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  • HDFC ERGO Critical Illness Plan

    HDFC Ergo Health Insurance

    HDFC ERGO critical illness, a policy which provides cover against critical illnesses, comes in two variants- Silver and Platinum. Silver Plan covers eight critical illness while Platinum plan covers more number of ailments. The policy pays a lump sum on confirmed diagnosis of critical ailments, following a survival period of 30 days. However, a policyholder cannot make multiple claims as the cover ceases after a claim is made. HDFC ERGO is suitable for individuals with a history of life threatening ailments.

    Features & Benefits - HDFC ERGO Critical Illness Plan

    HDFC Ergo critical illness policy offers two sub plans - Silver and Platinum which have similar features with the exception of some benefits such as the number of critical ailments covered among others as shown in the table below.


    Coverage type Individual
    Entry age Minimum is 5; maximum is 45
    Eligibility

    Critical illness policy covers individuals in the age group of 5 to 45 years.

    Children aged from 5 to 18 years can be covered if parents are already insured

    Medical screening No pre-policy medical check up is required for individuals up to 45 years
    Maximum Sum Insured Rs. 10 lakh
    Minimum Sum Insured Rs. 2.5 lakh
    Discount Discount on a policy tenure of 2 years
    Policy renewal up to 66 years (1 year policy term) and up to 67 years (2 years policy term)
    Grace period for policy renewal 15 days
    Costs covered
    • Includes physician’s fees in addition to costs associated with the actual treatment
    • Policyholders can pay off debt related to critical ailments and recuperation costs
    • Includes any lost income owing to a decreasing ability to earn
    • Includes fund for a change in lifestyle
    Ailments covered under both Silver and Platinum Plans

    Platinum Plan

    • Heart Attack
    • Stroke
    • Coronary Artery Bypass
    • Cancer
    • Kidney Failure
    • Multiple Sclerosis
    • Paralysis
    • Major Organ Transplant
    • Primary Pulmonary Arterial Hypertension
    • Aorta Graft Surgery
    • Heart Valve Replacement
    • Benign Brain Tumor
    • Parkinson's Disease
    • Alzheimer's Disease
    • End Stage Liver Disease

    Silver Plan

    • Heart Attack (Myocardial Infarction)
    • Stroke
    • Coronary Artery Bypass Surgery
    • Cancer
    • Kidney Failure
    • Multiple Sclerosis
    • Paralysis
    • Major Organ Transplantation
    Waiting period 90 days from the date of buying the policy
    Tax benefit

    Premiums paid under this plan qualify for deduction. Policyholders can claim upto Rs.15,000 as tax benefit under section 80D. Also, senior citizens can avail up to Rs.20,000

    Termination

    Insurer may cancel the policy by giving a 30 day written notice to policyholder. Likewise, the policyholder can cancel the policy via a written notice, in which case, a certain percentage of premium would be refunded based on the policy term

    Documentation Required
    • Claim form
    • Discharge summary
    • Consultation forms
    • Medical reports and invoices
    • Hospitalization bills (including break up)
    • Pharmacy bills and prescriptions
    Exclusions
    • Pre-existing diseases are not covered under HDFC ERGO critical illness plans.
    • Benefits to the policyholders will be paid only after a survival period of 30 days after confirmed diagnosis.
    • The policy takes 90 days (waiting period) to come into effect.
    • Policy does not cover HIV/ AIDS or any other related disease in addition to war, participation in any unlawful activity or adventurous activities such as mountaineering and so forth.
    • Policy does not include persons in military or naval operations, war or any act of war and so forth.
    • No coverage would be provided for persons who have committed any criminal acts.
    • Policy does not cover individuals engaging in dangerous sports such as racing, scuba-diving and so forth.
    • Policy does not include use of drugs, alcohol or intoxicants, treatment of nicotine addiction or any substance abuse.
    • Pregnancy related, miscarriage, or congenital diseases are not covered under the policy.
    • No coverage is provided in cases of intentional self-injury.

    Other Health Insurance Plans from HDFC ERGO Health Insurance

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