HDFC ERGO Health vs SBI General Health Insurance Plans
| HDFC ERGO Health | SBI General | |
|---|---|---|
| Claims Settlement Ratio** | 89.50% | 62.73% |
| Number of Lives Covered* | 51,16,000 | 27,48,000 |
| Network Hospitals | 10,000 + | 6,000 + |
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| Easy Health | Optima Restore | Arogya Sanjeevani | Retail Health | Arogya Premier | Arogya Plus | Arogya Sanjeevani |
| In-patient Treatment | ||||||
| Covered up to sum insured | Covered | Covered | Covered | Covered | Covered | Covered |
| Room Rent | ||||||
| Covered | Covered | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day | 1% of sum insured per day | Covered | Covered | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day |
| ICU Charges | ||||||
| Covered | Covered | Up to 5% of the sum insured subject to maximum of Rs.10,000 per day | 2% of sum insured per day | Covered | Covered | Up to 5% of the sum insured subject to maximum of Rs.10,000 per day |
| Pre-hospitalization | ||||||
| Covered up to 60 Days | Covered up to 60 Days | 30 days before the date of admission to the hospital | Up to 30 days | Up to 60 days | Up to 60 days | 30 days before the date of admission to the hospital |
| Post-hospitalization | ||||||
| Covered up to 90 Days | Covered up to 180 Days | 60 days after discharge from the hospital | Up to 60 days | Up to 90 days | Up to 90 days | 60 days after discharge from the hospital |
| Day Care Procedures | ||||||
| Covered | All day care treatments covered | All day care treatments covered | 142 day care expenses covered | 142 day care expenses covered | 142 day care expenses covered | All the day care treatments |
| Domiciliary Treatment | ||||||
| Covered | Covered upto sum insured | Not Covered | 20% of the sum insured maximum up to Rs.20,000 | Insurer will cover reasonable and customary charges towards domiciliary hospitalisation | Insurer will cover reasonable and customary charges towards domiciliary hospitalisation | Not Covered |
| Emergency Ambulance | ||||||
| Up to Rs.2,000 per hospitalisation | Up to Rs.2,000 per hospitalisation | Up to Rs.2,000 per hospitalisation | 1% of sum insured per policy period up to a maximum of Rs.1,500 | Actual | Actual ambulance expenses or Rs.1,500 | Subject to a maximum of Rs.2,000 per hospitalisation. |
| Dental Treatment | ||||||
Individual - Standard & Exclusive: Not Covered Platinum (4 lakhs to 10 lakhs): Up to 1% of Sum insured subject to a maximum of Rs.5,000 Platinum (15 to 50 Lakhs): Up to 1% of Sum insured subject to a maximum of Rs.7,500 Family - Standard & Exclusive: Not Covered Platinum (4 to 10 Lakhs): Up to 1% of Sum insured subject to a maximum of Rs.5,000 Platinum (15 to 50 Lakhs): Up to 1% of Sum insured subject to a maximum of Rs.10,000 (waiting period: 3 years) |
Not Covered | Dental treatment, necessitated due to disease or injury | Covered | Covered | Covered | Dental treatment necessitated due to disease or injury |
| Bariatric Surgery | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Ayush Benefit | ||||||
Standard: Up to Rs.20,000 Exclusive & Platinum (3 to 10 Lakhs): Up to Rs.25,000 Exclusive & Platinum (15 to 50 Lakhs): Up to Rs.50,000 |
Not Covered | Covered | Ayurvedic medicine: Covered up to maximum 15% of sum insured per policy period up to a maximum of Rs.20,000 Homeopathic and Unani system of medicine: Covered up to maximum 10% of sum insured per policy period up to a maximum of Rs.15,000 |
Covered | Covered | Covered |
| Maternity Benefits | ||||||
Standard: Not Covered Exclusive & Platinum (3 to 10 Lakhs): Normal Delivery Rs.15,000, Caesarean Delivery Rs.25,000 Exclusive & Platinum (15 to 50 Lakhs): Normal Delivery Rs.30,000, Caesarean Delivery Rs.50,000 (Waiting Period: 4 Years) |
Not Covered | Not Covered | Not Covered | Reasonable and customary charges towards maternity expenses during hospitalisation are covered after first 9months from the date of inception of first policy | Covered but only under OPD section and up to OPD Limit specified in policy schedule. | Not Covered |
| New Born baby cover | ||||||
Standard: Not Covered Exclusive & Platinum: Additional Benefit on payment of additional premium |
Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Daily Cash for Accompanying an Insured Child | ||||||
Standard: Not Covered Exclusive & Platinum (3 to 5 Lakhs): Rs.300 per day, maximum Rs.9,000 Exclusive & Platinum (7.5 to 10 Lakhs): Rs.500 per day, maximum Rs.15,000 Exclusive & Platinum (15 to 50 Lakhs): Rs.800 per day, maximum Rs.24,000 |
Not Covered | Not Covered | Rs.500 for each completed day of hospitalisation of a child below 10 years of age, subject to maximum of 30 days during the policy period | Not Covered | Not Covered | Not Covered |
| Organ Donor Expenses | ||||||
| Covered | Covered up to sum insured | Not Covered | Covered | Covered | Not Covered | Not Covered |
| Cataract Treatment | ||||||
