Compare HDFC ERGO vs Oriental Health Insurance Plans
| HDFC Ergo | Oriental | |
|---|---|---|
| Claims Settlement Ratio ** | 62.73% | 99.48% |
| Number of Lives Covered * | 27,48,000 | 3,03,25,000 |
| Network Hospitals | 6,000 + | 4,300 + |
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| Health Suraksha | Health Suraksha Silver | Arogya Sanjeevani | Individual Mediclaim | Happy Floater | Arogya Sanjeevani |
| In-patient Treatment | |||||
| Covered | Covered | Covered | Covered | Covered | Covered |
| Room Rent | |||||
| At Actual | capping on room rent | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day. | Not exceeding 1% of the sum insured per day | Silver & Gold: 1% of the sum insured per day Diamond: Rs.10,000 and 0.5% of the sum insured above Rs.10 lakhs per day |
2% of the sum insured subject to maximum of Rs.5,000 per day |
| ICU Charges | |||||
| At Actuals | Covered | Up to 5% of sum insured subject to maximum of Rs.10,000 per day | Not exceeding 2% of the Sum Insured per day | Silver & Gold: 2% of the sum insured per day Diamond: Rs.20,000 and 1% of the sum insured above Rs.10 lakhs per day |
Up to 5% of sum insured subject to maximum of Rs.10,000 per day |
| Pre-hospitalization | |||||
| 60 days before the date of admission to the hospital | 60 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | 30 days before the date of admission to the hospital | 30 days before the date of admission to the hospital |
| Post-hospitalization | |||||
| 180 days after discharge from the hospital | 180 days after discharge from the hospital | 60 days after discharge from the hospital | 60 days after discharge from the hospital | 60 days after discharge from the hospital | 60 days after discharge from the hospital |
| Day Care Procedures | |||||
| Covered | Covered | Covered | Covered | Covered | Covered |
| Domiciliary Treatment | |||||
| Covered | Covered | Covered | Covered up to sum insured | Covered up to sum insured | Not Covered |
| Emergency Ambulance | |||||
Silver Smart: Rs.2,000 Gold Smart: Rs.3,500 Platinum Smart: Sum insured 20 to 50 lakhs: Rs.3,500; Sum insured 50 & 75 lakhs : Rs.15,000 |
Covered | Maximum of Rs.2,000 per hospitalisation | Rs.2,000 or 1% of the sum insured not exceeding Rs.4,000 | Silver: Rs.1,000 per illness and 1% of the sum insured subject to maximum Rs.3,000 per policy period Gold: Rs.2,000 per illness and Rs.6,000 per policy period Diamond: Rs.3,000 per illness and Rs.8,000 per policy period |
Rs.2,000 per hospitalisation |
| Dental Treatment | |||||
| Not Covered | Not Covered | Dental treatment, necessitated due to disease or injury | Not Covered | Not Covered | Dental treatment, necessitated due to disease or injury |
| Bariatric Surgery | |||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Ayush Benefit | |||||
| Covered | Covered | Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy |
Covered | Covered | Covered |
| Maternity Benefits | |||||
| Covered(Optional) (Waiting period : 3 years) |
Not Covered | Not Covered | Not Covered | Silver & Gold: Not Covered Diamond: COvered up to 2.5% of the sum insured |
Not Covered |
| New Born baby cover | |||||
| Up to parent care sum insured(Optional) | Not Covered | Not Covered | Not Covered | Silver & Gold: Not Covered Diamond: Covered up to 2.5% of the sum insured up to 90 days from the date of birth |
Not Covered |
| Organ Donor Expenses | |||||
| Covered | Covered | Not Covered | Covered | Lumpsum payment of 10% of the sum insured. | Not Covered |
| Vaccination (In case of post bite treatment) | |||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Health Check-up | |||||
| Covered | 1% of Sum Insured after every 4 consecutive and continuous claim free years with us (Subject to a maximum up to Rs.5,000) |
