About HDFC ERGO Health Insurance

HDFC ERGO Health Insurance company is a premier health insurer in India working with the vision of becoming the most admired insurance conglomerates in the country. By being responsive to their consumer’s needs, the company aims to achieve continued progress for them.

Claim settlement ratio 99.90%

NCB* 5%, up to 10% of SI*

PED Waiting# 2-4 Years

Network Hospital 12000+

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HDFC ERGO Health Insurance Plan(s) Plan Type Entry Age
my: Optima Secure Plan Type : Base Product Entry Age : Adult : 18 - 65 Years, Children : 91 days - 25 years for dependent
HDFC ERGO Health Insurance company is a part of HDFC ERGO General Insurance Company Ltd., which is a joint venture between HDFC Ltd., and ERGO International AG. As a General Insurance provider, HDFC ERGO offers an entire range of products under the general insurance category like Motor insurance, Health insurance, Travel insurance, as well as Home and Personal Accident insurance. They also offer customized products such as Marine insurance, Property insurance, along with Liability Insurance. The company has over 9700+ employees working in more than 200 branches of the company across 170+ cities in India. In terms of claim settlement, HDFC ERGO health insurance claim settlement ratio is one of the best in the industry with the company claiming to settle 1 claim per minute and approve claim within 20 minutes.

Key Highlights of HDFC ERGO Health Insurance Company

Key Features  Specifications
Network Hospitals Available 12000+
Waiting Period (Pre-existing Ailments) Between 2 years to 4 years
Claims Settlement Ratio
Policies Issued 1.5 Crore
Covid-19 Cover Yes
Renewability Lifetime (in most plans)

Awards and Achievements of HDFC ERGO Health Insurance Company

HDFC ERGO is the proud recipient of the following awards and achievements:
  • HDFC Ergo received the BFSI Leadership Awards 2022 for Cyber Insurance and Optima Secure Health Insurance plans under the ‘product innovator’ category.  The award recognises and appreciates the pioneers in the BFSI sector
  • The company also is the recipient of ETBFSI Excellence Awards 2021 for Best Covid Strategy Implemented - Customer Experience in Insurance category
  • HDFC ERGO is also the receiver of FICCI Insurance Industry Awards in September 2021, which is a highly reputed award that was offered for the company’s Excellence in Claims and Customer Service
  • The joint venture also received the ICAI Awards in 2015-16 for their Excellence in Financial Reporting under Category IV (non – life). They already received this award 3 times before during their insurance journey
  • SKOCH Order-of-Merit is another glory of the company received for Claims Survey Management (CMS) for qualifying amongst the Top 100-projects in India

Key Features of HDFC ERGO Health Insurance

Among the key features of HDFC ERGO include:
  • A wide range of Cashless Hospital Network of over 12,000+ across India
  • The policyholder can avail tax benefits under the HDFC ERGO health insurance schemes
  • Allows HDFC ERGO health insurance renewal benefit in the form of Free Health Check-up within 60 Days of policy renewal
  • HDFC ERGO health insurance company is known to settle 1 claim per minute and approve claim within 20 minutes (T&C applicable)
  • The health insurance plans under HDFC ERGO allow coverage on Hospitalization Expenses, Day Care Treatments, Home Treatments, AYUSH Treatment, Organ Donor Expenses and more
  • These plans also cover expenses for 60 days of pre-hospitalization and 180 days of post-hospitalization coverage

HDFC ERGO Health Insurance - Eligibility Criteria

  • Minimum age of entry - 18 years for adults, 91 days for children
  • Maximum age of entry - 65 years for adults, 18 years for dependent children

Top 7 HDFC ERGO Health Insurance Plans

Some of the best health insurance plans offered by HDFC ERGO Health Insurance are;
  1. Optima Secure Health Insurance Plan
  2. my:health Suraksha Health Insurance Plan
  3. Optima Restore Health Insurance Plan
  4. my:health Koti Suraksha Health Insurance Plan
  5. HDFC ERGO Critical Illness Insurance
  6. iCan Cancer Insurance
  7. my:health Medisure Super Top-up

1. Optima Secure Health Insurance Plan:

This is a health plan offering four times the health cover at no extra cost. Here are some features:
  •  Sum Insured – ranges between 5 Lakhs to 2Cr
  • Multiple Discount Options – you can save up to 50% that you pay on premium using different discount options offered by the insurer
  •  Protect Benefit – Allows the insured to enjoy zero deductions on non-medical expenses listed under the plan

2. my:health Suraksha Health Insurance Plan:

This is a comprehensive but affordable health insurance plan with numerous benefits. Here are some features:
  • No room rent capping – The plan allows the insured to choose their favorite hospital room as the plan doesn’t levy any room rent capping
  • Preventive Health Check-up -The plan allows the insured to enjoy precautionary health check-up every time they go for HDFC ERGO health insurance renewal online
  • Sum insured Rebound – This is another best feature of the plan that allows sum insured back-up which gets reinstated once the existing sum insured exhausts

3. Optima Restore Health Insurance Plan:

This is a beneficial plan especially recommended for small families.  Here are some features:
  • Sum Insured – It ranges from 5 lakhs to 50 lakhs
  • Restore Benefit – The plan allows immediate addition of 100% basic SI to your insurance plan on the first claim you raise
  • Multiplier Benefit – This benefit allows the insured to doubles their sum insured in two successive years of no claim

4. my:health Koti Suraksha Health Insurance Plan:

This comprehensive and cost-effective policy allows big coverage at small prices. Here are some features:
  • Sum Insured - Ranges from 50 lakhs to 1crore
  • No room rent capping – The plan is available with no room rent capping up to private AC room
  • Unlimited day-care – The plan allows unlimited day care procedures

