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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 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.

    1. 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.
    2. 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 Company Limited,

      6th floor, MBC Tower,

      #199, Luz Church Road,

      Mylapore,

      Chennai - 600004

      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.

    3. 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.

    This Insurance Company has not partnered with BankBazaar.com. For more details, please visit its website/branch office. The trademarks, logos and other subject matters of intellectual property belong to their respective owners.

    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 49 1 2 3 4 5
    • HDFC Ergo Health Insurance
      "EXCELLENT"
      0.5 5.0/5 "Blown Away!"
      I have been using my health insurance policy with the HDFC ERGO GENERAL INSURANCE and the premium i am paying six hundred and thirty five rupees per month also it gives the coverage up to one crore rupees. It is a corporate policy, i am using from past 10 years but i had no claim experience.
      Was this review helpful? 0
      , bhubaneshwar
      Reviewed on Nov 16, 2018
    • HDFC Ergo Health Insurance
      "Average service"
      0.5 3.0/5 "Satisfactory"
      I have been using HDFC ERGO health insurance for while , I never had any claim experience with the policy. I will have to wait and see how they respond to their claim requests in future, overall service was good it cover accidental policy and they charge nominal premium amount.
      Was this review helpful? 0
      , anantapur
      Reviewed on Nov 15, 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 opt there policy yet and i use to pay premium on monthly bases up to 400 rupees 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.
      Was this review helpful? 0
      , mumbai
      Reviewed on Nov 14, 2018
    • HDFC Ergo Health Insurance
      "Recommendble Top up policy"
      0.5 5.0/5 "Blown Away!"
      I have done health policy top up with HDFC Ergo, the customer service is also very good. There is no processing fee for the top up, they gave me the medical amount Rs. 12 lakhs for entire family its for 3 person, I don't have claim experience. They are covering major or minor but for waiting period for pre existing is three years.
      Was this review helpful? 0
      , hyderabad
      Reviewed on Nov 13, 2018
    • HDFC Ergo Health Insurance
      "Good"
      0.5 4.0/5 "Great!"
      I already a health insurance with HDFC Ergo. I am satisfied with the benefits. The policy coverage is one year. It covers only minor disease. There is no claim experience. They provide a good network of hospitals for the cashless treatment. I don't get any reminder call for the policy renewal.
      Was this review helpful? 0
      , panipat
      Reviewed on Nov 13, 2018
    • HDFC Ergo Health Insurance
      "Best Policy"
      0.5 5.0/5 "Blown Away!"
      I have taken health insurance form Hdfc ergo .Am satisfied with the premium amount which am making the payment yearly . Their customer representative explained the benefits and features of the policy . They have given the list of network hospitals and health card also. This policy covers cashless hospitalization and pre disease coverage . I make the payment through net banking .
      Was this review helpful? 0
      , ahmedabad
      Reviewed on Nov 02, 2018
    • HDFC Ergo Health Insurance
      "Average Policy"
      0.5 3.0/5 "Satisfactory"
      My health is insured with HDFC ERGO from last 10 months, i did not received any documents so far for this insurance. I make my payment every month through RTGS. I have no claim experience so far and they did not inform about the benefits of the policy.
      Was this review helpful? 0
      , bangalore
      Reviewed on Nov 01, 2018
    • HDFC Ergo Health Insurance
      "Good policy"
      0.5 4.5/5 "Excellent!"
      I took health insurance from Hdfc ergo general insurance . I have choose this insurance mainly because of convincing premium with too many benefits . This policy covers Cashless hospitalization. , pre diseases coverage . Overall am satisfied with customer care and service. Am getting income tax benefits
      Was this review helpful? 1
      , chennai
      Reviewed on Nov 01, 2018
    • HDFC Ergo Health Insurance
      "Excellent service"
      0.5 5.0/5 "Blown Away!"
      I have been using HDFC ERGO health insurance for a while, i never had any claim experience with the policy. i will have to wait and see how they are responding to their claims request in future, till now service is good no issue, there premium they are charging is nominal.
