HDFC Ergo General Insurance Company Ltmd

About HDFC Ergo General Insurance Company

HDFC Ergo General Insurance Company Limited is amongst the most admired and leading private insurance companies in India. It is a joint venture between India’s premier housing finance institution, HDFC Limited and the primary insurance entity of Munich Re Group, Ergo International AG. 

The company offers a wide range of general insurance solutions for both retail and corporate sector ranging from health, travel, motor, home, personal accident to marine & liability insurance and property insurance. HDFC Ergo General Insurance Company is the third largest general insurance provider in the private sector. 

Key highlights of HDFC Ergo General Insurance Company

Some of key highlights of the company which makes it a leading insurance provider are as follows: 

Overall market share6.2 % for the fiscal year 2020-21
Solvency ratio190% vis-a-vis 150% requirement of IRDAI
Network hospitals10,000 + network hospital across India
Branches200 plus branches across 170+ cities in India
Employees7000+ employees
Policies issuedIssued 10 million+ policies and service 2 million + claims in the financial year 2021

Awards and Accolades of HDFC Ergo General Insurance Company

Ever since it was established, HDFC Ergo General Insurance Company has received various accolades and awards. Here is a look at some of them: 

  • HDFC Ergo was awarded ‘ICAI Awards 2015-16’ for its excellence in the financial reporting by ICAI. 
  • The company received ‘Best Customer Experience Award of the Year’ in the financial sector by Kamikaze. 
  • HDFC Ergo was awarded ‘CMS Outstanding Affiliate World Class Service Award’ by Multinational Soutions in 2015 for its efficient and outstanding services. 
  • The world HRD Congress awarded HDFC Ergo as the ‘Best Insurance Company’ in the Private Sector- General 2014 at ABP News Banking, Financial Services and Insurance Awards. 

Key features of HDFC Ergo health insurance plans

The health insurance policies offered by HDFC Ergo have a comprehensive scope of coverage. Some of the most common coverage benefits are as follows –

Features Meaning 
Inpatient hospitalisation coverInpatient hospitalisation is when you are admitted to a hospital following an illness or an injury. If you are admitted for 24 hours or more, the cost of hospitalisation and treatments are covered 
Pre hospitalisation coverBefore hospitalisation, if you incur medical costs on the same illness or injury for which you are being hospitalised, such medical costs would be covered for a specified number of days
Post hospitalisation coverAfter being treated and discharged, if there are medical expenses incurred on recovery and post-operative care, such expenses would be covered for a specified number of days
Daycare coverDaycare treatments are those wherein hospitalisation for 24 hours is not needed. Such treatments are also covered under the plan
Ambulance coverThe cost incurred when you engage an ambulance for transportation to the hospital is covered under this head
Organ donor coverIf you are receiving an organ from a donor, the cost of the donor’s hospitalisation and subsequent organ harvesting surgery would be covered by the policy
AYUSH coverNon-allopathic treatments like Ayurveda, Unani, Homeopathy or Siddha are also covered under many HDFC Ergo health insurance plans
Domiciliary coverHospitalisation at home either because of the non-availability of hospital beds or because you couldn’t be transported to the hospital is called domiciliary hospitalisation. Such a hospitalisation is covered under HDFC Ergo health plans
Free health check-upsHDFC Ergo policies also allow the facility of health check-ups, free of cost, after regular intervals so that you can monitor and assess your health

Common exclusions in HDFC Ergo health insurance plans

Despite their coverage, HDFC Ergo health insurance policies have a specified list of exclusions wherein the claim is not paid. The exact exclusion list is plan specific and can be accessed in the policy wordings. Some of the most common exclusions, however, include the following –

