HDFC ERGO Health Insurance Network Hospitals 

• 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**

With more than 1 crore policyholders, HDFC ERGO Health Insurance has more than 9,000 network hospitals that give health insurance policyholders the benefit of the cashless claim settlement facility to cover hospitalisation expenses. The claim settlement team of HDFC ERGO responds to cashless claims in about 22 minutes and in up to 3 days for reimbursement claims.

What are the benefits of choosing a HDFC ERGO network hospital?

Listed below are some of the benefits of receiving treatment at an HDFC ERGO network hospital:

• The claim settlement team of HDFC ERGO health insurance works round-the-clock - 24/7.
• On an average, the claim settlement team of HDFC ERGO has responded to pre-authorisation of cashless claims within 22 minutes and reimbursement claims are approved in just 3 days.
• Over 9,000 network hospitals are spread across the country where policyholders can raise a cashless claim.
• Policyholders can track their claims on the website of the insurer and will receive claim updates on their registered mobile number.
• The sum assured of the policy offers coverage for hospitalisation expenses including pre-hospitalisation and post-hospitalisation expenses.
• Policyholders can choose their sum assured and there is no limit on the room rent for certain health insurance policies.
• Coverage for 144-day care procedures at the network hospital of HDFC ERGO health insurance.
• Coverage for Ayurvedic and Homeopathy treatments under certain health insurance policies.
• Coverage for ambulance expenses and organ donor expenses.

What procedures are covered under the HDFC ERGO cashless claim facility?

Listed below are some of the treatments and procedures that are covered under the cashless claim facility of HDFC ERGO health insurance:

• End-stage renal disease – kidney failure
• First heart attack
• Stroke
• Cancer treatments
• Organ transplant
• Paralysis
• Aorta surgery
• Primary pulmonary arterial hypertension
• Coronary artery disease
• Multiple sclerosis
• Accidental hospitalisation

What procedures are not covered under the HDFC ERGO cashless claim facility?

Listed below are some of the exclusions of coverage under the HDFC ERGO cashless claim facility:

• Injury, disability or disease arising from war, invasion, nuclear activity, civil war, riot, etc.
• Attempting to commit suicide or self-inflicted injury.
• Any insured person injured or disabled following his/her participation in military activity, aviation, scuba diving, parachuting, etc.
• Any disease arising from substance abuse or intake of alcohol.
• Treatment of obesity or any weight related program.
• Hospitalisation due to HIV or AIDS.
• Any pregnancy-related issues, including abortion, etc.
• Fertility treatments, sterility surgery, birth control treatment, surrogacy, etc.
• Outpatient dental treatments.
• Hormone therapy or stem cell implantation.
• Coverage for mental disorder treatments, psychiatric treatments, etc.

How do you file a claim at an HDFC ERGO network hospital?

Listed below are the steps that policyholders need to take to raise a cashless claim at a network hospital of HDFC ERGO Health Insurance:

• In the case of planned hospitalisation, the policyholder has to intimate HDFC ERGO 72 hours prior to admission in the hospital. In the case of emergency hospitalisation, the policyholder or insured person has to intimate HDFC ERGO within 24 hours from the point of admission in hospital.
• For emergency hospitalisation as well as planned hospitalisation, the policyholder has to fill the pre-authorisation form that has to be attested and acknowledged by the doctor in charge of the treatment.
• On approval of the pre-authorisation for the cashless claim settlement, HDFC ERGO will send an authorisation letter to the network hospital within 6 hours of receiving relevant documents for verification as well as the pre-authorisation form.
• If the treatment is not covered under the policy, then the insurer will reject the cashless claim within 6 hours of receiving the documents.
• If the cashless claim is approved by HDFC ERGO, then the hospitalisation expenses will be settled between HDFC ERGO and the network hospital.

The policyholder might have to cover expenses if the treatment cost goes beyond the sum assured of the policy or if there are any non-medical expenses which are not covered by the health insurance policy.

If the cashless claim is rejected by the insurer for some reason, then the policyholder will have to raise a reimbursement claim following discharge from the hospital. As already mentioned above, HDFC ERGO responds to reimbursement claims within 3 working days on average and settles the claim within 7 days.

FAQs

1. Is it possible to add a new member to my existing family floater health insurance policy?

Yes, it is possible to add a new member to your existing family floater health insurance policy. You will have to submit a health declaration form of the new member along with an endorsement form at any of the branches of HDFC ERGO Health insurance. You might have to pay an extra premium as well.

2. I wish to get an independent health insurance policy for my child who is 2 years old. Is it possible?

No, it would not be possible to buy an independent health insurance policy for a child that is 2 years old. Based on the basic terms and conditions of health insurance as set by HDFC ERGO, all children below the age of 5 years old have to be covered under the policy of their parents.

3. What should be done if the policyholder of the family floater health insurance policy dies?

If the policyholder of a family floater insurance policy dies, then the policy has to be shifted to another adult insured under the family floater insurance policy. No changes will be made to the coverage of the policy or the premium cost.

4. Is it possible to cancel my HDFC ERGO health insurance policy?

Yes, if you wish to cancel your policy within the first 15 days which is the free-look period, you can do so, and the premium that you have paid in full will be returned. However, if you wish to cancel your policy during the tenure of the policy, then you will get a refund of the premium based on the refund chart as set by HDFC ERGO.

5. What should be done if the policyholder or insured person is admitted in a non-network hospital of HDFC ERGO following an emergency?

If possible, the policyholder can choose to be shifted to a network hospital and have the benefit of the cashless claim settlement facility. If not, he/she can file for a reimbursement once discharged from hospital.