides numerous advantages to policyholders, making it a preferred choice for many. Here are some key reasons to consider:
Impressive Claim Settlement Ratio - In the fiscal year 2019-20, HDFC Ergo General Insurance achieved a commendable claim settlement ratio of 86.52%. This demonstrates the company's commitment to efficiently and fairly settling claims, earning the trust of over 1 crore customers.

Round-the-Clock Customer Support - HDFC Ergo General Insurance provides 24/7 customer support, ensuring assistance is readily available to its valued customers. The company's dedicated claims team operates around the clock, guaranteeing a smooth and hassle-free claims process during times of need.

Established Track Record - With a rich experience spanning 16 years, HDFC Ergo General Insurance has been successfully meeting the insurance requirements of its customers. Its exceptional customer service was recognized with the Best Customer Experience Award in the financial sector in 2016 by KamiKaze.

Nationwide Presence - HDFC Ergo General Insurance has established a widespread presence across India. With a vast network of over 10,000 cashless hospitals, 120+ branch offices, and a workforce of over 3,000 employees, the company ensures accessibility and convenience for its customers throughout the country.

Key Features of HDFC Ergo Health Insurance

  • HDFC ERGO ensures speedy processing of pre-authorized cashless health insurance claims with a remarkable 30-minute turnaround time (TAT). Additionally, for pre-authorized cashless motor insurance claims, the company maintains an efficient 15-minute TAT.
  • To enhance customer service, HDFC ERGO provides the convenience of DIA, an AI-enabled chatbot service available on the company's website, Amazon Alexa, and Google Assistant.
  • The plan accommodates a maximum of 4 family members, including up to 2 children and 2 adults.
  • HDFC ERGO offers lifelong renewal for its plans, providing financial security and peace of mind during medical emergencies, and ensuring preparedness for any situation.
  • An advantage of HDFC ERGO's plans is the absence of sub-limits on room rent. This prevents the reduction of your sum insured and adds to the attractiveness of their offerings.
  • The company rewards customers with a 5% bonus on the sum insured for every claim-free year, offering wide options for sum insured amounts.
  • Comprehensive coverage includes pre and post-hospitalization medical expenses for 60 days and 90 days respectively, limited to related medical expenses.
  • Upon completing 4 claim-free years, HDFC ERGO reimburses health check-up expenses, promoting proactive healthcare management.
  • Pre-existing diseases are covered after a waiting period of 4 years.
  • With no co-payment policy, the plan relieves customers from the burden of sharing medical expenses.

HDFC Ergo Health Insurance Claim Settlement Ratio

The Claim Settlement Ratio of a health insurance company represents the percentage of claims successfully settled by the company compared to the total number of claims received during a financial year. It serves as an important indicator of an insurance company's efficiency in handling customer claims.

As a prudent health insurance buyer, it is essential to consider the Claim Settlement Ratio of an insurer before purchasing a plan. Here are the Claim Settlement Ratios for HDFC Health Insurance in the last two financial years:

Financial Year | Claim Settlement Ratio

FY 2018-2019 | 83.66%
FY 2019-2020 | 86.52%

These figures demonstrate the insurer's commitment to efficiently settling claims and providing timely support to policyholders when they need it most. HDFC Ergo Health Insurance stands out as a reliable and trustworthy option for individuals seeking comprehensive health coverage.

Dedicated Whatsapp Claim Assistance

HDFC Ergo Health Insurance Claim Process

HDFC Ergo Health Insurance ensures a prompt and seamless claim settlement process for its policyholders. The insurer facilitates two types of claim settlements: cashless claims and reimbursement claims.

Cashless Claim Process

When you choose a network hospital affiliated with HDFC Ergo General Insurance, all claims can be processed in a cashless manner. This means that you won't have to make any payments to the hospital, as HDFC Ergo General Insurance settles the bills directly with the hospital, subject to the sum insured. Follow the steps below to raise a cashless claim with HDFC Ergo General Insurance:

Step 1: Hospitalization
First, locate the nearest hospital in the HDFC Ergo network and get admitted there. To find an HDFC Ergo network hospital, you can click here or refer to the provided link.

Step 2: Cashless Claim Form
Obtain a cashless claim form from the hospital, complete it accurately, and submit it along with the necessary documents, including your ID proof and health insurance card.

Step 3: Claim Pre-Authorization
Once you submit the cashless claim form, HDFC Ergo General Insurance's internal claims team will review and either approve or reject your claim based on the submitted documents, treatment required, and coverage. The claim approval process is typically completed within 20 minutes.

Step 4: Claim Settlement
Once your claim is approved, you can proceed with the necessary medical treatment without making any payments to the hospital (subject to coverage and sum insured). After your discharge from the hospital, HDFC Ergo General Insurance will review the documents and discharge summary to finalize the claim settlement directly with the hospital.
Please note that the steps mentioned above outline the general process for raising a cashless claim with HDFC Ergo General Insurance. It's always advisable to refer to the specific instructions and guidelines provided by the insurer or consult with their customer support or Insurejoy’s claim assistant for any additional requirements.

Reimbursement Claim Process

When a policyholder receives medical treatment at a hospital that is not part of the HDFC Ergo General Insurance network, the insurer provides reimbursement for the incurred medical expenses, up to the sum insured. This means that for reimbursement claims, you are initially responsible for paying all medical expenses out of pocket, and then the insurer reimburses you for those expenses. Follow the steps below to request a reimbursement claim from HDFC Ergo General Insurance:

Step 1: Hospitalization and Intimation
Get admitted to a non-network hospital and inform HDFC Ergo General Insurance about your hospitalization by contacting them at 022-6234-6234 / 0120-6234-6234.

Step 2: Collect and Submit Documents After Discharge
Upon discharge, collect all the necessary documents from the hospital and send them via post to HDFC Ergo General Insurance Company Ltd.

Documents Required for Health Insurance Reimbursement Claim with HDFC Ergo General Insurance:

  1. Valid ID proof
  2. Doctor's letter recommending admission
  3. Original bills from chemists and pharmacies
  4. Doctor's prescription for medical tests, medicines, consultations, etc.
  5. Original receipts, bills, and discharge forms signed by the doctor
  6. Original diagnostic test reports, radiology reports, and payment receipts
  7. First Information Report (FIR) in case of a police case.

Step 3: Document Scrutiny and Approval
HDFC Ergo General Insurance will carefully review the submitted documents and make a decision to either accept or reject your claim.

Step 4: Claim Settlement
Upon approval of your claim, HDFC Ergo General Insurance will initiate reimbursement through NEFT (National Electronic Funds Transfer). The insurer aims to complete the reimbursement process within 3 days.

Please note that the above steps provide a general overview of the reimbursement claim process with HDFC Ergo General Insurance. It is advisable to refer to the specific instructions and guidelines provided by the insurer or contact their customer support for any additional details or requirements.

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HDFC Ergo Health Insurance

Network Hospitals:
Claim Settlement
Ratio: 90%
PED Coverage
Covered after 3 Year
Save Tax Under
Section 80D
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