  • In case you suffer from any illness or condition when buying the policy, the illness would be termed as a pre-existing illness and would be excluded for a specified waiting period
  • Some illnesses and treatments are covered only after their specified waiting period of 2 years. Examples include cataracts, joint replacement treatments, fissures, piles, etc.
  • Illness that occurs during the first 30 days of buying the policy are not covered within that period
  • Cosmetic treatments and weight loss surgeries are excluded from coverage
  • Claims attributable to war, nuclear threats, mutiny, rebellion, etc. are excluded
  • Participation in adventure sports, hazardous activities, or criminal acts and their consequent claims are not covered
  • Self-inflicted injuries, attempted suicides, alcohol and drug abuse are also excluded instances of claims
  • Treatments that are not recommended by the doctor or are unscientific are not covered
  • The cost of lenses, hearing aids, spectacles, etc. are not covered 

Features of HDFC Ergo health insurance plans

HDFC Ergo offers different types of health insurance plans. Out of them, the most popular plans sold by PayBima are as follows –

1. My: Health Suraksha 

A comprehensive health insurance plan, My: Health Suraksha offers you coverage up to Rs.75 lakhs and three different plan variants to choose from. The salient features of the policy are as follows –

  • Coverage for mental and home healthcare

The plan covers inpatient treatment costs incurred if you are hospitalised for any mental illness. Similarly, coverage is allowed if you are treated at your own home for any medically necessary reasons.

  • Sum insured rebound

If you suffer multiple claims within the same policy year and the sum insured is not sufficient to pay for the second claim, the plan would provide an additional amount equal to the original sum insured for paying the claim. This rebound facility is allowed even if you have not exhausted the actual sum insured under the policy but the sum insured falls short in fulfilling a subsequent claim. 

  • Air ambulance cover

Coverage for air ambulances is allowed under the Gold Smart and Platinum Smart variants of the plan. This ensures that in emergencies you can get treated in a hospital outside of your city and the cost of transporting you to such a hospital would be covered by the policy.

  • Range of optional coverage benefits

My: Health Suraksha offers a range of optional coverage benefits to help you enhance the scope of the policy. You can choose one or more of these coverage benefits and customise your plan as per your needs

Eligibility conditions 

Entry age Adults – 18 years onwardsChildren – 91 days to 25 years
Policy term1 to 3 years
Sum insured Rs.3 lakhs to Rs.75 lakhs
Premium payment frequency QuarterlyHalf-yearlyAnnually 
Pre-existing waiting period48 months 

2. My: Health Medisure Super Top-up 

This is a super top-up health insurance policy that helps you enhance existing health insurance coverage at affordable premiums. The salient features of the plan are as follows –

  • Coverage without sub-limits

Hospitalisation coverage under the policy is allowed without any sub-limits on room rent. This ensures that you can enjoy complete coverage and reduce your out of pocket expenses.

  • Uniform premium after 61 years of age

The plan allows lifelong renewability and after you hit 61 years of age, the premium does not change even if increasing age increases your health risks.

  • Easy availability 

You can buy the policy instantly without having to undergo any medical check-ups up to 55 years of age if you do not suffer from any medical condition. 

Eligibility conditions 

Entry age Adults – 18 years to 65 yearsChildren – 91 days to 23 years
Policy term1 and 2 years
Sum insured Rs.3 lakhs to Rs.20 lakhs
Deductible limitsRs.2 lakhs to Rs.5 lakhs
Premium payment frequency QuarterlyHalf-yearlyAnnually 
Pre-existing waiting period36 months 

How to buy HDFC Ergo Health Insurance plans?

Buying insurance plans was never so easy. PayBima provides a seamless and quick process to buy HDFC Ergo Health plans which can be done within minutes. HDFC Ergo health insurance policies are available both online as well as offline. The steps of buying through PayBima are as follows: 

  • Go online and select ‘Health Insurance’ 

Visit the PayBima website and click on ‘health insurance’ to buy a health plan. 

  • Fill your details

Once you select health insurance, PayBima will ask you to fill in certain personal and medical details to find suitable health plans for you based on your eligibility and insurance requirements. Provide basic details such as name, location, Pin code of your address, contact number, gender, age, number of dependents, etc and medical details such as health status, medical history, pre-existing illness, etc. PayBima also offers personal consultation to help you buy the health plan easily. 

