HDFC Ergo General Insurance

About HDFC Ergo

HDFC ERGO General Insurance Company Limited is a joint venture of HDFC Ltd. and a German company ERGO International AG, which in turn is a part of Munich Re Group. The partnership between the two stakeholders stands at 74:26.

Founded in the year 2002, the Company is headquartered at Mumbai and has over a 100 branches across the country. One of the largest general insurance companies in the nation, it offers a complete range of products including Health, Travel, Motor, Home, Personal Accident, Marine and Liability Insurance.

The health insurance plans designed by HDFC ERGO are one of the best in the industry and offer medical coverage in case of hospitalization and critical illness. The health insurance policies on offer are:

Health Suraksha

Health Suraksha Plan offers cashless hospitalization in any of the 5000+ network hospitals without sub-limits on the hospitalization expenses.

Highlights

• Cashless hospitalization in over 5000 hospitals.
• Available both as individual and family floater plan.
• Term plan may be 1-2 years.
• Sum Insured (SI) may be Rs. 3/4/5/7.5/10 lakhs.
• No medical check-up required for those under 45 years of age.
• Income tax benefits under section 80-D of Income Tax Act.
• No sub-limits on room rent, hospitalization expenses, and doctor fees.

Benefits

Hospitalization Expenses	Covered up to Sum Insured. It includes room rent, nursing charges, doctor fee, operation theatre (OT) charges, cost of blood, oxygen and surgical instruments, diagnostic procedures and prosthetic devices.
Pre-hospitalization Charges	Covered up to 60 days before hospitalization.
Post-hospitalization Charges	Covered up to 90 days after hospitalization.
Daycare Procedures	Cost of 144 listed procedures covered which do not require hospitalization more than 24 hours.
Domiciliary Treatment	Covered for availing medical treatment at home in case the patient cannot be transferred to a hospital due to his/her condition or unavailability of bed.
Organ Donor	Expenses covered in case of a transplant.
Ambulance Charges	Covered in the case of an emergency.
AYUSH Treatment	Covered for expenditure on Ayurveda, Unani, Siddha, and Homeopathy.
Cumulative Bonus/No Claim Bonus	5% increase in SI every claim-free year, up to a maximum of 50%
Medical Check-up	Up to 1% SI or Rs.5000, whichever is less, after 4 continuous claim-free years.

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Exclusions

The main exclusions under the policy are:

• Pre-existing conditions till 4 years of the policy.
• 30 day waiting period for claims.
• A 2-year waiting period for certain conditions mentioned in the policy document e.g. cysts, internal tumors, surgeries on sinuses and tonsils etc.
• Any intentional self-harm or suicide attempt.
• Claims arising out of armed conflicts or wars.
• Treatment of HIV/AIDS.
• Drug abuse.
• Cosmetic surgery unless necessitated by accidental injury.
• Vaccinations.

Health Suraksha with Regain and ECB

This health insurance policy provides financial security in case of exhaustion of the sum insured.

Highlights

• Cashless hospitalization in over 5000 hospitals.
• Available both as individual and family floater plan.
• Term plan may be 1-2 years (10% discount for 2-year term).
• Family discount of 10% if 2 or more members are covered on an individual basis.
• Sum Insured (SI) may be Rs. 3/4/5/7.5/10 lakhs.
• REGAIN benefit - automatic availability of sum insured upon exhaustion.
• Income tax benefits under section 80-D of Income Tax Act.
• No sub-limits on room rent, hospitalization expenses, and doctor fees.

Benefits

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Hospitalization Expenses	Covered up to Sum Insured. It includes room rent, nursing charges, doctor fee, OT charges, cost of blood, oxygen and surgical instruments, diagnostic procedures and prosthetic devices.
Pre-hospitalization Charges	Covered up to 60 days before hospitalization.
Post-hospitalization Charges	Covered up to 90 days after hospitalization.
Daycare Procedures	Cost of 144 listed procedures covered which do not require hospitalization more than 24 hours.
Domiciliary Treatment	Covered for availing medical treatment at home in case the patient cannot be transferred to a hospital due to his/her condition or unavailability of bed.
Organ Donor	Expenses covered in case of a transplant.
Ambulance Charges	Covered in the case of an emergency.
AYUSH Treatment	Covered for expenditure on Ayurveda, Unani, Siddha, and Homeopathy.
Enhanced Cumulative Bonus (ECB)	10% increase in SI every claim-free year, up to a maximum of 100%
REGAIN Benefit	Automatic availability of SI upon exhaustion during the policy year. It will be replenished only once during the year and shall not be carried forward to the next year.
Medical Check-up	Up to 1% SI or Rs. 5000, whichever is less, after 4 continuous claim-free years.

Exclusions

The main exclusions under the policy are:

• Pre-existing conditions till 4 years of the policy.
• 30 day waiting period for claims.
• A 2-year waiting period for certain conditions mentioned in the policy document e.g. cysts, internal tumors, surgeries on sinuses and tonsils etc.
• Any intentional self-harm or suicide attempt.
• Claims arising out of armed conflicts or wars.
• Treatment of HIV/AIDS.
• Drug abuse.
• Cosmetic surgery unless necessitated by accidental injury.
• Pregnancy, dental and external aids.