| Not Covered | Not Covered | Up to 25% of Sum insured or Rs.40,000, whichever is lower, per eye, under one policy year (Waiting period: 2 years) |
15% of the sum insured subject to a maximum of Rs.25,000 per eye | Not Covered | Not Covered | 25% of sum insured or Rs.40,000, whichever is lower, per each eye in one policy year |
| Vaccination (In case of post bite treatment) | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Health Check-up | ||||||
Standard: Every 4 years 1% of sum insured, up to Rs.5,000, irrespective of claim Exclusive: Every 3 years 1% of sum insured, up to Rs.5,000, irrespective of claim Platinum: Every 2 years 1% of sum insured, up to Rs.5,000, irrespective of claim |
Individual - 3 Lakhs: Not Covered 5 Lakhs: Up to Rs.1,500 10 Lakhs: Up to Rs.2,000 15 Lakhs: Up to Rs.4,000 20 to 50 Lakhs: Up to Rs.5,000 Family - 3 Lakhs: Not covered 5 Lakhs: Up to Rs.2,500 10 Lakhs: Up to Rs.5,000 15 Lakhs: Up to Rs.8,000 20 to 50 Lakhs : Up to Rs.10,000 |
Covered | 1% of sum insured up to a maximum of Rs.2,500 for every 4 claims free year | Rs.5,000 for every 4 claims free year | Not Covered | Not Covered |
| Hospital daily allowance | ||||||
Standard: Rs.500 per day, maximum Rs.3,000 Exclusive & Platinum (3 to 5 Lakhs): Rs.500 per day, maximum Rs.3,000 Exclusive & Platinum (7.5 to 10 Lakhs): Rs.800 per day, maximum Rs.4,800 Exclusive & Platinum (15 to 50 Lakhs): Rs.1,000 per day, maximum Rs.6,000 (Choosing shared accommodation) |
3 to 15 Lakhs: Rs.800 per day, maximum Rs.4,800 20 to 50 Lakhs: Rs.1,000 per day, maximum Rs.6,000 (Choosing shared accommodation) |
Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Co-pay | ||||||
| NIL Co-pay under this plan | NIL Co-pay under this plan | 5% Co-pay applicable on all claims | No co-pay for treatment in Network / 10% in Non Network Hospitals | No co-pay for all treatment | No co-pay for all treatment | 5% Co-pay applicable on all claims |
| Pre-existing diseases coverage | ||||||
| Covered after a waiting period of 3 years | Covered after a waiting period of 3 years | Covered after a waiting period of 4 years | Covered after 4 years of continuous coverage | Covered after a waiting period of 4 years | Covered after a waiting period of 4 years | Covered after a waiting period of 4 years |
| Restore Benefit | ||||||
| NIL Restoration Benefit under this plan | Up to 100% of Base Sum Insured per year | NIL Restoration benefit | Not Covered | Covered up to 100% of base sum insured | Covered up to 100% of base sum insured | Not Covered |
| General waiting period | ||||||
| 30 days | 30 days | 30 days | 30 days | 30 days | 30 days | 30 days |
| Renewal Benefit / Cumulative Bonus | ||||||
| 10% on base sum insured for every claim free year and up to 100% | 50% for every claim free year up to 100% of basic sum insured | 5% for every claim free year up to 50% of sum insured | 5% every year, maximum up to 25% of sum insured | 10% every year, maximum up to 50% of sum insured | Not Covered | 5% every year, maximum up to 25% of sum insured |
| Emergency Air Ambulance | ||||||
Standard: Not Covered Exclusive & Platinum (3 to 10 lakhs): Not Covered Exclusive & Platinum (15 to 50 Lakhs): Up to Rs.2.5 lakhs per hopsitalisation |
3 to 5 Lakhs: Not Covered 10 to 50 Lakhs: Covered up to Rs.2.5 lakhs per hospitalization and maximum up to sum insured in an year |
Not Covered | Not Covered | Up to Rs.100,000 | Not Covered | Not Covered |
| Available sum insured options | ||||||
Individual - Standard Plan: Rs.1 to 15 Lakhs Exclusive Plan: Rs.3 to 50 Lakhs Platinum Plan: Rs.4 to 50 Lakhs Family - Standard Plan: Rs.2 to 15 Lakhs Exclusive Plan: Rs.3 to 50 Lakhs Platinum Plan: Rs.4 to 50 Lakhs |
Individual: Rs.50,000 to 10 Lakhs Floater: Rs.2 to 10 Lakhs |
Rs.1 to 5 Lakhs | Rs.50,000 to 5 Lakhs | Rs.10 to 30 Lakhs | Rs.1 to 3 Lakhs | Rs.1 to 5 Lakhs |
| Policy can be purchased for | ||||||
| 1/2 years | 1/2 years | 1 year | 1/2/3 years | 1/2/3 years | 1/2/3 years | 1 year |
| Eligibility criteria | ||||||
| 5 years onwards, Dependent children between 91 days to 5 years can be covered only if both parents are covered under the policy | 5 years onwards, Dependent children between 91 days to 5 years can be covered only if both parents are covered under the policy | Adults from 18 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 115 years (dependents 91 days to 17 years) | Adults from 18 to 115 years (dependents 91 days to 17 years) | Adults from 18 to 75 years (dependents 91 days to 17 years) | Adults from 18 to 65 years (dependents 91 days to 17 years) |
| Renewability | ||||||
| Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life | Renewal for whole life |
| Claims loading | ||||||
| Loading | Loading | No Loading | No Loading | Loading | Loading | No Loading |
| Portablity(At the time of renewal) | ||||||
| Yes | Yes | Yes | Yes | Yes | Yes | Yes |
| Tax Benefits Limit | ||||||
| Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D | Income tax benefit under section 80D |