5. HDFC ERGO Critical Illness Insurance:

Here are some features of this plan:
  • Up to 15 critical illness covered
  • Lump sum payment in a single transaction
  • 2 variants of the plan are available
  • You can buy the plan for 1 or 2 Years

6. iCan Cancer Insurance:

Here are some features of the plan:
  • It covers all kinds of cancers
  • Allows cashless treatment of cancer
  • 60% Sum insured is offered to the policyholder as lump sum payout
  • 100% SI can also be availed for cancer treatment

7. my:health Medisure Super Top-up:

This is a plan offering greater health cover at premium prices that are pocket-friendly. Here are some features:
  • No health checkups up to 55 years of age
  • Constant premiums from 61 years of age
  • The plan allows the insured to get more while paying less
  • It covers pre-and post-hospitalization expenses
  • The plan allows the insured to work on aggregate deductibles
  • It also covers day care procedures
The premium for the above plans can be calculated with the help of HDFC ERGO health insurance premium calculator.  Here you can see the HDFC ERGO health insurance premium chart to buy plans suiting your needs.

Scope of Coverage of HDFC ERGO Health Insurance Plans

Below are some of the coverage benefits that are permitted under the HDFC ERGO health insurance policy:
  • HDFC ERGO Health Insurance Plans cover hospitalization expenses
  • These plans offer coverage for Pre-Hospitalization and Post-Hospitalization costs for 60 and 180 days respectively
  • The plan covers hospitalization expenses incurred for treatment of mental conditions
  • The HDFC ERGO Health Insurance Plans cover Day Care Treatments as well
  • These plans also cover Home Healthcare to offer medical treatment right at the comfort of your home
  • Sum Insured Rebound is another coverage that you receive for uninterrupted medical coverage whenever required
  • The plan covers Organ Donor expenses
  • It also covers AYUSH treatment expenses
  • HDFC ERGO Health Insurance Plans allow lifelong renewability
  • It also allows free renewal health check-up within 60 days of renewing policy

Exclusions of HDFC ERGO Health Insurance Plans

Below are the key exclusions that are not covered as part of most HDFC ERGO health insurance plans:
  • Expenses of any injury caused due to adventure or hazardous sports are not included
  • It doesn’t include any self-inflicted injuries that you have self-imposed knowingly
  • Expenses on treatment caused due to war are also not covered under HDFC ERGO health insurance plans
  • HDFC ERGO also doesn’t cover accidental injury that were incurred upon by insured while participating in defense operations including Army/Navy/Air Force
  • The venereal or sexually transmitted diseases are also not covered under HDFC ERGO health insurance plans
  • The health insurance plans offered by HDFC ERGO also do not cover the expenses of treatment of obesity or cosmetic surgery

How to File a HDFC ERGO Health Insurance Claim?

Health insurance claims are generally settled in two ways – cashless claims or reimbursement claims

1. Cashless Claims Procedure

Under a cashless claim process the policyholder is not required to make any payments from their own pocket at the time of hospital discharge. Here, the insurance company is directly in touch with the hospital and they make the payment on their own. However, for a successful cashless claim you must ensure that your particular medical insurance plan covers the disease that is being treated in the hospital. Also, you must ensure that the hospital you have chosen to get the treatment done is one of the hospitals enrolled in the network of the insurer.

2. Reimbursement Claim Procedure

Unlike in cashless claims, the policyholder has to make all the payments under the reimbursement claim process. If you have gone through the treatment in a non-network hospital, you have to go through a reimbursement claim process. Here, you can undergo the treatment as per the procedure of the normal hospitalization and make the payment at the time of discharge. However, after getting discharged you must reach out to the insurance company as soon as possible to raise a claim. For that you have to submit a duly filled claim form and all the relevant documents which are mentioned below.

Documents Required to Claim a HDFC ERGO Health Insurance Plan

Here are the documents needed to claim a HDFC ERGO health insurance policy:
  • You need to submit the duly filled and signed claim form mentioning the HDFC Ergo policy number
  • You would also need the original discharge summary of your bill
  • Do not forget to submit the original final bill along with the break-up of payment details and receipt as well as original pharmacy invoices and prescriptions for medicines
  • Further, you would also need original investigation reports of any diagnosis and tests etc.
  • You may also require implant sticker/invoice (if any used for the treatment)
  • Also, requirement of any past treatment papers might be there, if applicable
  • If it is an accident, Medico Legal Certificate (MLC) or a copy of FIR might be required
  • Also, you may need any other relevant documents, as required by your insurer
  • NEFT details for payment such as a canceled cheque in the name of the proposer is also needed

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Frequently asked questions

You can file as many claims as you want in a year. However, the amount of the total claims within that year should not go beyond the sum insured of your health plan. For example, if you are covered under a health policy with a sum insured of INR 3 lakh, you can claim up to that amount within a year from the insurer.

Yes, you have the option to add family members to your existing family health insurance plan. However, this may require you to fill some forms, like the health declaration and endorsement form. Also, you may have to pay an additional premium amount.

In case of non-network hospitals, the insured or the policyholder is required to pay the bills on their own at the time of discharge. However, you can claim for reimbursement within a specified time as mentioned in the policy document by submitting all the papers and documents related to bills and treatment for reimbursement.

Yes, you can get your premium back by canceling the policy but only during the free-look period, which is a duration of 15 days from the date of buying the policy.

Yes, they offer affordable senior citizen health insurance plans.

* The accumulated cumulative bonus or the NCB shall not exceed 100% of the Sum Insured on the Renewed Policy as specified in the policy terms.

# Ailments diagnosed within 48 months before policy issuance date or any medical treatment received within 48 months before the issue date of policy