Health Suraksha Gold

This plan offers not only coverage for the hospitalization and its related expenses but also  provides additional benefits like maternity and newborn cover and the option of e-opinion for critical illness.

Highlights

• Cashless hospitalization in over 5000 hospitals.
• Available both as individual and family floater plan.
• Lifelong renewability.
• Term plan may be 1-2 years (discount of 10% on 2-year term).
• Family discount of 10% if 2 or more members are covered on an individual basis.
• Sum Insured (SI) may be Rs. 3/4/5/7.5/10 lakhs.
• Maternity benefit and newborn cover after 4 years of the policy.
• Income tax benefits under section 80-D of Income Tax Act.
• No sub-limits on room rent, hospitalization expenses, and doctor fees.
• E-opinion in critical illness.

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Benefits

Hospitalization Expenses	Covered up to Sum Insured. It includes room rent, nursing charges, doctor fee, OT charges, cost of blood, oxygen and surgical instruments, diagnostic procedures and prosthetic devices.
Pre-hospitalization Charges	Covered up to 60 days before hospitalization.
Post-hospitalization Charges	Covered up to 90 days after hospitalization.
Daycare Procedures	Cost of 144 listed procedures covered which do not require hospitalization more than 24 hours.
Domiciliary Treatment	Covered for availing medical treatment at home in case the patient cannot be transferred to a hospital due to his/her condition or unavailability of bed.
Organ Donor	Expenses covered in the case of a transplant.
Ambulance Charges	Covered in the case of an emergency, up to Rs. 2000 (for SI of Rs. 3/4/5 lakhs) and Rs. 3500 (for SI of Rs. 7.5 and 10 lakhs).
AYUSH Treatment	Covered for expenditure on Ayurveda, Unani, Siddha, and Homeopathy.
Maternity Benefit	Cover of Rs. 15000 for normal delivery and Rs. 25000 for cesarean section.
E-Opinion	Second opinion by an empaneled healthcare specialist in case the policyholder is diagnosed with a critical illness.
Convalescence Benefit	Lump sum amount, up to 1% of SI is paid if hospitalization exceeds 10 days.
Cumulative Bonus	5% increase in SI every claim - free year, up to a maximum of 50%
Medical Check-up	Up to 1% SI or Rs.5000, whichever is less, after 4 continuous claim-free years.

Exclusions

The main exclusions under the policy are:

• Pre-existing conditions till 4 years of the policy.
• 30 day waiting period for claims, except in the case of an accident.
• A 4-year waiting period for maternity benefit and newborn cover.
• A 2-year waiting period for certain conditions specified in the policy document.
• Any intentional self-harm or suicide attempt.
• Claims arising out of armed conflicts or wars.
• Treatment of HIV/AIDS.
• Drug abuse and mental disorders.
• Cosmetic surgery unless necessitated by accidental injury.
• Vaccinations.

Health Suraksha Gold with REGAIN and ECB

This plan offers you financial security in case of exhaustion of the sum insured during the policy year.

Highlights

• Cashless hospitalization in over 5000 hospitals.
• Available both as individual and family floater plan.
• Lifelong renewability.
• Term plan may be 1-2 years (discount of 10% on 2-year term).
• Family discount of 10% if 2 or more members are covered on an individual basis.
• Sum Insured (SI) may be Rs. 3/4/5/7.5/10 lakhs.
• Maternity benefit and newborn cover after 4 years of the policy.
• Income tax benefits under section 80-D of Income Tax Act.
• No sub-limits on room rent, hospitalization expenses, and doctor fees.
• E-opinion in critical illness.

Benefits

Hospitalization Expenses	Covered up to Sum Insured. It includes room rent, nursing charges, doctor fee, OT charges, cost of blood, oxygen and surgical instruments, diagnostic procedures and prosthetic devices.
Pre-hospitalization Charges	Covered up to 60 days before hospitalization.
Post-hospitalization Charges	Covered up to 90 days after hospitalization.
Domiciliary Treatment	Covered for availing medical treatment at home in case the patient cannot be transferred to a hospital due to his/her condition or unavailability of bed.
Organ Donor	Expenses covered in case of a transplant.
Ambulance Charges	Covered in the case of an emergency, up to Rs. 2000 (for SI of Rs. 3/4/5 lakhs) and Rs. 3500 (for SI of Rs. 7.5 and 10 lakhs).
AYUSH Treatment	Covered for expenditure on Ayurveda, Unani, Siddha, and Homeopathy.
Maternity Benefit	Cover of Rs. 15000 for normal delivery and Rs. 25000 for cesarean section.
E-opinion	Second opinion by an empaneled healthcare specialist in case the policyholder is diagnosed with a critical illness.
REGAIN Benefit	Automatic availability of SI upon exhaustion. It can only be replenished once in a policy year and cannot be carried forward to the next if unused.
Enhanced Cumulative Bonus (ECB)	10% increase in SI every claim-free year, up to a maximum of 100%

Exclusions

The main exclusions under the policy are:

• Pre-existing conditions till 4 years of the policy.
• 30 day waiting period for claims, except in the case of an accident.
• A 4-year waiting period for maternity benefit and newborn cover.
• Any intentional self-harm or suicide attempt.
• Claims arising out of armed conflicts or wars.
• Treatment of HIV/AIDS.
• Drug abuse and mental disorders.
• Cosmetic surgery unless necessitated by accidental injury.

