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HDFC ERGO Health Insurance Claims Procedure

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Cashless Treatment

Customer Service

Medical Coverage

Claim Experience

Responsiveness

One of the most awarded 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 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.

Incurred Claim Ratio for HDFC ERGO Health Insurance:

The Incurred Claim Ratio (ICR) of an organisation is a strong indicator of their performance, helping people get a broad understanding about what they can expect. The Incurred Claim Ratio for HDFC ERGO Health Insurance for the period 2014-15 and 2015-16 is mentioned in the table below.

For 2017-18:

Net Earned Premium (in crores INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
805.11 4.81 52.58

For 2016-17:

Net Earned Premium (in crores INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
517.36 2.89 50.76

For 2015-16:

Net Earned Premium (in lakhs INR) Net Claims Paid (in lakhs INR) Incurred Claims Ratio (Percentage)
63809 32542 51.00

For 2014-15:

Net Premium Earned (Rs Lakhs) Net Claims Paid (Rs Lakhs) Incurred Claims Ratio (%)
58,145 32,843 56.48

The ICR indicates the ability of HDFC ERGO to make profits, showcasing that they are in a position to clear claims without having to overburden their finances.

Claim Scenarios:

There are two different scenarios one can experience with regards to using a health policy , with the first one being cashless treatment and the second one related to reimbursement of expenses incurred after a treatment.

In Case of Cashless Treatment:

Cashless treatment involves getting treated for a particular illness with all medical expenses taken care off by HDFC ERGO, subject to the cover availed by an individual. One can avail cashless treatment at any of the network hospitals across the country.

Procedure to File a Claim (Planned/Emergency Hospitalisation):

Listed below are the simple steps which an insured individual should follow in order to file a medical insurance claim.

    • 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 Process:

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.

In Case of Reimbursement of Treatment Expenses:

There are cases when HDFC ERGO could reject the claim for cashless hospitalisation and treatment, but the insured individual can claim a reimbursement for the expenses incurred by him/her by keeping a few simple points in mind.

Procedure to File a Claim:

Listed below are the steps one needs to follow in order to file a claim

  • 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 non-network or unregistered 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:

HDFC ERGO General Insurance Company Limited,

5th floor, Tower 1,

Stellar IT Park,

C-25, Sector 62,

Noida - 201301

Or

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 Process:

  • 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.

Disclaimer

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.

Read terms, conditions and exclusions mentioned in the policy document.

Find cashless network hospitals nearby: HDFC ERGO Cashless Network Hospitals

Other Health Insurance Plans from HDFC ERGO Health Insurance:

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.

