|Step 1||Get admitted to any one of HDFC Ergo network hospitals, currently they have 6000+ hospitals across the country…check out the hospital list.
(Note: Cashless Facility is only available at hospitals in the company’s cashless network)
|Step 2||Use your HDFC Ergo Health Card or share your Policy number and Passport / PAN card / voter’s ID for identification purposes|
|Step 3||The Network Hospital will check your identity for validation and submit the pre-authorisation request form to HDFC Ergo as per the defined process/format|
|Step 4||HDFC Ergo will review and provide our confirmation to the Network Hospital regarding the coverage limits and admissibility for the treatment for which the insured has been admitted.|
|Step 5||HDFC Ergo will settle the claim (as per policy terms & conditions) with the hospital after completion of all formalities of documentation as per submission by the hospital.|
|Step 1||In case of hospitalization notify HDFC Ergo within 24-48 hours of your admission in our network or non network hospital. After getting admitted settle bills directly to the hospital.|
|Step 2||On discharge, please ensure you collect all relevant documents, invoices, medical reports and discharge certificate from the Hospital in originals.|
|Step 3||Send these documents and the completely filled and signed claim form to us along with your valid ID proof and age proof. The claim form is available on the company website and in your policy document kit as well.|
|Step 4||We review your claim request and the supporting documents provided along with the claim form. Accordingly based on policy terms & conditions, HDFC Ergo will approve, query or reject the same.|
|Step 5||Subject to the claim being approved, HDFC Ergo will settle the claim (as per policy terms & conditions) and reimburse the approved amount to the insured.|
Looking at the healthcare inflation cost coupled with the lifestyle disease epidemic, health insurance is needed to help you pay for health care in the event of an unexpected illness or injuries. HDFC Ergo Health Insurance covers medical uncertainties and ensures quality medical treatment at the time of need.
The earlier the better, typically, when you are in your early 20's and you have just started earning Health insurance also helps in financial planning and offers wider coverage at a lower premium.
Your own health insurance means an all round cover that secures your medical needs. After a period when you are no more eligible to stay covered under your parent's policy, your own health insurance helps you at times of need.
Your ideal sum insured or total coverage would highly depend on factors such as your current age, lifestyle, medical history, income and place of residence. Looking at the medical inflation, most of our customers prefer a health insurance policy with a sum insured of 5 lacs and above.
Health Insurance covers not just major illnesses arising due to infection and accidents which can affect anyone at any point of time in life. Hence HDFC Ergo Health Insurance is equally important for a fitness expert or an athlete.
Absolutely! With employee health cover the major drawbacks come in picture when you leave your job that's when your policy goes out of action and exposes you to health risks. Your new employer may or may not cover you sufficiently. Also, having your own policy means a better buying decision and complete control to buy a cover which suits your requirement from time to time.
Yes! We do cover you subject to no adverse medical conditions due to same.
You can raise a claim via their mobile application my:health active. At HDFC ERGO, 90% reimbursement claims are settled within 3 days and around 90% are cashless claims are pre-authorized within 20 minutes.
Under cashless hospitalization, the insured person does not settle the hospitalization expenses at the time of discharge from hospital. The settlement is done directly by us for treatment that the insured person is eligible to receive under the terms of his/her policy. This is for your convenience. However, it is important to note here that prior approval is required from us before admission into the hospital. In some cases, you may have to pay for all or part of the treatment if it is not fully covered under the terms of the policy. However, in case of emergency hospitalization, you can obtain approval post-admission. Please note that the cashless facility is available only at our Network Hospitals.
HDFC Ergo has an extensive network of 10,000+ network hospitals across India growing steadily over the years. One must get admitted to a network hospital in order to avail cashless treatment for their illness. One can find the hospital closest to them by reviewing the list of network hospitals at HDFC Ergo health insurance
There is no upper limit on the number of claims during the policy period. However, the total cumulative claim amount cannot exceed the Policy Sum Insured.
A pre - existing disease is any condition, ailment or injury or related condition(s), for which the insured person had signs or symptoms, and /or were diagnosed, and / or received medical advice / treatment within 36/48 months prior to 1st health insurance policy issued by Us under which the insured person was covered.
Most of the Health Insurance Policies offered by the General Insurance companies in India have waiting periods during which certain pre existing diseases are excluded in the coverage. They are excluded for certain predefined period (number of years) before they are covered i.e. The Policy holder is expected to have continuous cover for the predefined period before the pre existing diseases are covered under the policy. Portability will ensure that these accrued benefits are transferred (without any dilution) to the new insurer at the time of renewal and porting and the consumer do not lose on these accrued benefits while opting to switch the insurer using Health Insurance Portability. The Policy holder can port the following accrued credits: General waiting period Waiting periods pertaining to the coverage of pre - existing diseases / conditions Any time bound exclusions
It refers to payment of the Medical Expenses incurred by the insured, immediately 90 days before and 180 days after Hospitalization.
It refers to payment of the Medical Expenses incurred by the insured while undergoing Specified Day Care Procedures/ Treatment (as mentioned in the Day Care Surgeries list), which require less than 24 hours Hospitalization.
Pre - acceptance Health check is not mandatory for people who are less than 45 years old and without any history of illness. Insured’s with following condition, acceptance of proposal is subject to a satisfactory medical examination as per HDFC Ergo’s requirements.
Premium for Family Floater Policy is calculated basis the age of the oldest member of the family to be insured.
Individual plan has to be separate for every individual. Floater covers all in family (max. 2 Adults and Children upto 25 years and Dependent parents) and provides one sum insured to all, hence there is saving of premium.
There is No maximum exit age for HDFC Ergo medical insurance.
Sub limit defines the capping of insurance amount, for specific surgeries and medical procedures, which reduces the premium of the plan. You can also opt for an add on cover by paying extra premium to remove the sub- limits under the policy.
The duration only after which a claim can be made is called the waiting period.
The premium paid on a health insurance policy is eligible for deduction under Section 80D of the Income Tax Act. So save with your policy now!
Co-payment is a cost-sharing requirement under a health insurance policy, where the Policy Holder / insured will bear a specified percentage of the admissible costs
A ‘Free Look Period’ is a period of 15 days from the date of receipt of the policy that a policyholder, in this case you, have to review the entire health insurance plan. If you disagree with any of the terms or conditions mentioned in the policy, you have the option of returning the policy by stating the reasons for the objection. Following this, you are entitled to a refund of the premium paid, provided no claim has been made under this mediclaim insurance policy (subject only to a deduction of the expenses incurred by the company on medical examination and the stamp duty charges). Please note that this facility is not applicable on renewal and portability cases.
A deductible is a cost-sharing requirement. It states that the insurer will not be liable for a specified amount in case of indemnity policies. This is applicable for a specified number of days/hours in case of hospital cash policies which apply before any benefits are payable by the insurer. Remember that a deductible does not reduce your sum insured.
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