HDFC ERGO Critical Illness Health Insurance Plan

HDFC ERGO Critical Illness Silver provides protection against 8 major illnesses. The list of illnesses covered by this medical insurance policy can be given as follows: The plan covers the following critical illnesses:

1. Heart Attack (Myocardial Infarction)
2. Stroke
3. Coronary Artery Bypass Surgery
4. Multiple Sclerosis
5. Cancer
6. Kidney Failure
7. Paralysis
8. Major Organ Transplantation

Features and Benefits

HDFC Ergo Critical Illness Silver Plan comes with several exclusive features and benefits. Here are the details of the coverage under this policy:

1. This policy provides a lump-sum amount to the insured after the first diagnosis of the disease, provided he/she survives a period of 30 days from the date of the initial diagnosis.
2. The lump-sum amount not only covers the cost and care of the treatment and recuperation aids, but it also mitigates the loss of income caused due to the diagnosis. It also helps in paying off the debts, if any.
3. The policyholder gets the option of choosing between one year or two years of policy coverage period.
4. The insured needs to wait for a period of 90 days from the date of buying the policy before making a claim.
5. The policyholders are eligible to get tax deduction benefits on the premiums paid under this policy as per Section 80D of the Income Tax Act, 1961. Policyholders can claim up to Rs.15,000 as tax benefit while senior citizens can avail up to Rs.20,000.
6. Individuals who are up to 45 years of age need not undergo any kind of medical check-up while availing this policy. It depends on the assumption that the applicant is not suffering from any health issues.
7. If the policy owners undergo diagnostic tests at the empanelled diagnostic centre of the company, they are eligible to receive a 50% discount on the cost of the tests. Once the policy is accepted and issued, the amount spent on the tests is reimbursed.
8. In the event of diagnosis of a critical illness the insured can receive a minimum sum assured of Rs.5 lakh and a maximum of Rs.10 lakh.
9. The policy comes with the benefit of lifetime renewability.
10. Before the issuance and acceptance of the policy the insured will have a 15-day free-look period to cancel the policy.

Exclusions

The company has outlined the following exclusions under the HDFC ERGO Critical Illness Silver Plan for which it is not liable to provide any compensation to the insured:

1. The policy takes a waiting period of 90 days to come into effect unless the insured was covered under this policy continuously during the previous policy year.
2. It does not cover HIV/ AIDS, STDs, venereal disease, tuberculosis, Kaposi's sarcoma, brain lymphomas or any other related disease.
3. The policy doesn't provide coverage for health adversities occurred due to war, revolution, public defence, invasion, radiation, nuclear and biological weapons, and military, air force, or naval operations.
4. No coverage would be provided for individuals who have committed or attempted to commit any criminal acts or involved in any unlawful activity
5. The policy does not cover individuals engaging in adventurous sports such as mountaineering, parachuting, racing, diving, and so forth.
6. It does not include consequences resulted from abuse of drugs, intoxicants, alcohol, or treatment of nicotine addiction, smoking cessation programs or any substance abuse treatments.
7. Pregnancy related issues, voluntary termination, miscarriage, maternity or birth, congenital diseases, and defects or anomalies are not covered under the policy.
8. No coverage is provided to the policyholder in cases of intentional self-injury and attempted suicide while being insane or sane.

Eligibility

People who want to opt for HDFC ERGO Critical Illness Silver Plan must meet the following eligibility criteria:

1. Individuals who are in the age group of 5 to 65 years are only eligible to avail this critical illness plan.
2. Applicants up to the age of 45 years of can avail this policy without undergoing any kind of medical check-up. However, it is subject to no existing health issues.
3. The policyholders may have to undergo a pre-policy check depending on the age and sum insured at the empanelled diagnostic centres at their own cost.

Claim Procedure and Documentation

The following documents need to be submitted to the company while raising a claim:

1. Claim form of the company
2. Consultation forms
3. Medical reports and invoices
4. Hospitalization bills (including break up)
5. Pharmacy bills and prescriptions
6. Discharge summary

The procedure of raising a claim under this policy is detailed below:

1. In the event of raising a claim the policyholder should immediately inform the company via call, mail, or by visiting the nearest branch.
2. The company may record all the conversation and evaluate it later as a part of the claim record.
3. Upon receiving the final documents, the company will consider the claim and if they are satisfied with the evidences, the claim will be settled.

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.