Not Covered | Not Covered | Not Covered | Not Covered |
| Hospital daily allowance | |||||
| Covered up to Sum Insured | Covered up to Sum Insured | Not Covered | 0.1% of the sum insured per day subject to maximum of 6 days per insured person | Silver: Not Covered Gold: 0.1% of Sum Insured (Rs.600 to RS.1,000) per day of Hospitalisation,subject to a maximum compensation for 10 days per Illness. Overall liability of the Company during the Policy Period will be limited to 1.5% of the Sum Insured Diamond: 0.1% of Sum Insured (Rs.1,200 to RS.2,000) per day of Hospitalisation,subject to a maximum compensation for 10 days per Illness. Overall liability of the Company during the Policy Period will be limited to 1.5% of the Sum Insured |
Not Covered |
| Daily Cash for Accompanying an Insured Child | |||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Co-pay | |||||
Silver Smart: No co-pay for all treatment, Optional Co pay available between 10%/20%; Gold Smart : No co-pay for all treatment, Optional Co pay available between 15%/25%; Platinum Smart: No co-pay for all treatment, Optional Co pay available between 15%/25% |
NIL / co-pay applicable upto 20% for treatment in higher class cities | 5% co-pay on all claims | Option of voluntary Co-pay of 10% or 20% with premium reduction | Mandatory Co-pay of 10% up to 70years / Additional 20% above 70 years | 5% Co pay applicable on all claims |
| Pre-existing diseases coverage | |||||
| Pre-existing diseases covered after 3 years of continuous coverage | Pre-existing diseases covered after 4 years of continuous coverage | Pre-existing diseases covered after 4 years of continuous coverage | Covered after 4 years of continuous coverage | Covered after 4 years of continuous coverage | Covered after 4 years of continuous coverage |
| Restore Benefit | |||||
| Sum Insured Rebound upto 100% of Sum Insured per year | Not Covered | Not Covered | NIL Restoration benefit | NIL Restoration benefit | NIL Restoration benefit |
| General waiting period | |||||
| 30 days | 30 days | 30 days | 30 days | 30 days | 30 days |
| Renewal Benefit / Cumulative Bonus | |||||
Silver Smart & Gold Smart: 10% on base sum insured for every claim free year and up to 100%; Platinum Smart: 25% on base sum insured for every claim free year and up to 200% |
5% on base sum insured for every claim free year and up to 50% | 5% on base sum insured for every claim free year and up to 50% | Not Covered | Not Covered | 5% for every claim free year up to 50% of sum insured |
| Emergency Air Ambulance | |||||
Silver Smart:Not Covered; Gold Smart: Up to 2 lakhs; Platinum Smart : Up to 5 lakhs. |
Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Available sum insured options | |||||
Silver Smart: Rs.3 to 5 Lakhs Gold Smart: Rs.7.5 to 15 Lakhs Platinum Smart: Rs.20 to 75 Lakhs |
Rs.3 to 50 Lakhs | Rs.1 to 5 Lakhs | Rs.1 to 10 Lakhs | Silver: Rs.2 to 5 Lakhs Gold: Rs.6 to 10 Lakhs Diamond: Rs.12 to 20 Lakhs |
Rs.1 to 5 Lakhs |
| Policy can be purchased for | |||||
| 1/2/3 Years | 1/2/3 Years | 1 Year | 1/2/3 years | 1/2/3 years | 1 year |
| Eligibility criteria | |||||
| Adults from 18 Years to lifetime entry (dependents 91 days to 25 years) | Adults from 18 Years to lifetime entry (dependents 91 days to 25 years) | Adults from 18 to 65 years (dependents 91 days to 25 years).If the child above 18 years of age is financially independent, he or she shall be ineligible for coverage in the subsequent renewals | Adults from 18 to 65 years (dependents 91 days to 17 years) | Adults from 18 to 65 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 |
| Claims loading | |||||
| Loading | Loading | No Loading | Loading | No Loading | No Loading |
| Portablity(At the time of renewal) | |||||
| 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 |
