HDFC ERGO Family Health Insurance- Types, Features & Benefits

Updated: 05-09-2023 05:16:39 AM

HDFC ERGO Family Health Insurance Plan

Family is everything for an individual and their protection is undeniably the first and foremost responsibility. To help people financially, protect their loved ones and keep them safe all the times, it is important to safeguard their health. With changing lifestyle, the risk of diseases and illnesses is also increasing. In this circumstance, it is quite difficult for an ordinary person to meet the immediate medical emergency and its cost. To meet those unexpected medical needs and provide financial support during hard times, HDFC ERGO Family Health Insurance Plan comes with two type – Health Suraksha Gold Insurance Plan along with My:Health Medisure Super Top Up Insurance for Family to provide them with additional cover.

Types of HDFC ERGO Family Health Insurance

There are two types of HDFC ERGO Family Health Insurance:

1. Health Suraksha Gold Insurance
2. My: Health Medisure Super Top up Insurance

Health Suraksha Gold Insurance Plan

This health insurance plan is uniquely designed for family that protects the immediate medical needs of the insured and their family. This plan offers the maximum coverage at the most reasonable cost. Opting for this family health plan will provide the insured and their loved ones with the comprehensive financial protections and safeguard them from unexpected medical expenses. Just like individual plans, this plan can also be added to an existing health plan – whether it is an HDFC Ergo product or not.

Eligibility details of Health Suraksha Gold Insurance Plan

The following are the eligibility details of this family health plan:

• This plan can be bought by anyone who is 18 years and above. They can be the proposer for this policy
• There is no maximum age to buy this plan
• To provide cover to the dependent children, their age should be between 91 days to 21 years
• Children who are age 5 years can also be covered, but only when both the parents are covered

Features of Health Suraksha Gold Insurance Plan

There are some of the major features of the Health Suraksha Gold Insurance Plan as mentioned below:

1. There is no restriction on entry age
2. Lifelong Renewability
3. Cashless treatment at more than 6000 network hospitals
4. Easy claim settlement procedure
5. Documentation required is minimum

 Benefits of Health Suraksha Gold Insurance Plan

The health insurance plan for family by HDFC Ergo offers a range of features and benefits to the policyholders. Some of them have been explained here:

• Wide Network of Hospitals for Cashless Treatment: HDFC Ergo has more than 6,000 network hospitals across the country. To avail the benefits of cashless hospitalisation and treatment, the policyholder has to get admitted to one of those network hospitals. The list of service providers is available on the official website of HDFC Ergo. There is no limit on the medical expenses like doctor fees, rent of the special room, health examination and medical test costs with this plan.
• Additional Discounts and Attractive Add-Ons:The family health plan provides several attractive add-ons and discounts to the policy owner. This family plan provides 10% discounts if opted for 2 years and 10% discount if it opted for more than 2 family members, but on individual sum insured basis. In addition to this, more 5% cumulative bonus can also be availed at the end of each claim-free policy year. The plan comes with several add-on options to cater to the different needs of its target and extensive customer base.
• Maternity Benefits:A traditional insurance plan and a lot of health insurance policies usually not provide coverage to the childbirth and related expenses. However, this plan by HDFC Ergo provides coverage against all the expenses incurred due to childbirth and related issues.
• Free Medical Examination and Check-Ups: This plan designed for family provides the policyholders and their loved ones with free medical examination and health check-ups after the 4 claim-free policy years. An insured can avail this facility contacting their nearest HDFC Ergo branch office. 

• Get Income Tax Benefits:This family health plan also offers income tax benefits on the premiums paid for the plan. These benefits are provided as per the extant income tax laws. Currently, the tax savings amount is Rs. 60,000. This benefit is given by the insurer on the basis of section 80D of the Income Tax Act, 1961. Income tax laws are subject to amendments from time to time. Benefits may also change with the changes made in the laws. Section 80C benefits are not included in this plan.

