SBI General vs HDFC ERGO Health Insurance

Compare SBI General vs HDFC Ergo Health Insurance Plans
Plan Type
Health
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  OR age    years
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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 +
  • * As per IRDAI report for 2018-19
  • ** As per NL25 data published on the Insurance Company website
SBI General SBI General SBI General SBI General Hdfc ergo Hdfc ergo Hdfc ergo
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
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CIN: U66000KA2018PTC117713 | IRDAI Web aggregator License Code Number: IRDAI / INT / WBA /53/ 2018, Valid till 07/08/2025