HDFC ergo Health Suraksha Gold Plan Regain & ECB

Medical Expenses Covered

HDFC ERGO Health Suraksha Gold Plan Regain & ECB provides extensive coverage to the policy holders. The policy covers the expenses and medical expenses incurred due to the following:

1. Hospitalisation due to accident/illness - This policy covers the hospitalisation expenses incurred due to an accident or illness in addition to cost of room rent, nursing, boarding, intensive care unit, doctors, medicines, and other related expenses.
2. Alternative medicines - It also provides coverage for the in-patient treatments taken under alternative medicines such as Homeopathy, Ayurveda, Sidha, Unani etc.
3. Pre and post hospitalisation - The medical expenses resulted due to an illness 60 days immediately before the date of hospitalisation and 90 days immediately after the discharge post hospitalisation are covered under the policy.

1. Day care procedures - The policy includes medical expenses for 144-day care procedures not requiring 24-hour hospitalisation due to hi-tech facilities.

1. Domiciliary treatment - If the policyholders take medical treatments at home on the advice of a doctor the cost will be borne under the policy.
2. Organ donor's medical treatment - In case of organ transplantation, the policy will pay for the medical expenses incurred due to the organ donor's treatment.
3. Maternity and child birth - Once a waiting period of 4 years is completed, maternity expenses including pre-natal and post-natal care is covered under the policy. In addition to that, the policy also provides coverage for new born babies since birth.
4. Utilisation of emergency ambulance - The policy also includes the cost of using ambulance services during an emergency.

Features and Benefits

Some of the notable features of HDFC ERGO Health Suraksha Gold Plan Regain & ECB are as follows:

1. The policy comes with policy coverage period of one year or two years which the policyholders can choose as per convenience.
2. Policyholders must wait for a period of 30 days from the date of buying the policy before making a claim, except accidental cases.
3. It offers tax deduction benefits to the insured on the premiums paid under it as per Section 80D of the Income Tax Act, 1961. They can claim up to Rs.15,000 as tax benefit while senior citizens can avail up to Rs.20,000.
4. No need of undergoing any kind of medical check-up for individuals who are up to 45 years of age while availing this policy.
5. If the policyholders undergo pre-policy check at the empanelled diagnostic centre of the company, 50% of the charges of the standard medical tests will be reimbursed after the acceptance and issuance of the policy.
6. In the event of hospitalisation and other medical treatments listed under the policy the insured can receive a minimum sum assured of Rs.3 lakh and a maximum of Rs.10 lakh.
7. The policy offers lifetime renewability benefits to the policyholder.
8. There are no sub-limits on any disease, hospital charges, room rent, and doctor fees under this policy.
9. Insured get the option to cover on individual sum insured basis and on family floater basis.
10. A family discount of 10% can be availed if two or more members of a family are covered under this policy on an Individual sum insured basis.

1. The policy provides the policyholders with a lump-sum payment of 1% of the sum insured up to a maximum of Rs.10,000 in case of hospitalisation for a period of 10 continuous and completed days.
2. It offers benefit of automatic availability of the basic sum insured in case the basic sum insured inclusive of the no claim bonus is exhausted during the policy year. 5% extra premium will be charged on the base premium unless the sum insured is Rs.2 lakh.
3. The policy includes an optional cumulative bonus which will automatically increase to 10% with the maximum cumulative bonus not exceeding 100% of Base Sum Insured. 2.5% extra premium will be charged on the base premium unless the sum insured is Rs.2 lakh.
4. Policyholders get 5% cumulative bonus up to a maximum of 50% for every claim-free year. Moreover, after 4 consecutive claim-free years the policy pays up to 1% of Sum Insured and maximum up to Rs. 5000 for a health check-up.
5. Policyowners get 15 days of time (free-look period) from the date of receipt of the policy document to cancel the policy before its issuance and acceptance.

Exclusions

The company is not liable to provide any compensation to the insured for the following exclusions under this policy:

1. Pre-existing illnesses are not be covered under Health Suraksha Gold Plan Regain & ECB for initial 48 months from the date of policy purchase.
2. The policy will not cover the cost of treatment within first 30 days of cover unless there is any accidental injury.
3. It doesn't provide coverage for any treatment arising from HIV, AIDS, and other related diseases.
4. Treatment costs of cosmetic surgery, mental disorder/insanity, and weight control therapy are not covered by this policy.
5. No coverage is provided to the insured in cases of abuse of alcohol, intoxicants, and drugs.
6. Hospitalisation resulted due to war or acts of war, radiation, and chemical or nuclear or biological weapon of any kind is not covered under it.
7. The policy doesn't cover expenses incurred due to dental and external aids and appliances in addition to pregnancy except these are included under specific plans.
8. It includes 2-year exclusions for certain diseases.
9. The policy doesn't cover investigational, experimental, or unproven treatment, pharmacological regimens, and devices.

Eligibility

The company has not outlined any specific eligibility criteria for availing the Health Suraksha Gold Plan Regain & ECB:

1. Any individual can avail this policy by submitting the required documents.
2. New born babies are eligible to be covered under this plan since their birth as there is no age restriction at entry.
3. Children below the age of 5 years can be covered if both the parents are already insured under the policy.
4. Individuals who are up to 45 years of age can avail this policy without undergoing any kind of medical test.

Claim Procedure and Documentation

1. In an event of hospitalisation, the company should be immediately intimidated before 7 days.
2. In other situations which may lead to a claim the company should be informed at least 7 days before taking any consultation, and treatment as the company should pre-authorise them.
3. The information and documents requested by the company should be provided within 15 days of request or completion of treatment or discharge of the policyholder from hospital, whichever is earlier.

GST rate of 18% applicable for all financial services effective July 1, 2017.