  • Compare the health plans

Once all the details have been provided, a list containing the plan names, features and premium will be displayed based on your coverage needs and eligibility. The list will show the best available plan at affordable and competitive premium rates. You can compare the plans based on their benefits and premium and select the plan which best suits you. 

  • Submit the proposal form

Provide your details in the proposal form after shortlisting your policy. Make sure to provide complete and correct details in the form to avoid the rejection of your claim later on. 

  • Premium payment

You can pay the premium online through the online modes available. PayBima offers secured premium payment modes to provide a hassle-free experience. 

  • Policy issuance

Your health plan will be issued instantly on payment of premium if you have not made any adverse declarations in the proposal form regarding your lifestyle habits and medical history. 

  • Pre-entrance medical check-up

Based on certain criteria such as age, habits, medical illness, higher sum assured, you might have to undertake a pre-entrance health checkup to check your health status and existing illness. You can opt for a pre-entrance health check-up free of cost at the networked facility of HDFC Ergo General Insurance. 

How to renew HDFC Ergo Health Insurance plans?

HDFC Ergo offers a lifelong renewal of health plans irrespective of your previous claim or health status. If you want to enjoy uninterrupted health coverage, renew your plan within the due date. PayBima not only provides the facility to buy but also to renew the plan through its website. 

How to claim HDFC Ergo Health Insurance plans?

HDFC Ergo provides a simplified claim process to help you get the settlement on time. The process is as follows:

  • Locating cashless hospital 

If you want to avail of the cashless facility, then you will have to get admitted to a hospital with which HDFC Ergo has a tie-up. You can locate the nearest network hospital online by visiting the official website of the insurance company. You can also get admitted to a non-network hospital in which your claim would be settled on a reimbursement basis. 

  • Hospitalisation

Get yourself hospitalised by showing your valid Identity proof or health card provided by the insurance company. 

  • Intimation through the pre-authorisation form

Fill up the pre-authorisation form at the network hospital for cashless approval of your claim. The form can be downloaded online or is available at the hospital. Fill the form correctly and completely to get your claim approved. The form is to be submitted at least three to four days before a planned hospitalisation. In the event of emergencies, you can submit the form within 24 hours of hospitalisation. 

  • Get the approval

Based on the pre-authorization form, the insurer would approve the cashless claim. Once the approval is received, the treatment would start. The medical bills would be handled by the insurer on a cashless basis. 

  • Reimbursement of claim

In the reimbursement facility, you need to pay all the bills initially and preserve the original invoices. In such cases, you would have to intimate the claim before planned admission. You can inform the claim after admission also but before discharge in case of emergencies. Send all the invoices and relevant documents to HDFC Ergo. The company will verify your claim invoices and documents and reimburse the claim amount. 

For successful settlement of health claim, you are required to submit certain documents to the company with the claim form. The documents required to be submitted are: 

  • Insured’s valid Identity proof 
  • Original prescription of the doctor suggested hospitalisation
  • Bank account details of the insured to credit the reimbursement of cost incurred. 
  • Original medical reports and bills
  • Original consultation notes of the doctor
  • Pre-authorisation claim form for cashless claims

Review of HDFC Ergo Health Insurance plans

HDFC Ergo Health Insurance plans provide 360-degree customer protection and happiness backed by a strong customer service and support team. Other highlights are discussed as follows: 

  • The company has successfully settled Rs 7500+ crore claims to date. 
  • HDFC Ergo General Insurance Company has a whopping claim settlement ratio of 97% in the Financial Year 2020. 
  • HDFC Ergo General Insurance has announced its partnership with Visa, the leader in digital payments which will provide insurance covers to all the visa business cardholders. 
  • The company offers a comprehensive product portfolio with a balanced channel mix to fulfil the varied needs of its customers. 
  • HDFC Ergo General Insurance is the second largest retail health Insurance provider in India with a 10% market share. 
  • HDFC Ergo General Insurance has secured 1.3 crore customers to date. 

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