HDFC Ergo has 12 different health insurance plans to choose from, some of which are brand new and extremely beneficial to consumers. Their top plans are great options for senior citizens, especially the my:health Suraksha policy, which starts 5% cheaper than the national average in India. The my:health Suraksha policy has no maximum entry age, so seniors will not be refused medical coverage based on their age.
The company also has a newly introduced COVID-19-specific policy: the Corona Kavach Policy, designed to keep you safe and healthy during the global pandemic. Their coverage feature list is plentiful, and their most popular and unique coverage aspect is their promise of no medical check-ups for 45 years for young and healthy policyholders.
|Summary of HDFC Ergo Health Insurance|
|My:health Suraksha starts 5% cheaper than market average.|
|12 different plans to suit the needs of individuals, families or senior citizens.|
|Up to 15 helpful coverages included in select policies|
HDFC Ergo Health Insurance Plan Benefits and Exclusions
HDFC Ergo has 12 different health insurance policy options, all with strong coverage and annual premiums that won't exceed your budget. Their plans aren't the most affordable on the Indian health insurance market, but annual premiums start 5% cheaper than average. HDFC Ergo's medical policies are grouped into three categories: Lump Sum Benefit Based Health Insurance, Indemnity/Base Health Insurance, and Top-Up Health Insurance.
Lump Sum Benefit Based Health Insurance is designed for policyholders with critical illnesses. These policies cover critical illnesses all at once, so you're not required to submit a claim each time you pay a medical expense.
Top-Up Health Insurance is an add-on to any base plan, and provides an additional sum insured at a low premium price.
Indemnity/Base Health Insurance pays for your hospitalisation expenses on the basis of medical treatment, and is often viewed as the standard, base plans. Their most popular policy in this category is my:health Suraksha, which is an excellent fit for senior citizens.
HDFC Ergo's my:health Suraksha policy is designed for those who require frequent medical attention, and many seniors unfortunately fit into this category. This plan comes with a feature that automatically restores your sum insured amount if the limit is reached before the end of the year. So, if you've received a lot of medical treatment and are worried about approaching or exceeding your sum amount, HDFC Ergo eliminates the worry and replenishes the sum amount for you.
Minimum entry age for the my:health Suraksha plan is 61 years old, which is just a year older than the market average. However, this policy has no maximum age, whereas most policies in our study set the maximum age around 70-75. So, senior citizens will not be rejected from coverage due to their advanced age. This policy also uniquely covers post-hospitalisation claims for up to 180 days, nearly double the average of HDFC Ergo's competitors. Another perk for senior citizens is the cashless home health care feature, which allows policyholders to be treated by a doctor in the comfort of their own home, instead of travelling to a medical facility or hospital. In addition to the my:health Suraksha policy, HDFC Ergo offers a variety additional plans, many of which are designed for specific needs and are extremely comprehensive in terms of coverage.
There are four different versions of the my:health Suraksha plan - the Silver Smart package, the Gold Smart package, the Platinum Smart package, the Women's package, and the Medisure Super Top-Up package. Each plan has an increased level of coverage, the Platinum Smart package being the most comprehensive, while the Women's package has features specifically designed to cover female-specific illnesses and surgeries.
|Optima Restore Family Plan||Most popular family plan, offers sum insured restoration|
|Optima Restore Individual Plan||Sum insured restoration and 2x multiplier for claims free|
|my:health Suraksha Silver Smart||Base package; cheap premiums, lowest level of coverage|
|my:health Suraksha Gold Smart||Middle-tier package; affordable premiums, increased coverage|
|Energy Health Plan||Specifically designed for diabetes and hypertension coverage|
|my:health Medisure Super Top-Up Plan||Additional sum insured on top of a standard plan|
|Corona Kavach Policy||Coronavirus (COVID-19) health insurance|
|iCan Health Insurance||Cancer health insurance|
|Critical Illness Insurance Plan||Covers up to 15 critical illnesses|
|my:health Women Suraksha Plan||Health plan for women-specific illnesses and surgeries|
|Health Wallet Insurance||Covers OPD and hospitalisation expenses|
|My:health Suraksha Platinum Smart||Highest sum insured health plan offered|
The majority of HDFC Ergo's health insurance plans contain up to 15 coverage features, the most unique of which is the promise of no medical tests for up to 45 years for young and healthy policyholders. They also offer sum insured rebound, which recharges your exhausted health coverage even if your policy term hasn't expired, and cashless home health care, which allows policyholders to be treated for illnesses in the comfort of their own home.