      Was this review helpful? 0
      , mumbai
      Reviewed on Oct 30, 2018
    • HDFC Ergo Health Insurance
      "Average service"
      0.5 3.0/5 "Satisfactory"
      I have a health insurance policy with the HDFC Ergo. I pay a premium of 6100 Per year, I do not have any claim experience with the policy and it offers full coverage for my entire family. They offer a coverage 2 lacs annually which is pretty good for me. Overall it has been a good experience with the features of the policy. .
      Was this review helpful? 0
      , hyderabad
      Reviewed on Oct 30, 2018
    • HDFC Ergo Health Insurance
      "Best policy"
      0.5 4.5/5 "Excellent!"
      I have a health insurance with HDFC ERGO from last 5 years, i am not aware of the premium amount as my company pays it. My claim experience was very good and it was a cashless treatment. The coverage value of this insurance is Rs 2 lacs.
      Was this review helpful? 1
      , kochi
      Reviewed on Oct 11, 2018
    • HDFC Ergo Health Insurance
      "Average policy"
      0.5 3.0/5 "Satisfactory"
      I have choose this health insurance from Hdfc ergo mainly because of convincing premium benefits . This policy covers Cashless hospitalization. , pre diseases coverage . Overall am satisfied with customer care and service, Am making the payment through online
      Was this review helpful? 0
      , thane
      Reviewed on Oct 09, 2018
    • HDFC Ergo Health Insurance
      "Best Policy"
      0.5 5.0/5 "Blown Away!"
      I took health insurance from Hdfc Ergo insurance . I have choose this insurance mainly because of convincing premium with too many benefits . This policy covers Cashless hospitalization. Pre diseases coverage . In this policy where i have to make payment for 1 years i will be getting 2 years coverage for free.
      Was this review helpful? 0
      , bangalore
      Reviewed on Oct 06, 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
      , new delhi
      Reviewed on Oct 03, 2018
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with HDFC ERGO from last 2 years, i am happy with the coverage value of this insurance policy. I have no claim experience so far with this insurance policy. A premium of Rs 6000 has to be paid for this insurance and the coverage value is Rs 3-4 lacs.
      Was this review helpful? 0
      , vadodara
      Reviewed on Sep 17, 2018
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have my health insured with HDFC ERGO from last 1.5 months, i am happy with the coverage value of this insurance policy. A premium of Rs 6000 has to be paid for this insurance policy. I have no claim experience with this insurance the coverage value is Rs 5 lacs.
      Was this review helpful? 0
      , palanpur
      Reviewed on Sep 12, 2018
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have company provided health insurance policy with HDFC ERGO from last 7 years. I am not aware of the premium amount as my company pays it. I have not claimed anything so far from this insurance policy and i am not aware of the coverage value.
      Was this review helpful? 1
      , hyderabad
      Reviewed on Sep 06, 2018
    • HDFC Ergo Health Insurance
      "BEST POLICY "
      0.5 5.0/5 "Blown Away!"
      I have chosen this health insurance mainly because of convincing premium benefits . This policy covers Cashless hospitalization. , pre diseases coverage . Overall am satisfied with customer care and service. Am getting income tax benefits and the premium amount which am paying is satisfied , Am making the payment through online
      Was this review helpful? 0
      , mumbai
      Reviewed on Sep 05, 2018
    • HDFC Ergo Health Insurance
      "Best Policy"
      0.5 5.0/5 "Blown Away!"
      I took health insurance from Hdfc ergo Am satisfied with the premium amount which am making the payment , i don't have claim experience . But this policy hold benefits of cashless hospitalization and network of hospital. Their customer explained the policy very well.
      Was this review helpful? 0
      , bangalore
      Reviewed on Sep 04, 2018
    • HDFC Ergo Health Insurance
      "Good Policy"
      0.5 4.0/5 "Great!"
      I have a health insurance policy with HDFC ERGO from last 2 years, i have to pay an insurance premium of Rs 20000 for 2 years. I have not claimed anything so far from this insurance policy. The coverage for this policy is 3 lacs per head and this policy is for family.
      Was this review helpful? 2
      , bangalore
      Reviewed on Aug 30, 2018
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