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HDFC ERGO Health Insurance

HDFC ERGO is a general insurance company that came into existence as a joint partnership between HDFC Ltd. (India’s premier Housing Finance Institution) and ERGO International AG. (the primary insurance entity of Munich Re Group). This company deals in a vast range of insurance categories ranging from motor, health, travel, home, property, and marine insurance. The company holds a strong reputation in the market for making continued progress and being responsive to the needs of the customers. At present, HDFC ERGO falls into the list of one the most trusted insurance providers of India.

Key Highlights of the Company

Incurred claim ratio (2019-20)69.01
Network Hospitals 10,000+
Solvency ratio (2019-20)1.77
No. of policies sold (2019-20)987,590
Premium Underwritten (2019-20) Rs. 9,308.40 crore
Equity Share Capital605.42 (as on 31st March 2019)
Corporate Address1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020.
Recent Awards & Recognitions
  • ICAI Awards in year 2015-16 for Excellence in Financial Reporting
  • CMS Outstanding Affiliate World-Class Service Award 2015
  • Best Insurance Company in Private Sector General Award 2014 by the World HRD Congress at ABP NEWS
  • Best General Insurance Company in India Award 2014 by International Alternative Investment Review

HDFC ERGO Health Insurance Plan

HDFC ERGO offers a vast range of health insurance products to cater for the needs of all types of customers coming from different segments of society. The list of health insurance plans provided by the company is given below. Let’s have a look at it. 

  1. My:Optima Secure
  2. My:Health Suraksha
  3. Optima Restore
  4. Critical illness Insurance
  5. Medisure: Super Top up Insurance
  6. Corona Kavach Policy
  7. Arogya Sanjeevani Policy
  8. Energy- Diabetes Health Insurance Plan
  9. Koti Suraksha
  10. my:health Women Suraksha

1. HDFC ERGO My:Optima Secure

HDFC ERGO My Optima Secure is a comprehensive health insurance plan that offers wider coverage at a very affordable cost. The policy comes with a variety of benefits such as no room rent capping, wider pre and post hospitalisation, unlimited day-care procedures and exciting discount options. There are two categories available under this plan- My:Optima Secure Individual and My:Optima Secure Family Floater.

Features: 

  • Covid-19 treatment: This plan provides coverage against the hospitalisation and treatment expenses arising due to Covid-19.
  • Sum insured options: Customers can select their desired amount of sum insured from a base cover ranging between Rs.5 lakhs to Rs. 2 crores.
  • 2X coverage: A unique benefit of this policy is that it doubles the insurance cover brought by the customer, instantly and automatically.
  • Restore Benefit: Under this benefit, customers get 100% of their claim amount restored upon making a claim of Rs. 10 lakhs base cover. The amount gets restored for any subsequent claims that are made in the same year.
  • Plus Benefit: The policy offers a special plus benefit under which the base cover opted by the policyholder automatically increases by 50% after 1 year, and 100% after 2 years, irrespective of any claims made.

Eligibility Criteria: 

CriteriaMinimumMaximum
Entry age

Adult- 18 years

Child- 91 days

Adult- 65 Years

Adult- 25 years

Policy period1, 2 and 3 years

2. HDFC ERGO My:health Suraksha

HDFC ERGO My:health Suraksha is a simplified yet wholesome health insurance plan that comes with a strong base cover and provides financial coverage to individuals, families and senior citizens.

Features: 

  • Sum insured rebound: This policy comes with a special sum insured rebound cover, which allows customers to get an additional sum insured up to the base sum insured in case their existing sum insured exhausts.
  • Mental health treatment: Under this feature, the policyholder gets coverage against the medical expenses that arise when any of the insured members suffer from mental illness.
  • Air Ambulance: A very distinguishing feature of this policy is that it provides cover for air ambulance services like airplanes or helicopters if the policyholder requires emergency air service to the nearest hospital.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age

Adult- 18 years

Child- 91 days

Adult- Lifetime Entry

Child – 25 years

3. HDFC ERGO My:Optima Restore

Optima Restore is a comprehensive health insurance plan that provides financial protection at a reasonable cost and comes with a host of attractive features to meet the healthcare needs of all types of customers. This policy is available in two forms- individual and family floater.

