Compare SBI General vs HDFC Ergo Health Insurance Plans
| SBI General | HDFC Ergo | |
|---|---|---|
| Claims Settlement Ratio ** | 62.73% | 85.97% |
| Number of Lives Covered * | 27,48,000 | 96.05,000 |
| Network Hospitals | 6,000 + | 10,000 + |
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| Retail Health | Arogya Premier | Arogya Plus | Arogya Sanjeevani | Health Suraksha | Health Suraksha Silver | Arogya Sanjeevani |
| In-patient Treatment | ||||||
| Covered | Covered | Covered | Covered | Covered | Covered | Covered |
| Room Rent | ||||||
| 1% of sum insured per day | Covered | Covered | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day | At Actual | capping on room rent | Up to 2% of the sum insured subject to maximum of Rs.5,000 per day. |
| ICU Charges | ||||||
| 2% of sum insured per day | Covered | Covered | Up to 5% of the sum insured subject to maximum of Rs.10,000 per day | At Actuals | Covered | Up to 5% of sum insured subject to maximum of Rs.10,000 per day |
| Pre-hospitalization | ||||||
| Up to 30 days | Up to 60 days | Up to 60 days | 30 days before the date of admission to the hospital | 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 |
| Post-hospitalization | ||||||
| Up to 60 days | Up to 90 days | Up to 90 days | 60 days after discharge from the hospital | 180 days after discharge from the hospital | 180 days after discharge from the hospital | 60 days after discharge from the hospital |
| Day Care Procedures | ||||||
| 142 day care expenses covered | 142 day care expenses covered | 142 day care expenses covered | All the day care treatments | Covered | Covered | Covered |
| Domiciliary Treatment | ||||||
| 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 | Covered | Covered | Covered |
| Emergency Ambulance | ||||||
| 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 | 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 |
| Dental Treatment | ||||||
| Covered | Covered | 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 | Not Covered |
| Ayush Benefit | ||||||
| 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 | Covered | Covered | Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy |
| Maternity Benefits | ||||||
| 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 | Covered(Optional) (Waiting period : 3 years) |
Not Covered | Not Covered |
| New Born baby cover | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Up to parent care sum insured(Optional) | Not Covered | Not Covered |
| Vaccination of the new born baby | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Silver Smart: Rs.5,000 Gold Smart: Rs.5,000 Platinum Smart: Sum insured 20 to 50 lakhs: Rs.5,000 Sum insured 50 & 75 lakhs: Rs.15,000 (Optional) |
Not Covered | Not Covered |
| Organ Donor Expenses | ||||||
| Covered | Covered | Not Covered | Not Covered | Covered | Covered | Not Covered |
| Vaccination (In case of post bite treatment) | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered | Not Covered |
| Health Check-up | ||||||
| 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 | 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 |
| Hospital daily allowance | ||||||
| Not Covered | Not Covered | Not Covered | Not Covered | Covered up to Sum Insured | Covered up to Sum Insured | Not Covered |
| Daily Cash for Accompanying an Insured Child | ||||||
| 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 | Not Covered | Not Covered | Not Covered |
| Co-pay | ||||||
| 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 | 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 |
| Pre-existing diseases coverage | ||||||
| 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 | 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 |
| Restore Benefit | ||||||
| Not Covered | Covered up to 100% of base sum insured | Covered up to 100% of base sum insured | Not Covered | Sum Insured Rebound upto 100% of Sum Insured per year | Not Covered | Not Covered |
| General waiting period | ||||||
| 30 days | 30 days | 30 days | 30 days | 30 days | 30 days | 30 days |
| Renewal Benefit / Cumulative Bonus | ||||||
| 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 | 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% |
| Emergency Air Ambulance | ||||||
| Not Covered | Up to Rs.100,000 | Not Covered | Not Covered | Silver Smart:Not Covered; Gold Smart: Up to 2 lakhs; Platinum Smart : Up to 5 lakhs. |
Not Covered | Not Covered |
| Available sum insured options | ||||||
| Rs.50,000 to 5 Lakhs | Rs.10 to 30 Lakhs | Rs.1 to 3 Lakhs | Rs.1 to 5 Lakhs | 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 |
| Policy can be purchased for | ||||||
| 1/2/3 years | 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 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) | 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 |
| 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 | ||||||
| No Loading | Loading | 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 |
