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 one of India’s top financial institutions, HDFC Limited and Munich Re Group’s primary insurance entity, ERGO International AG. The company is ISO certified with respect to policy issuance, claim services, customer services, security processes and more. ICRA has assigned HDFC ERGO with an ‘iAAA’ rating which indicates the company’s highest claim paying capability.
HDFC ERGO General Insurance Company Limited offers comprehensive insurance products including health insurance, motor insurance and home insurance among other products in retail space and insurance products including marine insurance, liability insurance and property insurance in corporate space.
The health insurance plans offered by HDFC ERGO are as follows:
Health Suraksha – Medical Insurance Plan: You can choose between Individual Health Insurance and Family Floater Health Insurance plans at affordable rates. It offers cover for in-patient treatments, day care procedures, pre and post hospitalization charges, medical check-ups and more.
Health Suraksha Gold with Maternity Coverage: This is a lifelong renewable policy that has no entry age restriction. It offers cover for in-patient treatments, day care procedures, pre and post hospitalization charges, cover for your newborn baby, e-opinion for critical illness, convalescence benefits and more.
Health Suraksha with Regain and ECB: This policy offers comprehensive medical coverage with AYUSH cover that has no sub-limit at an affordable cost. You will receive an enhanced cumulative bonus of 10% for every claim free year up to a maximum of 100% of your sum insured.
my:health Medisure Super Top Up Insurance: Get cover between Rs.3 lakhs and Rs.20 lakhs with no sub-limits on in-patient hospitalization costs. If 3 or more family members are covered under this policy, you will enjoy a 10% family discount.
Critical Illness Insurance Policy: You can use this policy to cover recuperation aid, paying for treatment and care, paying off any debts, compensating for any lost income, funds for a lifestyle change etc. This policy offers cover for the following illnesses – Cancer, Stroke, Heart Attack (Myocardial Infarction), Kidney Failure, Multiple Sclerosis, Major Organ Transplant, Paralysis And Coronary Artery Bypass Surgery.
Critical Illness Platinum Policy in India: Under this policy, you will receive a lump sum benefit after your first diagnosis post the 30 day survival period for the following critical illnesses - Cancer, Stroke, Heart Attack (Myocardial Infarction), Kidney Failure, Multiple Sclerosis, Major Organ Transplant, Paralysis, Coronary Artery Bypass Surgery, Heart Valve Replacement, Aorta Graft Surgery, Benign Brain Tumor, Primary Pulmonary Arterial Hypertension, Alzheimer’s Disease, Parkinson’s Disease And End Stage Liver Disease.
HDFC ERGO Health Insurance Cashless Network Hospitals
Most of the premier insurance companies in India today offer cashless hospitalization to their insured for a hassle-free claim process. If you choose to avail this facility, you can undergo any necessary medical treatments, check-ups, day care operations etc. without having to directly pay the hospital. You may only be required to sign your bills which will later be settled between your insurer and the hospital without further involvement from you. However, what you must remember here is that this facility will only be available at network hospitals with whom your insurer has tied-up.
HDFC ERGO has tied up with a network of more than 5,000 hospitals in the country where you can avail a cashless facility for your medical expenses. You can use the hospital locator for a list of all associated hospitals near you.
What are the type of claims that can be done at HDFC ERGO Health Insurance network hospitals?
The health insurance claims offered under HDFC ERGO Health Insurance can be classified into the following:
Cashless claim – For this claim service, there is no requirement for you to pay the hospital bills at admission or during discharge. HDFC ERGO will settle your hospital bill directly with the hospital. You can avail this service at all HDFC ERGO network hospitals.
Reimbursement claim – For this claim service, you will need to submit the original copy of all bills, receipts, investigation reports, consultation sheets, discharge summaries etc. to HDFC ERGO along with the claim form. You will be reimbursed for all applicable expenses covered under your policy.
Find below the claim process for cashless hospitalization:
You must approach a network hospital for cashless hospitalization with your TPA Health Card or your HDFC ERGO Health Card.
The hospital will then verify your card details with your ID proof (containing your photograph) and send your pre-authorization request to the HDFC ERGO TPA team/HCS team.
The respective team at HDFC ERGO will then verify your pre-authorization details with your policy and provide a response to the hospital.
HDFC ERGO will send one of the following responses to the network hospital:
Approved - HDFC ERGO will send the network hospital an approval letter to avail the cashless facility.