Features:

  • 2X Multiplier: This policy comes with a 2X multiplier benefit under which if the policyholder does not make a claim even once in the year, then he/she gets 100% cover enhancement as no claim bonus.
  • 100% Restore benefit: The plan provides restoration for 100% of sum insured on partial or complete utilization of the health cover, for their future needs.
  • Family discounts: Under this plan, customers get a family discount of 10% if 2 or more family members are covered under the individual sum insured plan.

Eligibility Criteria: 

CriteriaMinimumMaximum
Entry age

Adult- 18 years

Child- 91 days

Adult- 65 years

Child- 5 years

Policy period1 and 2 years

4. HDFC ERGO Critical Illness Insurance Plan

HDFC ERGO Critical illness insurance is a specially designed insurance policy that provides financial protection to tackle some of the life-threatening and critical diseases such as cancer, heart attack, stroke, etc. The plan offers wider coverage at a very reasonable premium cost to help customers focus on their health without any financial stress.

Features:

  • Plan Options: This critical illness plan is available in two categories- Silver Plan and Platinum Plan. The silver plan provides cover against 8 types of critical illnesses and the platinum plan offers coverage against 15 pre-listed critical diseases. Customers can select a plan that fits their needs.
  • No medical check-ups: With this policy, customers under the age group of 45 years are not required to submit any pre-medical check-ups at the time of buying the plan.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 years
Policy period1 and 2 years

5. Medisure: Super Top up Insurance Plan

HDFC ERGO Super Top-up insurance is designed to strengthen the existing plan of the policyholder in case their existing medical plan is not sufficient enough to cover the medical expenses. This plan increases the sum insured and provides wider coverage at an affordable premium. Customers can purchase it either as an independent policy or as a top-up to the existing health insurance plan.

Features:

  • Constant premiums benefit: This plan has a unique benefit called the ‘Constant premiums from Age 61’ under which customers are required to pay constant premiums post 61 years and enjoy their insurance cover peacefully for a lifetime.
  • Special discounts: Customers have the option to avail of special discounts if they opt for a long-term policy. For a policy period of 2 years, customers can get a 5% discount on the premium and if they choose to cover more than 2 family members on an individual sum insured basis, then they can avail 10% discount.

Eligibility Criteria: 

CriteriaMinimumMaximum
Entry age18 years65 years
Policy period1 and 2 years

6. HDFC ERGO Corona Kavach Policy

Officially designed by IRDAI, HDFC ERGO Corona Kavach Policy is a health insurance plan that provides financial coverage against the medical expenses arising due to Coronavirus infection. The plan provides a wider coverage by offering a variety of covers including hospitalisation, pre-post hospitalisation, home care treatment expenses and AYUSH treatment.

Features: 

  • Pre and post hospitalisation cover: The plan provides pre and post hospitalisation cover under which expenses arising 15 days before hospitalization and 30 days after discharge are covered.
  • Hospitalisation cover: This policy provides cover against all kinds of hospitalisation expenses incurred by the policyholder on the treatment of covid-19 disease including expenses related to PPE kits, oxygen, ventilators, and doctor’s consultation fees.

Eligibility Criteria: 

CriteriaMinimumMaximum
Entry age

Adult- 18 years

Child- 1 day

Adult- 65 years

Child- 25 years

7. HDFC ERGO Arogya Sanjeevani Policy

Arogya Sanjeevani Policy by HDFC ERGO is a budget-friendly insurance plan that is designed to offer financial coverage at an affordable premium rate. This plan provides financial coverage to the policyholders for a maximum sum insured amount of upto Rs 10 lakhs.

