HDFC ERGO Health Insurance
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Tax Benefit
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HDFC ERGO Health Insurance
With rising medical expenses in India, health insurance is no longer an option but a necessity. A single hospitalization can cost ₹3-5 lakh, and without adequate insurance, these costs can disrupt your financial stability.
HDFC ERGO, one of India’s leading health insurers, provides policies that cover hospitalization, pre-existing diseases, maternity, alternative treatments, and tax benefits under Section 80D. This guide will help you understand how HDFC ERGO health insurance works, its benefits, coverage, exclusions, and how to choose the right plan for your needs.
Did you know? India has a health insurance penetration rate of just 37%, meaning a significant population is still uninsured. Don’t be one of them!
What is HDFC ERGO Health Insurance?
HDFC ERGO is a joint venture between HDFC Ltd. and ERGO International AG (a part of Munich Re Group, Germany). It offers a wide range of health insurance plans, including individual, family floater, and group health policies.
Key Highlights of HDFC ERGO Health Insurance
- 13,000+ network hospitals for cashless treatment
- Claim settlement ratio of 100% (FY 2022-23) within 1 day
- Coverage for daycare treatments, alternative medicine (AYUSH), and maternity expenses
- No room rent cap and lifetime renewability
- Tax benefits under Section 80D of the Income Tax Act
Expert Insight “Many policyholders fail to check the claim settlement process before buying a policy. HDFC ERGO’s 100% claim settlement ratio in a single day makes it one of the fastest insurers in India.” – Rajeev Sharma, Financial Planner
HDFC ERGO Health Insurance Plans
HDFC ERGO offers plans catering to individuals, families, and corporate employees.
| Plan Name | Coverage Type | Key Benefits |
| Optima Restore | Individual & Family | Sum insured restoration, daily hospital cash, worldwide treatment |
| Health Suraksha | Individual | No sub-limits on hospital expenses, pre & post-hospitalization |
| My:Health Suraksha | Individual & Family | Covers AYUSH, mental health, maternity benefits |
| My:Health Medisure Super Top-Up | Super Top-Up | Additional coverage over base plan, cost-effective deductible |
| Critical Illness Plan | Individual | Covers 15+ major illnesses like cancer, stroke, heart attack |
| Group Health Insurance | Corporate Employees | Customizable coverage for companies and employees |
Fun Fact: A 30-year-old non-smoker can get ₹10 lakh health coverage for as low as ₹7,000 per year, making health insurance surprisingly affordable!
HDFC ERGO Health Insurance Coverage and Exclusions
| Category | Inclusions (Coverage) | Exclusions (Not Covered) |
| Hospitalization | In-patient hospitalization expenses (room rent, ICU, doctor fees, nursing) | Hospitalization without medical necessity or outside policy terms |
| Pre & Post-Hospitalization | Medical expenses before and after hospitalization (30-60 days) | Expenses beyond the covered pre/post-hospitalization period |
| Daycare Procedures | Coverage for treatments that don’t require 24-hour hospitalization | Non-listed daycare procedures |
| Ambulance Charges | Emergency ambulance services up to specified limits | Non-emergency ambulance services |
| Domiciliary Treatment | Treatment at home if hospital admission isn’t possible | Treatments taken at home without valid medical reasons |
| Organ Donor Expenses | Expenses related to organ donor’s treatment during transplant | Cost of organ donor’s non-medical expenses |
| AYUSH Treatment | Coverage for Ayurveda, Yoga, Unani, Siddha, and Homeopathy | Non-recognized alternative treatments |
| Maternity Benefits | Maternity-related expenses (if covered in the plan) | Complications arising from infertility treatments |
| Critical Illness Cover | Coverage for specified critical illnesses | Illnesses not listed under the critical illness cover |
| Pre-Existing Diseases | Covered after waiting period as per policy | Claims within the waiting period for pre-existing diseases |
| Mental Illness Cover | Coverage for mental health treatments (if included in the plan) | Non-medically necessary psychiatric treatments |
| Cosmetic & Aesthetic Procedures | Not covered unless due to injury or accident | Plastic surgery, cosmetic treatments for enhancement |
| Self-Inflicted Injuries | Not covered | Injuries due to suicide attempts, substance abuse, or intentional harm |
| War & Nuclear Risks | Not covered | Injuries due to war, nuclear risks, terrorism-related activities |
| Dental & Vision Care | Covered only if due to accidents (if included in the plan) | Routine dental checkups, spectacles, contact lenses, hearing aids |
| Congenital Conditions | Not covered unless specified | Birth defects, congenital external conditions unless policy covers it |
How to Choose the Right HDFC ERGO Health Insurance Plan?
- Sum Insured: Ensure your coverage is at least ₹10-15 lakh considering rising medical costs
- Waiting Period for Pre-existing Diseases: Shorter waiting periods are better
- Network Hospitals: More hospitals = higher chances of cashless treatment
- Premium vs. Coverage Balance: Low-cost plans might have hidden limits
Expert Tip: If you’re a first-time buyer, go for Optima Restore or My:Health Suraksha for maximum benefits and cashless ease.
