• HDFC ERGO Health Suraksha Gold Plan

    Health Insurance
    • Premiums as low as Rs12/day for coverage of Rs.4 Lakhs*
    • 10,000+ hospitals for cashless treatment
    • Claim up to Rs. 55,000 deduction under section 80D**

    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.

    Eligibility for HDFC ERGO Health Suraksha Gold

    People looking to enroll in this cover must meet the following eligibility criteria:

    • This policy does not have a maximum entry age.
    • Anyone can be enrolled in this cover right from the age of 91 days.
    • Dependent children below the age of 5 can be enrolled only if both their parents are enrolled in this cover.

    Features of HDFC ERGO Health Suraksha Gold

    The key features of HDFC ERGO Health Suraksha Gold can be listed as follows:

    • This policy is available in multiple sum insured options ranging from Rs.3 lakh to Rs.10 lakh.
    • This policy is available in both individual and family floater variants.
    • A premium discount of 10% is available if 2 or more family members are enrolled in this policy cover.
    • Pre-insurance medical examination is required for people who are entering this cover after 45 years of age.
    • There is no sub limit on the sum insured amount for room rent, doctor’s fees, hospital charges, and specific diseases.
    • This cover is available in 1 or 2-year policy terms.
    • A discount of 10% is available if the premium amount is paid for a 2-year policy term.
    • Maternity benefit along with newborn cover is available in this policy subject to a waiting period of 4 years.
    • Coverage is provided for AYUSH (ayurveda, unani, siddha, and homeopathy) treatment without any specific sub limits.
    • Free health check up is offered by the company after a waiting period of 4 claim-free years.
    • Pre-hospitalisation medical expenses are covered for up to 60 days prior to the date of hospitalisation.
    • Post hospitalisation medical expenses are covered for up to 90 days after discharge from the hospital.
    • There is an initial waiting period of 30 days (except for accidents) with this policy cover.
    • Pre-existing illnesses can be covered after a waiting period of 48 months.
    • The premium amount paid towards this policy is eligible for income tax benefit as per Section 80D of the Income Tax Act.
    • There is a free look period of 15 days for policyholder to review the terms and conditions of this policy.

    Benefits of HDFC ERGO Health Suraksha Gold

    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)

    Exclusions of HDFC ERGO Health Suraksha Gold

    Some of the exclusions applicable to HDFC ERGO Health Suraksha Gold can be listed as follows:

    • Expenses related to the treatment of HIV, AIDS, or sexually transmitted diseases
    • Expenses related to the treatment of mental disorders or insanity
    • Any kinds of cosmetic or aesthetic treatments
    • Treatment related to weight management and obesity
    • Treatment expenses related to alcohol or drug abuse
    • Medical expenses arising out of war or warlike activities
    • Injuries or illnesses arising out of nuclear, chemical, or biological weapons
    • Expenses related to various external aids and appliances

    Claim Procedure

    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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