Features: 

  • Sum insured options: This plan provides wider coverage by offering a variety of sum insured options which can be as low as Rs. 3 Lakhs and a maximum of Rs. 10 Lakhs.
  • Cumulative Bonus: This plan provides an additional reward in the form of a cumulative bonus. Under this benefit, if the customer does not make any sort of claim in a policy year then his/her sum insured is increased by 5% every year for a maximum upto 50%.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 years
Policy period1 year

8. HDFC ERGO Energy- Diabetes Health Insurance Plan

HDFC ERGO Energy health insurance is a specially designed plan that provides financial protection in the form of medical coverage to individuals suffering from Diabetes Type 1 Diabetes, Type 2 Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), pre-diabetes (IFG, IGT) or hypertension. This plan offers benefits in the form of below-stated categories:

  1. Diabetes/Hypertension specific- This includes cover for in-patient expenses arising due to diabetes or hypertension, personalized wellness program, wellness incentives, personal health coach, integrated web portal.
  2. Standard Health Insurance- This includes cover for accidental injuries, critical illnesses, restore benefit, no claim bonus, tax benefits, organ donor expenses, co-payment (optional) and others.

Features:

  • Personalized wellness portal: With this plan, customers get access to a personal wellness Web Portal that keeps a track of all medical records of the policyholder and helps him/her to monitor their condition and avail special offers for the purchase of health products.
  • Special reward points: Another very useful feature of this plan is that it offers special renewal premium discounts of up to 25% on the basis of the customer’s medical tests and critical health parameters such as BMI, BP, HbA1c and Cholesterol.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age18 years65 years

9. HDFC ERGO My:health Koti Suraksha

My:health Koti Suraksha is a health insurance plan that offers wider coverage to meet the rising medical costs. The plan is available within a sum insured of up to Rs.1 crore to insure customers against various types of medical expenses like hospitalisation costs, critical illness treatments, costs for major surgeries, daycare procedures, and so much more.

Features: 

  • Covid-19 treatment: This plan provides cover for the hospitalization expenses arising due to the treatment of COVID-19 infection.
  • Free Preventive Health Check-Up: Customers can enjoy free health check-ups within 60 days of renewing their My:health Koti Suraksha policy.
  • Special discounts: The plan provides a variety of discounts including a long term discount of 10%, a family discount of 10% upon adding 2 or more members and a fitness discount up to 10% at the time of policy renewal.

Eligibility Criteria: 

CriteriaMinimumMaximum
Entry age18 years65 years

10. HDFC ERGO My:Health Women Suraksha

My:Health Women Suraksha is a specially designed health insurance product that caters to healthcare needs of women and provides financial assistance to keep them secured against minor ailments, major illnesses, surgeries and critical illnesses as well. There are three sub plans available under this category. In addition to the basic cover, all these three plans come with optional cover such as loss of Job, pregnancy & new-born baby complications, and post-diagnosis support. Detailed description of all the three sub plans are given below-

Features:

  1. Women Cancer Plus Plan- This plan provides coverage against all major categories of cancer along with a variety of major illnesses such as osteoporosis, Systemic Lupus Erythematosus, Lupus Nephritis and Rheumatoid Arthritis.
  2. Women Critical Illness Essential Plan- This plan offers cover for several major illnesses including cancer, heart diseases and other major surgeries. The claim amount of the plan is also paid instantly in a lump sum method.
  3. Women Critical Illness Comprehensive Plan- This plan covers women specific illnesses that are both minor and major, specialized surgeries and 41 listed critical illnesses to provide women with complete healthcare protection.

Eligibility Criteria:

CriteriaMinimumMaximum
Entry age

Basic cover- 18 years

Optional covers- 18 years

Basic cover- 45 years

Optional covers- 40 years

Policy Period1, 2 and 3 years

Key Features of HDFC ERGO health insurance

  • Network hospitals

Cashless hospitalization is a very prominent factor that helps in determining the efficiency of a health insurance company in settling the claims quickly. In the case of HDFC ERGO, this company partners with a long list of network hospitals that helps customers in availing seamless cashless hospitalization experience. At present, the company has nearly more than 10,000 network hospitals. 