HDFC ERGO Health Insurance Claims Procedure Reviews

Page 1 of 50 1 2 3 4 5
  • HDFC Ergo Health Insurance
    "Average Policy"
    0.5 3.0/5 "Satisfactory"
    I have purchased the health insurance from HDFC Ergo. For some enquiry, i have called the customer care service and they have resolved my query immediately. I have not made any claim experience so far. I pay the premium amount of Rs. 37000 and myself has been covered in this policy.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I experience my health insurance with HDFC Ergo,they have tie up many hospital ,i have not have claim experience yet,there is cashless treatment option available,the premium they have charged me on monthly basis,they have charged me up to 700 which is nominal , i pay premium through on line.
    Was this review helpful? 0
    , kolkata
    Reviewed on Jan 20, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I got the health insurance with HDFC Ergo, they got tie up with many hospitals, and they have shared me location on those hospital in mail, and they have charged me nominal premium amount ,they have charged me up to 17000-18000 as premium, it is on yearly basis, and i use to pay the premium on an on line basis.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 17, 2019
  • HDFC Ergo Health Insurance
    "Very good benefits"
    0.5 5.0/5 "Blown Away!"
    I have a health insurance from HDFC ERGO which was purchased by me in the year of 2018 because the benefits are very good. The claim process was simple and they have more number of hospitals for cashless. I have paid 18,800 for one year and took 3 years policy for myself and my wife. The medical coverage is 10L for myself and 5L for wife.
    Was this review helpful? 2
    , bangalore
    Reviewed on Jan 14, 2019
  • HDFC Ergo Health Insurance
    "Good"
    0.5 3.0/5 "Satisfactory"
    I have taken health insurance from HDFC Ergo which was offered along my personal loan. I have received the insurance paper and its been couple of months. It covers critical illness and need to go through the policy benefits. Always the customer is good.
    Was this review helpful? 0
    , bangalore
    Reviewed on Jan 14, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have taken my health insurance with HDFC ERGO, there service is good, there agent had explain me about the policy which is covered in this insurance and they have tie up with many hospital and they have shared me there location , and the premium amount they have charged me was nominal,they have charged me up to 5000 on yearly basis for 4,00,000 coverage,i use to pay through on line.
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 08, 2019
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using my health insurance with HDFC ERGO for long time, there service is too good, they have tie up with many hospital , and they have shared me all the location regarding the hospital location and the premium amount i use to pay on yearly basis, and premium amount is not fixed every year it use to varies .
    Was this review helpful? 0
    , chennai
    Reviewed on Jan 07, 2019
  • HDFC Ergo Health Insurance
    "Good service"
    0.5 5.0/5 "Blown Away!"
    I have taken my health insurance with HDFC ERGO , i have not opt there policy yet and i use to pay premium on yearly basis and they have charged me nominal, and it use to get auto debit from my account and while i applied for health insurance customer service had explained me about all procedure , so far the process went smoothly and it good, and they have tie up with maximum hospital.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Dec 30, 2018
  • HDFC Ergo Health Insurance
    "Good for every person"
    0.5 5.0/5 "Blown Away!"
    My health was insured from HDFC Ergo. Because of the claim ratio i have selected the HDFC ergo,This policy covers only for me. I pay the premium amount of Rs. 6000 per annum. They have provided me a coverage value of Rs. 2 lakhs. They have a many hospitals in their list and they have good cashless facility also.
    Was this review helpful? 0
    , hyderabad
    Reviewed on Dec 26, 2018
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have taken my health insurance with HDFC ERGO , i have not opted for the policy yet and i use to pay premium on monthly bases , and it use to get auto debit from my account and while i applied for health insurance customer service had explained me about all procedure , so far the process went smoothly and it was all good.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Dec 26, 2018
  • HDFC Ergo Health Insurance
    "Good service"
    0.5 4.0/5 "Great!"
    I have been holding my health insurance with HDFC ERGO GENERAL INSURANCE, there service is good, they have tie up with my hospital , as they have charged me the location of that in excel, and i pay premium amount on quarterly basis, and the premium amount use to get auto debited from my account.
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 20, 2018
  • HDFC Ergo Health Insurance
    "Its for emergency purpose"
    0.5 5.0/5 "Blown Away!"
    I got my medical card on time from HDFC Ergo its a corporate plan. They gave me medical coverage value of around Rs. 5 lakhs for three person in my family. They are providing major or minor disease cover and they have tie up many hospitals in my place.
    Was this review helpful? 1
    , bangalore
    Reviewed on Dec 17, 2018
  • HDFC Ergo Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken Health insurance from Hdfc ergo insurance . Am satisfied with the premium amount which am making the payment yearly . This policy gives good coverage with cashless hospitalization and pre disease cover . Even they have given network list of hospitals .
    Was this review helpful? 0
    , ahmedabad
    Reviewed on Dec 16, 2018
  • HDFC Ergo Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken Health insurance from Hdfc ergo insurance . Am satisfied with the premium amount which am making the payment yearly . This policy gives good coverage with cashless hospitalization and pre disease cover . Even they have given network list of hospitals .Even i had good experience in claim experience .
    Was this review helpful? 0
    , ahmedabad
    Reviewed on Dec 16, 2018
  • HDFC Ergo Health Insurance
    "Every must need this policy for future"
    0.5 5.0/5 "Blown Away!"
    My health insurance policy was taken with HDFC Ergo. They have provided me a coverage amount of RS. 8 lakhs. I have to pay the premium amount of Rs. 6000 for 4 years till my loan tenure period. When i purchase the loan, they have given this policy. I have not claimed anything from this policy. The hospital list was fine.
    Was this review helpful? 0
    , gurgaon
    Reviewed on Dec 13, 2018
  • HDFC Ergo Health Insurance
    "Best Policy"
    0.5 5.0/5 "Blown Away!"
    I have taken Health insurance from Hdfc ergo insurance . Am satisfied with the premium amount which am making the payment yearly . This policy gives good coverage with cashless hospitalization and pre disease cover . Even they have given network list of hospitals .Overall am satisfied with the service
    Was this review helpful? 2
    , faridabad
    Reviewed on Dec 13, 2018
  • HDFC Ergo Health Insurance
    "Good health insurance policy"
    0.5 3.0/5 "Satisfactory"
    I have purchased a policy for my family and i bought the policy from HDFC Ergo. I have paid the premium amount of Rs. 13650 yearly once. I have received a coverage amount upto Rs. 3 lakhs. This policy covers for me and my wife. The hospital list was fine. I had no claim experience with HDFC Ergo.
    Was this review helpful? 1
    , bangalore
    Reviewed on Dec 11, 2018
  • HDFC Ergo Health Insurance
    "Excellent service"
    0.5 5.0/5 "Blown Away!"
    I have been using my health insurance with HDFC ERGO for long time, there service is too good, they have tie up with many hospital , and they have shared me all the location regarding the hospital location and the premium amount i use to pay on yearly basis, and premium amount is not fixed every year it use to varies .
    Was this review helpful? 0
    , bangalore
    Reviewed on Dec 10, 2018
  • HDFC Ergo Health Insurance
    "Good Cash less option"
    0.5 5.0/5 "Blown Away!"
    My health insurance belongs to HDFC Ergo, they are providing medical cover of Rs. 6 lakhs its only me. Before 15 days I got text stating policy has expired I need to check with the customer service regarding this message. They do have cash less treatment that option is good.
    Was this review helpful? 0
    , new delhi
    Reviewed on Nov 24, 2018
  • HDFC Ergo Health Insurance
    "GOOD SERVICE"
    0.5 5.0/5 "Blown Away!"
    I have purchased the health insurance policy with the HDFC ERGO GENERAL INSURANCE where the process is easy to get the policy. I am using it from past 2-3 months but i have no claim experience with this policy. They have given the medical coverage of 1 lakhs. The premium i pay for 9k.
    Was this review helpful? 1
    , jaipur
    Reviewed on Nov 23, 2018
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