HDFC Ergo Insurance Plans

HDFC ERGO Health Suraksha Gold

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Eligibility of Health Suraksha Gold

  • This policy covers persons in the age group 91 days onwards. There is no maximum entry age.
  • Children below 5 years would be covered provided both the parents are covered under our policy.
  • There is no cover ceasing age in the policy.
  • The policy offers option on covering on individual sum insured basis and on family floater basis.
  • This policy can be issued to an individual and/or family.
  • The family includes spouse, dependent children and dependent parents.

HDFC ERGO Health Insurance Review

HDFC ERGO Health Insurance
HDFC ERGO Health Insurance sum insured
3 lacs − 75 lacs options available
Incurred Claims Ratio *
62.00%
HDFC ERGO Insurance tenure options
2 years
Claims Settlement Ratio **
85.97%
List of network hospitals
10,000+ hospitals
Number of policies issued *
1,066,395
Maximum family floater coverage
Self, Spouse + dependent (children (upto 25 yrs) + parents)
Number of lives covered *
96,05,000
* As per IRDAI report for 2018-19   |   ** As per NL25 data published on the Insurance Company website

HDFC ERGO Health Suraksha Gold benefits

  • Key Features
  • Policy Period
  • Benefits
  • Coverage Description

Key features of HDFC ERGO Health Suraksha Gold Insurance

  • Room Rent: Payable at Actuals upto Sum Insured
  • Co-pay: NIL for all treatment, Optional Co pay available between 10%-15%
  • Restoration Benefit: Sum Insured Rebound upto 100% of Sum Insured per year
The policy will be issued for 1 year /2 years period

Coverages of HDFC ERGO Health Suraksha Gold Insurance

Health Suraksha Gold - Individual Sum Insured
Plan Silver Gold Platinum
Basic Sum Insured per Insured Person per Policy Year [All figures in INR] 1,00,000 2,00,000 3,00,000 4,00,000 5,00,000 7,50,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000 1,00,000 2,00,000 3,00,000 4,00,000 5,00,000 7,50,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000 1,00,000 2,00,000 3,00,000 4,00,000 5,00,000 7,50,000 10,00,000 15,00,000 20,00,000 25,00,000 50,00,000
Health Suraksha Gold - Individual Sum Insured
In Patient Treatment Covered Covered Covered
Pre Hospitalisation 60 days 60 days 60 days
Post Hospitalisation 90 days 90 days 90 days
Day Care Procedures Covered Covered Covered
Domiciliary Treatment Covered Covered Covered
Organ Donor Covered Covered Covered
Emergency Ambulance Limit per Hospitalisation 2,000 2,000 35,000 2,000 2,000 35,000 2,000 2,000 35,000
AYUSH Benefit Covered Covered Covered
New Born Baby Covered Covered Covered
Section 2: Benefits not related to Basic Sum Insured & any claim under them will NOT affect entitlement to Renewal Incentive
Maternity Waiting Period 4 Years Optional Normal Delivery Rs. 15,000 Caesarean Delivery Rs. 25,000 Termination Rs. 15,000 (The maternity sum insured above Includes Pre/Post Natal limit of Rs. 1,500 and New Born limit of Rs. 2,000) Normal Delivery Rs. 25,000 Caesarean Delivery Rs. 40,000 Termination Rs. 25,000 (The maternity sum insured above Includes Pre/Post Natal limit of Rs. 2,500 and New Born limit of Rs. 3,500)
Dental Waiting Period of 3 years Co payment 50% Optional Optional Upto 1 % of Sum insured subject to a Maximum of 5000
Spectacles / Contact Lenses and/or Hearing Aid Every Third Year Co payment 50% Optional Optional upto 5,000
E-Opinion for Critical Illness Optional Covered Covered
Convalescence Benefit Minimum Hospitalisation of 10 continuous and consecutive days Optional Upto 1 % of Sum insured subject to a Maximum of 10,000 Upto 1 % of Sum insured subject to a Maximum of 10,000
Section 3: Optional Benefit; not related to Basic Sum Insured & any claim under them will NOT affect entitlement to Renewal Incentive
Critical Illness Lumpsum 50% or 100% of Basic Sum Insured or 10 Lacs whichever is lower 50% or 100% of Basic Sum Insured or 10 Lacs whichever is lower 50% or 100% of Basic Sum Insured or 10 Lacs whichever is lower
Section 4: Optional Benefit; not related to Basic Sum Insured & any claim under them will NOT affect entitlement to Renewal Incentive
Hospital Daily Cash 500/1000/1500/2000/ 2500 per day; Maximum 30/60 days as per plan opted 500/1000/1500/2000/ 2500 per day; Maximum 30/60 days as per plan opted 500/1000/1500/2000/ 2500 per day; Maximum 30/60 days as per plan opted
Section 5: Optional Benefit will be subject to Basic Sum Insured and any claim under them will affect entitlement to Renewal Incentive
Regain Benefit 100% of basic sum insured (applicable for 3 Lac and above Sum Insured) 100% of basic sum insured 100% of basic sum insured
Section 6: Optional Benefit will be subject to Basic Sum Insured and any claim under them will affect entitlement to Renewal Incentive
Enhanced Cumulative Bonus 10% of Sum Insured; Maximum 100% [Reduced by 10% in the event of claim]
Section 7: Optional Co-Pay
Co Pay 10% or 20% of the admissible claim amount subject to the sum insured specified in the schedule
Section 8: Renewal Incentive
Cumulative Bonus 5% of Sum Insured; Maximum 50% [Reduced by 5%% in the event of claim]
Health Check Up Upto 1% of Sum Insured; Max 5,000 per person