  • Solvency Ratio 

One of the very useful factors of health insurance plans is that it provides quick financial support during medical emergencies. But in order to offer immediate support, it is essential for an insurance company to have sufficient funds that can fulfill the future claim needs of the customers. The solvency ratio is a parameter that helps customers to determine the financial soundness of a company. HDFC ERGO insurance has a solvency ratio of 1.77 which is a very good number in comparison to other health insurance companies of India

  • Claim Settlement Ratio

Claim settlement is a very critical topic in insurance. All customers buy insurance with the hope of getting their claim in the form of financial help during the time when they need it the most. Therefore, it is always suggested to buy insurance from a trusted company that holds a good reputation in terms of the claim settlement process. If we talk about HDFC ERGO insurance, the company adopts a quick and simple claim settlement process along with a claim settlement ratio of 97%. 

  • Online buying process

HDFC ERGO adopts a completely digital method for selling its insurance products. This is really helpful for customers as it allows them to buy original products directly from the company itself without the involvement of any intermediary. Online buying also offers a variety of other benefits such as lower costs, fast buying and renewal process, secured payment methods and instant premium quotes. 

  • Country-wide presence

An insurance company with a wider presence always proves to be a valuable benefit for the customers as it helps them to avail instant support from the nearest branch of their insurance provider. HDFC ERGO General Insurance company has a PAN India presence with more than 200 branches located in nearly 170 cities across the country.

  • Lifelong renewability

A very useful and unique feature of HDFC ERGO health insurance plans is that all these plans come with lifelong renewability options. Customers can get their policy renewed quickly through a very simple and easy online method. Additionally, some of the health insurance plans also offer attractive discounts upon renewal.

How does HDFC ERGO calculate its health insurance plans’ premium?

HDFC ERGO adopts an online approach for calculating the premium of all its health insurance plans. Customers can get instant quotes about the premium rates of their HDFC ERGO plans by following the steps given below-

  1. Visit the official website of HDFC ERGO General Insurance.
  2. Click on the ‘Explore’ tab and select ‘health insurance’.
  3. Fill in your details and click on ‘View plans’ option.
  4. The next page will show you the premium rates of different plans that suits your needs.

To help you understand better, we’ve created below a tabular representation of different premium rates of Optima Secure Individual Plan.

Age of the policyholderSum Insured AmountPremium Rate
25 yearsRs. 5,00,000Rs. 8,619
30 yearsRs. 10,00,000Rs. 11,351
40 yearsRs. 20,00,000Rs. 14,462
50 yearsRs. 50,00,000Rs. 37,639
60 yearsRs. 1,00,00,000Rs. 89,092

*Note- Premium rates include GST and are calculated for a fixed policy term of 1 year.

How to buy HDFC ERGO health insurance plans?

HDFC ERGO Health insurance products can be bought easily through the online method. Customers should follow the below stated steps for buying a health insurance plan online- 

  1. Visit the official website of the company. 
  2. Click on the ‘Buy’ tab and select ‘health insurance’. 
  3. Fill in your details and click on ‘View plans’ option.
  4. Details of all the matching plans and their premium rates will be displayed on the screen. 
  5. Select a suitable plan and click on ‘Buy Now’. 
  6. Customise the plan and click on ‘Buy Now’. 
  7. Submit your details and pay the premium amount. 

Once the payment is made, the company will mail the policy documents on your registered email address.

What’s the renewal process of HDFC ERGO health insurance policy?

Customers can now get their HDFC ERGO health policy renewed online within just a span of minutes. All they have to do is follow the below stated steps: 

  1. Visit the official website of the company. 
  2. Click on the ‘Renew’ tab and select ‘health insurance’. 
  3. Enter your policy details. 
  4. Customise your plan by opting for add on covers, if required. 
  5. Fill in the required details and pay the premium amount. 

After receiving the payment, the company will send the updated policy documents to your registered email address.

Claim Process of HDFC ERGO health insurance

The claims for HDFC ERGO health insurance plans can be made through two methods- Cashless Claims and Reimbursement Claim Methods. Given below are the details of both these processes.