Denial - HDFC ERGO will send the network hospital a denial letter. But you can continue to be treated at the hospital. After your treatment, you can submit a claim form and all corresponding documents from the hospital to your insurer and claim for a reimbursement.
Query - HDFC ERGO will send the network hospital a query letter due to insufficient information and/or documentation. The hospital will then respond to all the queries of your insurer before they approve or deny the cashless hospitalization request.
Find below the claim process for reimbursement:
You must arrange all the hospital receipts in chronological manner and submit it for a reimbursement claim through the following process:
You must get the claim form from HDFC ERGO and submit the original copy for the claim submission.
You should keep a record of all original bills, receipts, investigation reports, consultation sheets, discharge summaries etc. that you obtained 30 days before and 60 days after your hospitalization/treatment.
As you need to submit the originals to the insurance company, it is advisable to make a copy of everything in case any document/s are lost or misplaced.
After compiling the documents, check them thoroughly to ensure that nothing is missing so there is no claim shortfall.
The next step is to enquire with the insurance company to which TPA you need to submit the claim documents.
You will need to file your claim documents within 7 days after your discharge/treatment completion.
Note that you will not receive complete reimbursement of your claim. Deductions will be made according to what expenses are covered under your policy.
Procedures offered/covered in HDFC ERGO Health Insurance network hospitals across India
The common procedures offered across network hospitals of HDFC ERGO include in-patient treatment, pre and post hospitalization, day care procedures, emergency ambulance, organ donor, cumulative bonus, medical checkups, maternity benefits etc.
Critical illness cover for HDFC ERGO Health Insurance across network hospitals include cover for Cancer, Stroke, Major Organ Transplant, Paralysis, Coronary Artery Bypass Surgery, Heart Valve Replacement etc.
If you apply for add-ons such as Indemnity Health Insurance plans offered under ERGO Health Insurance policies, you will receive additional coverage for doctor’s fee, hospital room rent expenses, operating theatre costs etc.
Exclusions under HDFC ERGO Health Insurance network hospitals
The common exclusions under HDFC ERGO Health Insurance include the following:
A waiting period of 30 days for all policies except critical illness policies are applicable before filing a claim. For critical illness cover, a waiting period of 90 days is applicable.
Health insurance cover will not be applicable for attempted suicide.
Health insurance cover will not be applicable in case of criminal or unlawful activity.
Health insurance cover will not be applicable if you have been under the influence of drugs or alcohol.
Health insurance cover will not be applicable if you have been involved in terrorist activities, war or radioactivity.
FAQs – Frequently Asked Questions:
What are network hospitals?
Network hospitals refer to the hospitals that an insurance company is tied-up with where you can avail a host of benefits, including the cashless facility.
How much cumulative bonus can I avail if I top-up my health insurance policy?
With the Health Suraksha Top-Up Plus, you will be entitled to receive 5% cumulative bonus for each year where you have not made any claim up to a maximum of 50% of the sum assured.
How do I make a claim if I am treated at a non-network hospital?
If you receive your treatment at a non-network hospital, you will have to settle your hospital bills and then claiming for reimbursement from your insurer. You must submit the original copies of all your hospital bills, receipts etc. along with the claim form to HDFC ERGO for reimbursement.
Do I have to take a medical test or go for a medical checkup before I apply for a health insurance policy with HDFC ERGO?
No. There is no requirement for a medical checkup for applicants up to the age of 55.
Am I eligible for any tax benefits if I apply for health insurance?
Yes. Under ‘Section 80D’, you are eligible for tax benefits of up to Rs.15,000. If you are a senior citizen, you are eligible for tax benefits of up to Rs.20,000.
What is the entry age to apply for a HDFC ERGO health insurance policy?
Health insurance policies are available for children from 91 days of age. There is no restriction on the maximum entry age for HDFC ERGO health insurance policies.
When should I file for a reimbursement claim settlement under my HDFC ERGO health insurance policy?
You must file for a reimbursement claim settlement within 7 days of your treatment completion or discharge from the hospital for it to be valid.
Do I need to submit any documents when applying for a critical illness policy?
No. There is no requirement to submit any documents when applying for a critical illness health insurance policy. You will be required to submit a completed and duly signed proposal with all relevant details.
Can I make multiple claims under my critical illness policy?
No. You can only make 1 claim per policy period.
Do I need to undergo a medical test to enroll for a critical illness policy?
No. Medical check-up is not required for applicants up to the age of 45 years.