Tax Benefits Under Section 80D
HDFC ERGO health insurance policies offer tax deductions under Section 80D.
| Who is Insured? | Maximum Deduction |
| Self, Spouse & Children | ₹25,000 |
| Parents (Below 60 years) | ₹25,000 |
| Parents (Above 60 years) | ₹50,000 |
| Family + Senior Citizen Parents | ₹75,000 – ₹1,00,000 |
Example: If you pay ₹40,000 for family insurance and ₹50,000 for senior citizen parents, you can claim ₹90,000 in tax deductions!
How to Buy HDFC Ergo Health Insurance from Fincover?
Fincover provides a straightforward process to acquire HDFC Ergo Health Insurance plans. Follow these steps:
- Visit Fincover’s Website – Users can navigate to Fincover’s website by accessing www.fincover.com
- Compare Plans – The comparison tool enables users to examine HDFC Ergo insurance plan options.
- Enter Personal Details – Provide details like age, location, and medical history.
- Choose Your Plan – Select a plan that suits your medical history and conditions
- Make Payment – Complete your payment through UPI payment method and Net Banking and Credit/Debit Cards options.
- Receive Policy Documents – The policy documents will be transmitted through email after processing.
How to Renew HDFC Ergo Health Insurance from Fincover?
The policy renewal process maintains uninterrupted policy protection. Customers can renew HDFC Ergo Health Insurance using these steps on Fincover:
- Browse Fincover’s Website – Access www.fincover.com.
- Go to Renewal Section – Move to the Renewal Section then select the “Renew Your Policy” button from the options.
- Enter Policy Details – Complete the Policy Details section by entering your current policy number and mobile number registered to your account.
- Review and Update – Edit the plan coverage by making necessary adjustments (raise sum insured amount and add riders to it).
- Proceed to Payment – Finish payment by using available payment options which include net banking, UPI, credit/debit cards. Kindly note that transaction will happen on the company’s website
- Receive Renewal Confirmation – Instant policy renewal becomes possible after confirmation of renewal.
Claim Settlement Process in HDFC ERGO
HDFC ERGO has a paperless, one-day claim approval system, ensuring a hassle-free claim experience.
| Step | Process | Details |
| 1. Intimation | Notify HDFC ERGO about the claim | Call 1800-270-0700 or log in to the HDFC ERGO website/app immediately after hospitalization. |
| 2. Document Submission | Submit required documents | Provide claim form, ID proof, policy copy, medical reports, hospital bills, and discharge summary. |
| 3. Claim Registration | HDFC ERGO registers the claim | Receive a claim reference number for tracking the status. |
| 4. Verification | Claim documents and medical details are verified | The insurer may request additional documents or conduct investigations if needed. |
| 5. Claim Assessment | Medical team assesses the claim for approval | Evaluation based on policy terms, coverage, and submitted documents. |
| 6. Approval/Reject | Decision on the claim | Claim is either approved, queried for more info, or rejected with reasons provided. |
| 7. Claim Settlement | Payment processed | If approved, the claim amount is paid to the hospital (cashless) or reimbursed to the policyholder. |
| 8. Status Tracking | Track claim status online or via customer care | Use the claim reference number on the HDFC ERGO website/app for real-time updates. |
Documents Required for HDFC Ergo Health Insurance Claims
To file a claim, you need the following documents:
For Cashless Claims:
- Health Insurance Policy Copy
- ID Proof (Aadhaar, PAN, Voter ID)
- Pre-Authorization Form (from the hospital)
- Doctor’s Prescription
- Original Medical Bills
For Reimbursement Claims:
- Duly filled claim form
- Health Insurance Policy Copy
- Hospital Discharge Summary
- Original Hospital & Pharmacy Bills
- Lab Test Reports
- Payment Receipts
HDFC Ergo Health Insurance Customer Care Details
For assistance, contact HDFC Ergo’s 24×7 customer support:
- WhatsApp: Send Hi to 8169500500 to initiate conversation
- Email: care@hdfcergo.com
- For Claim, Renewal and Policy related queries Call 022 6158 2020
- To buy new policy call us on 022 6242 6242
- For Policy related queries: 022 6158 2020
- Email: care@hdfcergo.com
- For Claim related queries: healthclaims@hdfcergo.com
Frequently Asked Questions (FAQs) on HDFC Ergo Health Insurance
1. What is the waiting period for HDFC Ergo Health Insurance?
Members must first serve a 30-day waiting period followed by a time span of 2-4 years for receiving coverage of pre-existing conditions based on their selected plan.
2. Can I add family members to my policy?
HDFC Ergo Health Insurance allows you to include spouse, children, parents and in-laws under a single family floater policy.
3. Does HDFC Ergo cover COVID-19 treatment?
The treatment costs related to COVID-19 hospitalization fall within the coverage area of standard health insurance policies under HDFC Ergo.
4. Can I port my existing health insurance to HDFC Ergo?
Policyholders can transfer health coverage from a different insurance provider to HDFC Ergo while safeguarding all active benefits.
5. What happens if I miss my renewal date?
The policyholders at HDFC Ergo have thirty days to renew their coverage within a grace period. The policy will expire and all your benefits become unavailable when you fail to perform timely renewal.
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