HDFC ERGO Health Insurance Claims Procedure
One of the most awarded health insurance companies in the country, HDFC ERGO is known for its quality service and world class products. A key reason for the company winning so many awards is its simple and transparent claims settlement process which minimise customer effort, eliminating red-tape and making it people friendly. With over 5,000 plus hospitals in its network across the country, insured members can be rest assured that a hospital isn't far away during emergencies, regardless of the town or city they are in.
HDFC ERGO health insurance has a dedicated claims settlement team in place, ensuring that policyholders or their loved ones have easy access to members during an eventuality. The company puts their customer ahead of other needs, providing assistance at all stages during hospitalisation or while applying for a claim.
Procedure to File a Claim for Planned or Emergency Hospitalisation
Listed below are the simple steps which an insured individual should follow in order to file a medical insurance claim.
HDFC Ergo Cashless Claims Procedure
- Approach a network hospital with the health card issued by HDFC ERGO and get admitted.
- Intimating HDFC ERGO about such admission is critical, with intimation expected to be provided 2 days before planned hospitalisation. Intimation can be done by calling the TPA on 1800-2-700-700 or 1800-200-1999.
- Submit the health card and a photo ID proof to the hospital to verify your credentials. Once this is done you will have to fill a pre-authorization form from the hospital, with the attending doctor expected to sign it. In case of planned hospitalisation, the letter of authorisation needs to be provided.
- The completed pre-authorization form will be sent by the hospital to the insurance company with other relevant information.
- The insurance company will communicate with the bank to update the status of your claim, either accepting it, denying it or requesting for additional information.
- On acceptance, all medical bills covered under the policy will be settled by HDFC ERGO, while those which aren't covered under the policy need to be paid by the patient/card holder.
- The policyholder will need to verify and sign the original bills while keeping a photocopy of the entire hospitalisation record.
Claims Procedure for Cashless Claim
HDFC ERGO has a simple and efficient claims process in place, with individuals expected to follow the following points.
- A claim should be registered within 7 days of discharge, with the policyholder expected to notify the company about the same.
- The policyholder should fill and submit the Claims Form, providing a photocopy of a valid ID proof along with it.
- Relevant medical certificates and diagnosis report should be sent, with the signature of a doctor.
- All reports and discharge summary (original) should be submitted for verification.
HDFC ERGO will look into the claims request and either approve or reject it based on the policy in place.
Procedure to File a Claim for Reimbursement
Listed below are the steps one needs to follow in order to file a claim
HDFC Ergo Re-imbursement Claims Procedure:
- The insured individual needs to inform the company immediately after being hospitalised. This can be done by calling the TPA on 1800-2-700-700 or 1800-200-1999.
- Post treatment, all hospital bills need to be settled by the policyholder, with all original bills and reports to be kept by him/her.
- Submit the duly filled claims form to the company for processing and reimbursement. The company will reimburse all bills if the information provided is in concurrence with the plan opted for.
Documents Required:
The following documents need to be submitted to HDFC ERGO.
- Claim form - The claim form should be duly filled, signed and submitted.
- Hospital bills - An individual should submit all the original hospital bills, duly stamped and signed by the hospital.
- Discharge report - The original discharge report should be submitted.
- Other reports - All other reports pertaining to the treatment (including medicine bills and investigation reports) should be submitted in original.
- Follow-up details - The future line of treatment and follow-up advice by the doctor should be sent.
- Hospital details - In the event of an insured undergoing treatment in a unregistered or non-network hospital, he/she should get the details of the hospital on the official letterhead, indicating the number of doctors, nurses and beds available.
These documents need to be sent to the health insurance claim office of HDFC ERGO. These offices are located in Noida and Chennai and one can mail the documents to either of the following addresses:
Address 1 : HDFC ERGO General Insurance Company Limited, 5th floor, Tower 1, Stellar IT Park, C-25, Sector 62, Noida - 201301 Address 2 : HDFC ERGO General Insurance Co. Ltd. RR Tower II, 2nd Floor, No: 94/95 T.V.K Industrial Estate, Guindy, Chennai - 600 032. |
One can also call them on their toll free number, 1800-2-700-700 or fax them on 1860-2000-600.
Note: HDFC ERGO might ask for additional supporting documents in certain cases, as per the requirement.
Claims Procedure for Reimbursement Claim
- The policyholder should intimate HDFC ERGO about hospitalisation within 7 days of his/her discharge.
- Pre-authorization from the company should be availed in relevant situations.
- All documents requested by the company should be submitted within 10 days of discharge.
GST rate of 18% applicable for all financial services effective July 1, 2017.
Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.
FAQs on HDFC ERGO Health Insurance Claims Procedure
- What is the timeframe for registering a claim with HDFC ERGO after the insured person's discharge from the hospital?
You should register the claim with HDFC ERGO within 7 days from the date of discharge. You can contact customer care at 0120 6234 6234 / 022 6234 6234 or send an email to care@hdfcergo.com for this purpose.
- What is the deadline for submitting all the required documents after registering a claim?
You need to submit all the necessary documents, along with the duly signed claim form, within 30 days from the date of discharge.
- What are the essential documents that need to be submitted when filing a health insurance claim with HDFC ERGO?
The required documents include the duly filled and signed claim form (with accurate policy details and information), discharge summary, original final bill, payment receipts, medicine invoices, investigation reports, implant sticker or invoice if used, past treatment documents (if applicable), and in the case of an accident, a Medico Legal Certificate or FIR. NEFT/KYC details are also required, along with legal heir information in case the proposer has passed away.
- How will HDFC ERGO keep claimants informed about the progress of their claims?
HDFC ERGO will provide regular updates at every step of the claim process through SMS and email notifications.
- What payment method is used by HDFC ERGO for settling claims, and is there an online option for claim submission?
Payment for claims will be made through NEFT. Claimants also have the option to upload their claims through the Self-Help portal on the HDFC ERGO website (www.hdfcergo.com) or via the HDFC ERGO app.
- Are there any specific points to keep in mind when filling out the claim form?
Yes, it's important to ensure that you mention the correct claim amount in the claim form.
- Are there any additional requirements for claims exceeding Rs.1 lakh in value?
Yes, for claims exceeding Rs.1 lakh, a mandatory KYC form is required.
- What specific details should be provided in the KYC form when filing a claim?
When filling out the KYC form, please ensure to include the mother's name along with other mandatory fields marked with an asterisk (*).
- Is there any additional document required when the proposer has passed away?
Yes, a blank cancelled cheque in the name of the proposer or nominee is required in case the proposer has expired.
- How can claimants access the Self-Help portal for online claim submission?
Claimants can access the Self-Help portal for online claim submission on the HDFC ERGO website (www.hdfcergo.com) or by logging into the HDFC ERGO app.
Disclaimer
Credit Card:
Credit Score:
Personal Loan:
Home Loan:
Fixed Deposit:
Copyright © 2025 BankBazaar.com.