Hdfc Ergo General Health Insurance Network Hospitals

Types of plans under cashless insurance:

HDFC ERGO provides cashless health insurance plans for individuals, families, parents, and senior citizens.

Services covered under cashless insurance:

There are two types of scenarios that are covered under cashless insurance. These are emergency hospitalisation and planned hospitalisation.

Emergency hospitalisation is when the insured has to be hospitalised immediately without any intimation for any emergency medical or surgical situations. Planned hospitalisation is when there is a prior intimation of at least 2-3 days before the hospitalisation.

Process for planned hospitalisation under cashless insurance:

• Visit the nearest network hospital of your preference. The customer support team of HDFC ERGO is at hand to help you with the names of the nearest hospitals.
• Visit the hospital and ask for the pre-authorisation form. This will be available at the insurance desk of the hospital. It can also be downloaded from the website of the Third Party Administrator (TPA).
• Take your cashless card or policy card with you.
• The form has to be filled up by both the patient and by the medical practitioner.
• The completed form is sent to the TPA for issuance of the authorisation letter. If approved, the sanctioned amount is mentioned and approval is intimated.

Process for emergency hospitalisation:

The process for hospitalisation for emergencies is the same as for planned hospitalisation. The only difference is that the steps given above should be done within 24 hours of hospitalisation.

Exclusions under cashless hospitalisation:

Under cashless hospitalisation, hospital bills up to the sum assured that is opted for are paid. However, there are certain exclusions to this which include service charges, visitor fees, toiletries, document charges, and expenses for diapers, nebulizers, and oxygen masks.

4 Benefits of cashless hospitalisation:

There are many benefits of cashless hospitalisation but the major ones are as follows:

1. Reduces the financial burden that occurs when bills have to be paid upfront
2. Greater peace of mind
3. Simple, quick, and easy process without any hassles
4. Makes medical treatment accessible and affordable without compromising on quality

Important points to remember:

1. Ensure you have photocopies of all the documents that you submit to the TPA
2. You can avail the cashless hospitalisation benefit only at hospitals that are part of HDFC ERGO's network of hospitals
3. If the hospitalisation expenses exceed the sum insured limit, the insured will have to pay the extra amount

Reasons why cashless hospitalisation claims could be denied:

There are certain situations in which the application for cashless claim authorisation is denied. These could be the following:

1. Delay in intimating the TPA
2. As per the policy, the age of the insured is not eligible for the treatment of a specific ailment
3. Sum insured has been exhausted
4. Hospitalisation is for a pre-existing illness which is not covered under the plan
5. Incomplete information or wrong information was filled in the form
6. The medical treatment is not covered under the plan
7. Claim has been raised during the waiting period of a specified medical treatment