|Sum insured rebound||Recharges your exhausted health coverage to treat the next expense|
|Instalment benefit||Allows annual premium payment in installments|
|No medical tests||Guarantees no medical check-ups are required for up to 45 years|
|Cashless home health care||Allows medical treatment in your own home|
|Hospitalisation expenses||Covers expenses from a hospital stay|
|Pre & Post hospitalisation||Pre-hospitalisation is covered up to 60 days, post: up to 180 days|
|Daycare procedures||Covers surgeries and treatments that finish within a day|
|AYUSH benefits||Covers alternative treatment options|
|Organ donor expenses||Covers the medical and surgical expenses of the donor|
|Recovery benefit||Assists with hospital stays of 10 days or more|
|Mental healthcare||Covers hospitalisation due to mental illness|
|Free renewal health check-up||Required check-up at plan renewal time is free|
|Save tax||Potential to save up to Rs. 75,000 in taxes|
|Lifetime renewability||Continue your plan for your entire lifetime|
|No entry age restriction||Avail a medical plan, regardless of how old you are (18 or older)|
Before purchasing a new health insurance policy with HDFC Ergo, consumers should be aware of the list of exclusions, in case one of your medical needs is outside the coverage package that the company offers. HDFC Ergo does not cover expenses incurred from:
- Adventure sport injuries
- Self-inflicted injuries
- Participation in defense and military operations
- Sexually transmitted diseases
- Obesity treatment
- Cosmetic surgery
HDFC Ergo has the second-largest network hospital list among the Indian health insurance providers we studied. With 10,000 cashless facilities to choose from, policyholders should have no issue finding a hospital or treatment center in a convenient area in case of an illness or emergency. Their claim settlement rate is a strong and slightly above-average 92%, so the majority of claims are settled in a timely fashion.
|HDFC Ergo||Market Average|
|Claim Settlement Rate||92%||91%|
|PolicyBazaar Reviews||4.6 (29 reviews)||4.1 (49 reviews)|
The company owns a strong market share, so many consumers trust their coverage, which is also proven by their strong 4.6-star rating on PolicyBazaar. However, one key drawback of HDFC Ergo's insurance platform is their sub-optimal incurred claims rate (ICR). The optimal range for an Indian health insurer is 75-90%, which indicates a strong ability to settle claims against annual premium collection. With an 62% ICR, 15% below the healthy range, policyholders can unfortunately expect some obstacles along the way during the claim settlement process.
Policy Annual Premium Cost and Comparison
HDFC Ergo offers the Top-Up plan option, which refreshes your sum insured amount should you meet or exceed it before the end of the policy term. But, with so many different policy options and variables depending on your age, needs and desired maximum sum, insured amount, it can be difficult to find the right plan to fit your budget.
The most popular set of policies than HDFC Ergo offers is their collection of my:health Suraksha plans, which start 5% cheaper than the market average. These plans offer lifetime renewability, and the platinum package offers sum insured amounts up to 75 lakhs.
|Sum Insured||3-5 lakhs||7.5-15 lakhs||Up to 75 lakhs|
|Sum Insured Rebound||X||X||X|
|Day Care Procedures||X||X||X|
|Road Ambulance Cover||X||X||X|
|Organ Donor Expenses||X||X||X|
|Free Health Check-Up||X||X|
|Cashless Home Healthcare||X|
|Free annual health check-ups||X|
Claim Submission and Settlement Process
HDFC Ergo does not promise a specific time frame for claim settlement, but they do provide both cashless and reimbursement settlement methods.
To submit a cashless claim, find a cashless hospital using the network hospital locater on HDFC Ergo's website. Then, once you're hospitalised, work with the insurance desk at the network hospital of your choosing, fill out the required documents as listed on the company's website, and submit a pre-authorisation form. Once you've been discharged, your claim will be submitted by the hospital to HDFC Ergo, who will evaluate, approve, and settle the claim. Policyholders can check the status of their claim at any time on the company's website by navigating to the claims portal.
To use the reimbursement method, submit your claim and all required documents online to HDFC Ergo once you are discharged from the hospital. You must also email them all documents and a claim form. HDFC Ergo will evaluate, approve and reimburse you for any covered expenses. Using this method, you may also check the status of your claim at any time on the company's website.
How to Apply or Renew
To apply for any of HDFC Ergo's medical insurance plans, navigate to their website, choose the plan that suits your needs and budget best, and fill out all required and personal information. HDFC Ergo makes this process simple and convenient online, and customer reviews cite how quickly they were able to complete the process and get approved for a new health insurance policy.
For those who are already members of HDFC Ergo, the renewal process is even simpler than the initial application process. Navigate to their website and choose the renew option, enter your current plan information, and walk through the step-by-step renewal process in just a few minutes.