Exclusions of HDFC Ergo Health Suraksha Gold Insurance Plan

Even though this plan provides maximum coverage to the policyholder and their family, there are some exclusions of this policy too. And they are:

• Expenses incurred due to the treatment of HIV/ AIDS and related conditions
• Expenses arising due to the treatment of intentional self-injuries, attempted suicide, etc.
• Treatment costs of any sort of plastic or cosmetic surgery
• Cost of the treatment of war injuries
• Treatment cost of intoxication

My:Health Medisure Super Top-Up Insurance for Family for Additional Cover

There are policies available that offer higher cover to the insured, but they usually cost big. Hence, HDFC Ergo offers this top-up plan for additional coverage of the existing family plan at the most affordable cost. This plan can easily cover the extensive treatment costs, offering maximum coverage.

For instance, Rs. 20 lakh coverage along with additional Rs. 5 lakh aggregate deductibles can be availed by a couple less than age 35 years. For this benefit, they will just have to pay Rs. 3,300 along with applicable taxes.

One can add this plan to their existing health plan purchased from HDFC Ergo or from any other insurer. This can also be added to a new health plan for family to provide them with additional financial support against medical uncertainties.

Filing Claims for HDFC Ergo Family Health Insurance Plans

To following is the table that explains the claim process:

Claim Process for Cashless Hospitalisation

Reimbursement Process

· Get admitted to one of the network hospitals of HDFC Ergo · Show your or your loved ones’ valid ID proof and health card to avail cashless treatment · The hospital will send the cashless treatment request to HDFC Ergo for authorisation · While discharging from the hospital, HDFC Ergo will scrutinise the documents received to convey appropriate final stand · The company will send the claim updates to the insured on their registered mobile number and mail ID · HDFC Ergo will receive the final bills from the hospitals for authorisation. All types of co-payments, inadmissible expenses and deductions will only be paid the insured.

· Policyholders need to contact their nearest hospital of the network · To register claim, fill out the claim form and send it to the Noida situated office of HDFC Ergo along with documents needed · The insurer will verify the documents received and approve the claim requested. In case they need any other document, they will contact the policyholder to complete the documentation · The insurer will update the insured through SMS and emails regarding the status of their claim · After receiving complete documents, the insurer will pay the claiming amount through NEFT.

After receiving the documents needed, the claim process would be initiated by the insurer as per the terms and conditions of the policy within 7 working days of the last document received. One notable point here is that if there is any internal verification, the final stand of the insurer will be confirmed within 30 days of the last document received.

Documents Required for Claiming the HDFC ERGO Family Health Insurance Plan

The following documents will be needed:

• Claim form along with KYC documents (driving license, Aadhaar card, voter ID, passport, etc.) if claiming amount is more than Rs. 1 lakh
• Original bills with detailed payment receipts, pharmacy invoices, prescriptions, etc.
• Investigation reports such as blood reports, x-ray, etc.
• Previous medical reports and treatment documents
• In case of accidents, copy of FIR or Medico Legal Certificate (MLC)
• Implant stickers or invoices if used for lens cataract or stent in angioplasty
• NEFT details and cancelled cheque or copy of passbook

Also Check: HDFC ERGO Parents Health Insurance

FAQs

Q1. What are the contact details in case of hospitalization?

For any hospitalization or claim policyholders can contact through:

Call: 18002700700

Fax: 18602000600

Email: healthclaims@hdfcergo.com

Mobile App: Register the claim using HDFC ERGO mobile app

Q2. What are the documents required to file the claim?

Some of the important documents required to claim include- Identity proof, Age proof, Address proof, Income proof and other medical examination reports.

Q3. Can I get medical insurance for family of 3?

Yes, you can easily buy the medical insurance for family through visiting the website of HDFC ERGO and click buy now on family health insurance tab

Q4. What is the eligibility criteria of purchasing the Health Suraksha Gold Plan?

Any individual who is above the age of 91 days can purchase the policy. However, there is no such restriction on the entry age.