HDFC ERGO Health Suraksha Silver Medical Insurance plan

• 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 a privately owned general insurance service provider that offers insurance service in multiple domains including health, travel, vehicle, etc. HDFC ERGO Health Suraksha Silver is a comprehensive health insurance policy that can be taken either as an individual cover or a family floater cover. The policy provides a range of benefits and ensures protection for all policyholders against various health risks. The premium charges for this cover is affordably priced, and it appeals to the middle class segment of the country. This policy is developed in such a way that it provides adequate coverage for all common health insurance requirements of a person or a family.

Eligibility for HDFC ERGO Health Suraksha Silver

The eligibility criteria set forth by HDFC ERGO for availing this cover can be listed as follows.

• There is no maximum entry age for this cover.
• This policy is available for children from the age of 31 days.
• Children below the age of 5 can be covered only when both their parents are covered under this policy.

Features of HDFC ERGO Health Suraksha Silver

Some of the key features of HDFC ERGO Health Suraksha Silver can be listed as below:

• This policy cover is available in multiple sum insured options - Rs.3 lakh, Rs.4 lakh, Rs.5 lakh and Rs.7.5 lakh.
• Pre-acceptance medical examination is not required for people who are less than 45 years of age.
• All pre-existing diseases have a waiting period of 48 months in this policy cover.
• This policy can be availed in 1 or 2-year policy terms.
• Premium charges for this policy vary based on the age of the insured and the number of members covered in a family.
• There are no sub-limits set under this policy for expenses like room rent, hospital charges, and doctor fees. Disease-specific limits are also not set for this policy cover.
• A premium discount of 10% is available if 2 or more members of a family are enrolled in this cover on an individual sum insured basis.
• Pre-hospitalisation medical expenses are covered for up to a period of 60 days before the date of hospitalisation.
• Post-hospitalisation medical expenses are covered for up to a period of 90 days after the date of hospitalisation.
• Day care procedures are also covered under this policy. Compensation can be obtained for up to 144 day care procedures as listed in the policy schedule.
• Expenses related to domiciliary treatment incurred by a patient are also covered under this policy.
• There is a waiting period of 30 days before making any claim under this policy. However, this waiting period does not apply for claims arising out of accidental injuries.
• There is a free look period of 15 days for policyholders to review the terms associated with this cover.
• Cashless treatments can be availed from any of the network hospitals.
• The plan offers lifelong renewability.
• The premium amount paid towards this policy cover is eligible for tax relief according to section 80D of the Income Tax Act.

Benefits of HDFC ERGO Health Suraksha Silver

The range of benefits offered under this medical insurance policy can be given in the following table.

Exclusions of HDFC ERGO Health Suraksha Silver

While a range of medical expenses are covered under this policy, there are certain exclusions for which HDFC ERGO is not liable to provide any compensation. Some of these exclusions can be listed as follows.

• Intentional self injuries and injuries caused the influence of drugs or alcohol
• Expenses related to treatment for HIV, AIDS, or sexually transmitted diseases
• Treatments associated with mental disorders or insanity
• Expenses related to cosmetic or aesthetic treatments of all kinds
• Treatments for weight management or obesity
• Hospitalisation due to war or warlike activities
• Injuries caused by nuclear weapons, chemical exposure, or radioactivity
• Expenses related to vaccination or inoculation
• Expenses related to pregnancy and childbirth
• Expenses related to experimental treatments or unproven treatment methods
• Specific diseases as mentioned in the policy
• External aids or medical equipment, unless covered for a specific treatment

Claim Procedure

The claim procedure under HDFC ERGO is simple and straightforward. For hospitalisation claims, the company must be informed immediately and not later than 7 days. For planned hospitalisation, the company must be notified at least 7 days before hospitalisation. For day care procedures and consultations, the company must be notified and pre-authorisation must be obtained.

For reimbursement claims, all documents and proofs must be submitted to the company within 15 days after discharge from the hospital. Once the documents are submitted, the claim process will be initiated by the company. After verification of all documents, the company will disburse the reimbursement amount to the insured person.