HDFC ERGO Health Insurance Network Hospitals

Find the state-wise list of network hospitals for HDFC ERGO GENERAL INSURANCE.

Search for details of HDFC ERGO GENERAL INSURANCE network hospitals in India.

HDFC ERGO General Insurance Company Limited is a joint venture between HDFC Ltd., holding 51% stake, and ERGO International AG holding 49% stake. The company was founded in 2002 and is headquartered in Mumbai. It has spread all over the country with 117 branches and more than 2000 employees in over 100 cities. It provides several insurance products and services. In the retail sector, some of its insurance offerings include travel insurance, motor insurance, health insurance, personal accident insurance, and home insurance. It is rated iAAA by ICRA which is an indication of the highest paying ability of the company.

In the health insurance category, HDFC ERGO provides individual health insurance, family health insurance, parents health insurance, senior citizen health insurance, my:health Medisure Super Top Up, critical illness policy, health insurance renewal, and Health Suraksha Top Up Renewal.

HDFC ERGO provides cashless Mediclaim policy for families and individuals.

What is cashless health insurance?

There are two ways medical bills can be paid if you have health insurance. The conventional way is through the process of reimbursement, where the bills are first paid in full and then reimbursements claimed from the insurance company by submitting all the necessary bills and documentation. With rising medical expenses, it has become increasingly difficult for people to pay their hospital bills upfront. This is where cashless health insurance comes in. In this system, the insured can undergo treatments, hospitalisation, surgeries, etc., without paying anything upfront from his/her pocket. Cashless health insurance can only be claimed in hospitals which are part of the network of the insurance company.

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:

  1. 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.
  2. 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).
  3. Take your cashless card or policy card with you.
  4. The form has to be filled up by both the patient and by the medical practitioner.
  5. 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

Frequently Asked Questions (FAQs):

  1. What is TPA?

  2. TPA is Third Party Administrator. This is the mediator between the insurer and the insured. All the bills are settled with the hospital directly by the TPA.

  3. How to know which hospitals to opt for treatment under cashless hospitalisation?

  4. A list of network-linked hospitals can be obtained from the company. It is better to consult the list and choose the hospital beforehand.

  5. Where do you get the list of network hospitals?

  6. The list of network hospitals is available on the website of HDFC ERGO.

  7. How to know the premium for the cashless hospitalisation plan?

  8. There is a calculator for premiums available online at the HDFC ERGO website. This is an easy-to-use online tool that gives you information about how much premium you need to pay after you fill up a few simple details such as your name, address, plan type, etc.

    It is important to keep the list of cashless health insurance network hospitals in your vicinity handy so that in the case of an emergency or even a planned hospitalisation, you can make the right choice without wasting any time. This can be searched for online on the HDFC ERGO website with the keywords such as the name of your city, state, and pincode.

    HDFC ERGO’s health insurance network hospitals that offer cashless health insurance remove the stress of the financial burdens caused by medical emergencies or planned treatments/surgeries by offering plans at affordable premiums and hassle-free processes.

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