HDFC ERGO Health Suraksha Gold Coverage Description

Salient Benefits In-patient Treatment Covers hospitalisation expenses due to an illness or accident. We will pay for the medical expenses for Room rent, boarding expenses, Nursing, Intensive care unit, Medical Practitioner, Anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, Medicines, drugs and consumables, Diagnostic procedures, Cost of prosthetic & other devices or equipments if implanted internally during a Surgical Procedure.

Pre- Hospitalisation The Medical Expenses incurred due to an Illness in 60 days immediately before the Insured Person was hospitalized

Post-Hospitalisation The Medical Expenses incurred in 90days immediately after the Insured Person was discharged post Hospitalisation.

Day care procedures The Medical expenses for 144Day care procedures which do not require 24 hours hospitalization due to technological advancement. We will also pay for Pre & Post Hospitalisation.

Domiciliary Treatment The Medical Expenses incurred by an Insured Person for availing medical treatment at his home which would otherwise have required Hospitalisation.

Organ Donor The Medical Expenses for an organ donor's treatment in the event of organ transplantation. g. Emergency Ambulance –Expenses for utilizing ambulance in emergency upto a limit of ₹2000/3200 as per plan opted.

AYUSH Benefit Medical expenses for in-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy.

Optional Benefits (Available in selective Planson additional premium payment) Newborn baby Coverage for newborn from birth.

Maternity Expenses Medical Expenses for maternity including pre-natal and post-natal expenses after a waiting period of 4 years.

Outpatient Dental Treatment 50% of the Medical expenses for X-rays, Extractions, Amalgam / Composite Fillings, Root Canal Treatments and prescribed Drugs from 4th year onwards. Spectacles, Contact Lenses, Hearing Aid 50% of actual expenses for one pair of spectacles or contact lenses or a hearing aid excluding batteries every third year subject to being prescribed by a Network EYE/ENT Medical Practitioner.

E-Opinion in respect of a Critical Illness. Convalescence Benefit Lumpsum payment of 1% of the sum insured upto a maximum of `10,000 in an event of hospitalisation exceeding 10 continuous and completed days.

Optional Benefits (Available in selective Plans on additional premium payment) These benefits include Critical Illness, Regain Benefit, Hospital Daily Cash, Enhanced Cumulative Bonus etc.

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.

The following KYC documents are required from the insured person/proposer in cases of reimbursement-
  • If claim amount is below 1 lakh- Photo Id proof & address proof
  • If claim amount is above 1 lakh- Photo Id proof, address proof and a recent photograph
List of necessary claim documents to be submitted for reimbursement are as following:
  • Claim form duly signed
  • Copy of photo id of patient
  • Hospital discharge summary
  • Operation theatre notes
  • Hospital main bill
  • Hospital break up bill
  • Investigation reports
  • Original investigation reports, X ray, MRI, CT films, HPE, ECG
  • Doctors reference slip for investigation
  • Pharmacy bills
  • MLC/ FIR report, post mortem report if applicable and conducted

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.

Brochure

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Proposal form

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Policy wordings

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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2025