Health Suraksha Top Up Plus

It is a Top Up plan specifically meant to supplement your pre-existing plan for additional coverage. The sum insured of the pre-existing plan can be deductible for this plan.

Highlights

• Coverage of up to Rs. 5 lakhs per annum over the selected deductible.
• Option to convert the Top Up policy into Health Suraksha policy.
• Lifelong renewability.
• Entry age from 5 years to 65 years.
• Policy term may be 1-2 years.
• No capping on expenses of doctor fee, room rent etc.
• A family discount of 10% if 3 or more members are covered.

Benefits

Sum Insured	Rs. 2/3/4 lakhs
Deductible	Rs. 1/2/3 lakhs
Hospitalization Expenses	Covered up to Sum Insured. It includes room rent, nursing charges, doctor fee, OT charges, cost of blood, oxygen and surgical instruments, diagnostic procedures and prosthetic devices.
Pre-hospitalization Charges	Covered up to 60 days before hospitalization.
Post-hospitalization Charges	Covered up to 90 days after hospitalization.
Daycare Procedures	Cost of 140 listed procedures covered which do not require hospitalization more than 24 hours.
Domiciliary Treatment	Covered for availing medical treatment at home in case the patient cannot be transferred to a hospital due to his/her condition or unavailability of bed.
Organ Donor	Expenses covered in case of a transplant.
Ambulance Charges	Covered in the case of an emergency, up to Rs. 2000 per hospitalization.
Cumulative Bonus	5% increase in SI every claim-free year, up to a maximum of 50%

Exclusions

The exclusions under the policy are:

• The company shall make no payment unless the expenditure exceeds deductible.
• 30 days waiting period for all claims, except in the case of an accident.
• A waiting period of 2 or 4 years on certain conditions, as specified in the policy document.
• Non- allopathic treatment expenses.
• Treatment of HIV/AIDS.
• Any claims arising out of war or armed conflict.
• Pregnancy, dental and external aids.
• Mental disorders and drug abuse.

Critical Illness Insurance

This health insurance product provides lump sum amount for the diagnosis of any of the mentioned critical illnesses.

Highlights

• Lump sum benefits on the diagnosis of the mentioned 8 critical illnesses.
• Tax Benefit under section 80-D of Income Tax Act.

Benefits

• Lump sum benefits in case of diagnosis of the following critical illnesses:
• Heart attack
• Multiple sclerosis
• Stroke
• Cancer
• Kidney failure

• Major organ transplantation
• Paralysis
• CABG (Coronary Artery Bypass Grafting)
• The amount can be used to pay for hospitalization expenses, to pay off debts, compensate for lost income and aid a change in lifestyle.

Exclusions

The following exclusions exist under the policy:

• A waiting period of 90 days for all claims.
• Treatment of HIV/AIDS.
• Pregnancy and related complications or delivery expenses.
• Intentional self-harm or suicide attempt.
• Claims arising out of an armed conflict or war.
• Drug abuse.
• Participation in adventure sports or similar activities.

Critical Illness Platinum

This plan provides lump sum benefit in case of the first diagnosis of any of the mentioned 15 critical illnesses.

Highlights

• Lump sum benefits on the diagnosis of the mentioned 8 critical illnesses.
• Tax Benefit under section 80-D of Income Tax Act.

Benefits

• Lump sum benefits after a survival period of 30 days in case of diagnosis of any of the following critical illnesses:
• Heart attack
• Multiple sclerosis
• Aorta graft surgery
• Primary pulmonary arterial hypertension
• Heart valve replacement
• Benign brain tumor
• Parkinson’s disease
• Alzheimer’s disease.
• Stroke
• Cancer
• Kidney failure
• Major organ transplantation
• Paralysis
• CABG (Coronary Artery Bypass Grafting)
• End stage liver disease
• The amount can be used to pay for hospitalization expenses, to pay off debts, compensate for lost income and aid a change in lifestyle.

Exclusions

The following exclusions exist under the policy:

• A waiting period of 90 days for all claims.
• Treatment of HIV/AIDS.
• Pregnancy and related complications or childbirth expenses.
• Claims arising out of an armed conflict or war.
• Drug abuse.
• Participation in adventure sports or similar activities.
• Intentional self-harm or suicide attempt.

Disclaimer: This information is extracted from the company’s official website to provide information to the general public. The information is likely to change based on the concerned insurance companies’ discretion. Alterations, deletions and/or additions to the existing policy products, coverage and their premiums may be enhanced or reduced. These figures are only guidelines. We recommend the individual to visit the official website of the insurance company for more details and updated matters.