HDFC ERGO is one of the reputed general insurance companies operating in the country. The company provides its service in various domains and has multiple insurance products in its lineup. Among the health insurance products offered by HDFC ERGO, Health Suraksha Gold is a comprehensive insurance plan designed to offer maximum protection for policyholders. This policy is a variant of the company’s Health Suraksha plan, and it offers additional protection in the form of maternity cover & newborn cover.
People looking to enroll in this cover must meet the following eligibility criteria:
The key features of HDFC ERGO Health Suraksha Gold can be listed as follows:
|Benefit||Extent of coverage|
|In patient hospitalisation||All medical expenses up to the sum insured limit|
|Day care treatment||Covered for up to 144 procedures that do not require 24 hours of hospitalisation|
|Domiciliary treatment||Covered up to the sum insured limit|
|Organ donor cover||Covered for the actual expenses of an organ transplant|
|Maternity cover||All expenses covered including prenatal and postnatal medical costs (after 4 years of waiting period)|
|Newborn baby cover||Covers the medical costs of a newborn for the first 90 days (after 90 days the newborn baby can be enrolled in the regular family floater cover)|
|Convalescence benefit||1% of the sum insured subject to a maximum of Rs.10,000 (for hospitalisation exceeding 10 consecutive and continuous days)|
|Cumulative bonus||5% every claim-free year subject to a maximum of 50% of the sum insured|
|E-opinion for critical illness||If the insured is diagnosed with a critical illness, a second opinion shall be arranged from a medical practitioner from the company’s panel.|
|Emergency ambulance cover||For a sum insured of Rs.3 lakh to Rs.5 lakh – Rs.2,000 For a sum insured of Rs.7.5 lakh & Rs.10 lakh – Rs.3,500 (The actual expenses subject to the maximum amount mentioned above will be reimbursed.)|
|Health checkup||1% of the sum insured subject to a maximum of Rs.5,000 (after 4 claim-free years)|
Some of the exclusions applicable to HDFC ERGO Health Suraksha Gold can be listed as follows:
The claim process for HDFC ERGO Health Suraksha Gold starts with intimation to the company. For hospitalisation, the company must be informed within 7 days after admission. For all kinds of consultation and follow-up treatment, the company must be notified at least 7 days ahead in order to receive pre-authorisation. Cashless treatment is available in the 6,000+ network hospitals affiliated with HDFC ERGO. To avail cashless treatment, the insured must provide his/her health card and a valid photo ID.
For hospitalisation claims, submission of all documents must take place within 15 days after discharge from the hospital. These documents include discharge summary, medical bills, cash memos, diagnostic reports, physician certificate, etc. Once these documents are submitted to the insurer, the claim process will begin. The company will validate the documents before providing the settlement amount to the insured.
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