HDFC Ergo Health Suraksha

Product Description:

Health Suraksha from HDFC Ergo gives you the option of taking a cover for an individual person or extending the benefit to the entire family under 1 plan. The family can include upto 2 Adults between the age of 18 & 65 yrs and upto 2 children between the age of 3 months & 21 yrs. People upto the age of 45 yrs can buy this plan without any medical tests, provided they have a clean proposal form. Apart from providing for the Inpatient hospitalization benefits, the Health Suraksha policy also covers all related expenses for 60 days prior to and for 90 days post hospitalization period. One also gets Domiciliary benefit and Ayush (Non-allopathic) treatment benefits under this policy, as per terms and conditions. The policy can be renewed max upto 65 yrs of age.

Know more about your Insurance

Key features: Availability, Benefits and Exclusions

Minimum Age at Entry : 3 months
Maximum Age at Entry : 65 years
Maximum Age at Renewal : 75 years
Minimum Sum Assured : Rs 2 lacs
Maximum Sum Assured : Rs 5 lacs
No claim Bonus – Annual : 5%
No claim Bonus – cumulative : upto 50%
Maternity Benefits : N/A
Pre-Existing Disease cover : after 4 years
Waiting Period : 30 Days

Product pricing (Incl. S/Tax)   (Rs)
2 Adults    
Age SA 2 lacs SA 2.5 lacs SA 3 lacs SA 3.5 lacs SA 4 lacs SA 4.5 lacs SA 5 lacs
0 – 17 yrs N/A N/A N/A N/A N/A N/A N/A
18 – 35 yrs 4737 N/A 5480 N/A 8228 N/A 10681
36 – 45 yrs 5945 N/A 6595 N/A 9180 N/A 11982
46 – 50 yrs 11263 N/A 12624 N/A 17373 N/A 22995
51 – 55 yrs 11826 N/A 13256 N/A 18241 N/A 23893
56 – 60 yrs 13776 N/A 15336 N/A 21876 N/A 27820
61 – 65 yrs 19331 N/A 22150 N/A 34698 N/A 39802

Claim procedure

  1. Intimation & Assistance - In case of planned hospitalization, select and approach the service desk of the chosen network hospital, preferably at least 3 days in advance. Use your HDFC Ergo Health card or share your policy no and passport no with the healthcare provider for identification purpose. One can also use PAN card and voter ID card for the same.

  2. Pre-authorization: Get the pre-authorization form (available at the hospital help desk and/or TPA website), filled and signed from the treating doctor and submit the same with the hospital. The network hospital checks the identity of the Insured for validation and submits the pre-authorization form to the TPA. After cross verifying the identity of the Insured and the policy coverage, the TPA will provide confirmation to the provider by e-mail/fax and also inform the Insured by way of a text message.

  3. Cashless settlement: Get admitted for treatment at the network hospital and sign all forms, invoices and documents on discharge. HDFC Ergo will directly make the payment to the hospital for pre-approved treatment and as per policy terms & conditions. Any non-medical expense and/or expenses towards conditions not authorized under hospitalization need to be paid directly by the beneficiary of treatment. Also, remember signing the HDFC Ergo claims form and hand it over to the hospital along with all the relevant supporting documents.

*Please note in case of treatment at non-network hospitals, claim should be registered not later than 7 days of discharge for reimbursement.

Some key statistics for HDFC Ergo

Claims Pending Ratio : To be Announced soon
Complaints Resolved Ratio : To be Announced soon
Provider Network (cashless) : To be Announced soon

General Health Insurance Tips

Understand the cost of healthcare in your city/area before deciding the total cover (Sum Assured)

If your family includes a young bride, it is important to ensure the coverage of maternity benefits

Ask about the coverage of pre-existing diseases

Look at the waiting period

Satisfy yourself about the specific disease’s coverage under the Critical Illness cover

Inquire about the availability of cashless facility at the Network hospitals

Always compare before buying

Disclaimer: This is only an illustrative document to serve as a quick guide for aide in decision making.

Information Source: HDFC Ergo website as on 10th Oct’2011
IRDAI annual report’2010