Cashless Claim Process

  1. Locate the nearest network hospital of HDFC ERGO. 
  2. Get admitted to the nearest hospital by submitting your health card and valid photo ID. 
  3. Fill in the pre-authorization form and submit it along with your documents at the network hospital. . 
  4. During the discharge time, the Hospital will transfer your claim request to the company. 
  5. The company will verify your documents and convey the final stand on the claim. 
  6. You will receive regular updates through SMS/Emails at every stage of the claim on your registered mobile number or email id.
  7. Upon approval, the Hospital will send the final bill to HDFC ERGO and the company will settle your hospital bills. 

Reimbursement Claim Process

  1. The customer should intimate the company by registering their claim request. 
  2. Submit your policy documents online at the claim registration portal of HDFC ERGO.
  3. The company will verify your documents. 
  4. Upon approval, the claim will be settled within 7 days from the time of last document is received and approved claim payment would be processed.

Frequently Asked Questions

1. What documents are required at the time of claim settlement?

Given below is a list of documents that should be submitted while applying for a claim- 

  • Complete claim form along with policy number.
  • Original discharge summary
  • Original medical bills, payment receipt and original pharmacy invoices
  • Original investigation reports including blood reports and X-Ray
  • Past treatment documents, if any.
  • Medico Legal Certificate (MLC) or FIR- in cases of accident
  • Legal heir certificate (if the proposer expires and the nominee is minor).
  • Other relevant documents, if any.
  • Cancelled cheque in the name of the proposer or passbook copy attested by bank. 
  • Photocopy of any one KYC document including Passport, Driving License and Voter ID card.

2. Is it possible to change the name of my nominee in the mid-term of the policy?

Yes, customers can change their nominee name by raising an endorsement request.

3. What are the diseases that are included within the critical illness insurance plan?

HDFC Critical illness policy is available within two variants. Given below are details of the diseases covered under both these plan variants.

SILVER PLANPLATINUM PLAN
Heart AttackHeart Attack
Multiple SclerosisMultiple Sclerosis
StrokeStroke
CancerCancer
Major Organ TransplantationMajor Organ Transplantation
Coronary Artery Bypass SurgeryCoronary Artery Bypass Surgery
ParalysisParalysis
Kidney failureKidney failure
Aorta Graft Surgery
Primary Pulmonary Arterial Hypertension
Heart Valve Replacement
Parkinson’s Disease
Alzheimer’s Disease
End-Stage Liver Disease
Benign Brain Tumour

4. Are there any exclusions to HDFC ERGO health insurance plans?

Yes, HDFC ERGO Insurance health plans have a certain set of excluded conditions under which no coverage is provided to the policyholder. Here is a list of some commonly excluded conditions- 

  • Injury or treatments arising due to adventure sport activities
  • Self-inflicted injuries
  • Treatments arising due to participation in defense operations
  • Venereal or sexually transmitted diseases
  • Treatment of obesity or cosmetic surgery
  • Injury or accidents happening due to war, invasion or any terrorist act.

5. Is it possible to make multiple claims for the same or any other listed Critical illnesses?

No, a policyholder can make only one claim during the lifetime of their critical illness policy.

6. I forgot to renew my policy on its due date. What should I do now?

HDFC ERGO provides its customers with a grace period of 30 days under which they can get their policy renewed without any hassle. However, once the grace period is over then the policy lapses and the customer has to contact the company for renewing their expired plan.

7. Is it mandatory to undergo a medical examination before buying health insurance?

Yes, customers are required to submit their medical test reports before buying health insurance. However, some of the HDFC ERGO health insurance plans ask for it only if you have a pre-existing illness or you are above 40 years old. Refer to the plan brochure for more specific details on pre-medical tests.

8. Is My:Health Suraksha Plan valid for customer’s living outside India?

My:Health Suraksha Plan is a benefit policy. Therefore, there are no territorial limits in this plan and has a worldwide scope.