HDFC Ergo Health Suraksha Gold with Regain and ECB

The Suraksha Gold with Regain and Enhanced Cumulative Bonus (ECB) is an affordable health insurance plan that offers special features so that policyholders and their families can avail complete health protection along with added benefits. With the help of the regain benefit, a policyholder can enjoy a re-instated sum insured amount in case the original sum insured amount is exhausted before the end of the term. Further, an Enhanced Cumulative Bonus is offered at 10% for every year that no claim is made under this plan type.

Features of Health Suraksha Gold with Regain and ECB

Given below are the major highlights of the Health Suraksha Gold with Regain and ECB:

There is no entry age limit to apply for this health insurance policy.
Family members can be included under the same policy.
A child below 5 years of age can be covered if both parents are covered under the same policy.
The sum insured amount can be opted for on an individual sum insured basis or floater basis.
The health plan offers the lifelong renewability feature.
The policy term options are 1 year and 2 years.
The sum insured option available are Rs.3 lakh, Rs.4 lakh, Rs.5 lakh, Rs.7.5 lakh, and Rs.10 lakh.
No medical check-ups are required under the policy as long as the applicant is 45 years old or below.
For applicants above the age of 45 years, 50% of the expenses incurred on the pre-policy check-up will be reimbursed if the application is accepted by the insurance company and if the check-up was undertaken in a network diagnostic centre.
E-opinions are provided to insured individuals regarding critical illnesses.
Policyholders are given a 15-day free-look period when the policyholder can choose to return the policy and request a refund of the premium paid. The refund will be made after necessary deductions.

Benefits of Health Suraksha Gold with Regain and ECB

The key benefits offered under this special health insurance policy are explained in the table below:

Benefit	Details
Hospitalisation	In-patient treatment for certain health conditions, along with injuries caused by accidents, is provided during hospitalisation
Pre-hospitalisation	The pre-hospitalisation benefit offers coverage for treatment expenses up to 60 days before hospitalisation
Post-hospitalisation	The post-hospitalisation benefit offers coverage for treatment expenses up to 90 days post hospitalisation
Domiciliary treatment	Treatments undertaken at home, on the advice of a medical professional, will be covered under the domiciliary treatment benefit
Day care treatment	Medical procedures that do not require 24 hours of hospitalisation due to the advancement in technology is covered under this benefit
Organ donor expenses	Expenses incurred by an organ donor while transplanting his/her organ to the insured member is covered under the policy
Convalescence benefit	If an insured member has been hospitalised for more than 10 continuous days, a lump-sum benefit is provided as the convalescence benefit
Ayush benefit	In-patient procedures conducted under Ayurveda, Unani, Sidha, or Homeopathy are covered under this benefit
Ambulance Charges	Emergency ambulance charges incurred by the policyholder will be paid for by the insurance company
Maternity expenses	Maternity-related expenses, including pre and post-natal procedures are covered
Newborn baby cover	Coverage for a newborn baby, starting from the time of its birth, is available

Additional benefits available under Health Suraksha Gold with Regain and ECB

A few of the discounts and additional benefits offered under the policies are given below:

A family discount of 10% on the premium payable, is offered to policyholders who include 2 or more family members in the same policy. An individual sum insured should be opted for each of the family members in this case.
An Enhanced Cumulative Bonus (ECB) equal to 10% of the sum insured amount is provided to the policyholder if he/she makes no claim in a policy year. The bonus is payable up to 100% of the sum insured. This is an optional feature and 2.5% of the premium payable, over and above the premium amount, will be payable towards it.
The Regain Benefit is another optional benefit offered under the policy. This feature makes the sum insured amount available to the insured individual even after the original sum insured is exhausted. The sum insured can be reinstated only once in a policy year and 5% of the premium payable is charged for this facility.
If a policyholder chooses to pay the 2-year premium in advance, a 10% discount will be provided on the premium payable.

Exclusions of Health Suraksha Gold with Regain and ECB

Not all treatments and procedures are covered. A few of the instances when the insurance policy will not offer coverage are:

Treatments during the first 30 days of the policy period, except for injuries caused by accidents.
Pre-existing conditions for the first 4 years of the policy period.
Specific diseases until completion of 2 years.
Treatment for HIV/AIDS or treatments related to such conditions.
Cosmetic surgeries or weight control treatments.
Illnesses or injuries suffered due to consumption of alcohol or use of drugs.
Injuries or health conditions resulting from war or war-like circumstances.
Pregnancy-related expenses.
Dental treatments.
Cost of external aids and equipment.
Experimental or investigational experiments.

Claim Procedure

HDFC Ergo offers two claim options – Cashless claim and Reimbursement claim. Both procedures are explained in detail here:

Cashless treatment

Claims for cashless treatments can be raised in network hospitals only. The policyholder is required to present his/her health card and photo ID at the hospital. The hospital will then send a request to HDFC Ergo for pre-authorisation. Once HDFC Ergo scrutinises all details and documents submitted, it will provide an update as to whether the request has been accepted or not. After authorisation, the insured person can enjoy the cashless treatment. Any deductions, co-payment, or expenses that are excluded under the policy, have to be borne by the insured individual.

Reimbursement claims

To get a reimbursement of the claims incurred on hospitalisation, the policyholder can submit the claim form along with the necessary documents to the insurance company. The company will verify the details and documents, and request for additional information if required. After complete verification, the company will transfer the amount through NEFT if the claim request is accepted.

Claim documents:

Here is a list of the claim documents that need to be submitted to process a claim:

HDFC Ergo Health Insurance claim form
Original discharge summary
Original investigation reports
Final hospital bill with breakup details
Original pharmacy receipts along with relevant prescriptions
Documents related to previous treatments
Implant receipts or stickers, if any
FIR or MLC in case of accidents
For NEFT: Photocopy of the policyholder’s passbook or a cancelled cheque. In case the claim is for an amount above Rs.1 lakh, a KYC form along with a photocopy of a KYC document.

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