mansi
does it cover covid 19 and in how many days it cover after policy start day
19 Jun 2020
Check out the key advantages of having Apollo Munich health insurance cover online on Coverfox. Accidents can happen anytime and diseases are unwelcome guests in everyone’s life. Therefore, preparing yourself to tackle unforeseen situations is always a good idea. With HDFC Ergo General Insurance, a reliable name in the health insurance space, insurers can invest in a plethora of health insurance plans that suit their need.
Plans like Optima Restore, Energy Health, iCan Health, Health Wallet cater to individual health needs to ensure all you have to worry about is your well-being and of those who matter to you.
This is a health insurance plan with restore benefit offered by HDFC ERGO General Insurance. It offers coverage on individual or family floater basis given below are the details of each plan.
This plan offers coverage in range of Rs.3 lakh and Rs.50 lakh for individuals between age 5 years and 65 years.
Pre and post hospitalization expense cover, coverage for expenses on day care treatments, no-claim bonus equal to 50 % of sum insured up to a maximum of 100%, etc. are the benefits offered in this plan.
This health insurance policy specifically offers restore benefits up to 100 % of sum insured after the entire sum insured is exhausted. E-opinion (in case of critical illnesses) is of the additional benefits offered.
This family floater plan offers coverage to entire family in range of Rs.3 lakh and Rs.50 lakh for adults up to age 65 years and dependent children between ages 3 months to 25 years.
A maximum of 2 adults and 5 children can be covered.
Pre and post hospitalization expense cover, coverage for expenses on day care treatments, no-claim bonus equal to 50 % of sum insured up to a maximum of 100%, etc. are the benefits offered in this plan.
This policy specifically offers restore benefits up to 100 % of sum insured after the entire sum insured is exhausted. E-opinion and multiplier benefit are some of the additional benefits offered.
If you want to buy a health insurance plan with restore benefit offered by HDFC Ergo General Insurance,
This is a personal accident disability plan offered by HDFC Ergo General Insurance, which provides compensation in case of death or disability due to accident. The details of coverage offered are as follows:
This policy covers expenses in case of accidents for people between age 91 days and 69 years in the range of Rs.5 lakh and 5 crore.
The sum insured after age of 70 years (for existing policy holders) is only Rs.5 lakh.
This policy provides worldwide accidental coverage. Accidental death, complete or partial disability, emergency ambulance charges, etc. are covered in this policy.
Ensure that this plan is best suited for your needs; contact Coverfox to know all the terms and conditions under this policy.
This is a top-up plan, a plan with an agreed upon deductible amount to be paid at the time of claim, here are the details of coverage offered:
The entry age for this plan is between 5 years and 65 years.
It can also cover a dependent child over the age of 91 days.
It has coverage of Rs.5 lakh with a deductible in range of Rs.1 lakh and Rs.5 lakh.
Before you buy this plan have a look at the terms and conditions, please click here.
This is an aggregate top-up plan, which gives you flexibility to choose the deductible and coverage amount. The details are as follows:
This is a top up plan, which covers anybody between age 5 years and 65 years. This plan can also cover a dependent child from the age of 91 days.
This plan offers coverage of Rs.5 lakh to Rs.10 lakh with deductible in range of Rs.1 lakh and Rs.10 lakh.
In this plan, individuals have the flexibility of choosing the combination of coverage amount and deductible amount as per one's needs.
Like Optima plus, this also offers the option to convert to zero deductible after retirement.
This is a family floater plan, which provides top-up cover for entire family for members between age 5 years and 65 years and dependent children from age 91 days on wards.
A maximum of 2 adults and 2 children can be covered under this floater.
This plan offers coverage of Rs.5 lakh to Rs.10 lakh. Along with benefit to opt for zero deductible after retirement this plan also offers flexibility to customers to choose their own combination of deductible and coverage.
No. of members- The plan covers maximum 6 members of your family with up to 4 children and 2 adults.
Lifelong Renewal – The plans offered are lifelong renewable hence it saves you from the financial burden and stress caused by a medical emergency and keeps you well prepared to handle any situation.
No Sub-Limits on Room Rent - As sub-limits on room rent practically eat into your sum insured, HDFC Ergo General Insurance scores brownie points for their plans without any sub-limits on the room rent.
Wide Sum Insured Options – offers varied choice of Sum Insured beginning at Rs. 1 lakh up to Rs. 15 lakhs at affordable premium.
Pre & Post hospitalization cover- The plan covers medical expenses for 60 days prior to hospitalization and 90 days post hospitalization only for related medical expenses.
Health Check-ups – The policy offers up to 1% of the sum insured under individual plan per insured person and also up to 1% of the sum insured per policy under family plans.
Pre-existing diseases- Pre-existing diseases are covered after 3 years of waiting period.
Co-payment- The plan has no co-payment policy.
Restore Benefit - In Optima Restore health plan, Restore benefit is offered if the sum insured is exhausted during the year. This amount can be used for any new illnesses without any paperwork or any extra charge.
Please Note: Apollo Munich Health Insurance is now HDFC ERGO General Insurance
HDFC Ergo General Insurance is one of the top rated health insurance companies in the country. The insurance provider has made a place in the market as it provides the following benefits:
Competitively priced products
Great customer service post sales
Dedicated claim handler to make the claim settlement process smooth & easy.
The incurred claim settlement ratio of HDFC Ergo General Insurance for F.Y. 2018 - 19 is 63%.
Some of the main exclusions of a health policy offered by HDFC Ergo General Insurance are as follows:
Hospitalization due to war or any act of war due to nuclear, chemical and biological weapons or radiations of any kind.
Any Insured Person committing or attempting to commit a criminal or illegal act, or self injury or attempted suicide while sane or insane.
Any Insured Person’s participation or involvement in naval, military or air force operations, racing, diving, aviation, scuba diving, parachuting, rock or mountain climbing.
Abuse or the consequences of the abuse of intoxicants or hallucinogenic substances.
Expenses arising from sexually transmitted diseases, like AIDS.
Non-allopathy treatment, congenital diseases, mental disorders etc.
Items of personal comfort and convenience.
Another main factor that as a policyholder, you should consider is the concept of waiting period. Until the waiting period lapses, no coverage is offered. For instance, if a pre-existing disease coverage comes with a waiting period of 3 years, it means that since the day the policy has been issued, there would be no coverage for those disease and its related expenses for the first three years. Similarly, the waiting period for some other disease might be different.
The eligibility criteria to buy HDFC Ergo General Insurance’s health insurance plan varies with each policy. The following table describes the criteria for each:
| Health Insurance Plan | Minimum Entry Age | Maximum Entry Age |
|---|---|---|
| HDFC Ergo General Insurance Optima Restore Plan | 5 years (newborn: 91 days) | 65 years |
| HDFC Ergo General Insurance Energy Plan | 18 years | 65 years |
| HDFC Ergo General Insurance Optima Cash | 5 years (newborn: 91 days) | 65 years |
| HDFC Ergo General Insurance Optima Cash- Top-up | 5 years (newborn: 91 days) | 65 years |
| HDFC Ergo General Insurance Maxima | 5 years (newborn: 91 days) | 65 years |
| HDFC Ergo General Insurance Optima Super | 5 years (newborn: 91 days) | 65 years |
The Health Insurance Policy can be claimed through two ways: Cashless settlement at the network hospital and Re-imbursement after the treatment/hospitalization. However, in both scenarios, an early intimation to the insurance company is mandatory. A pre-approval needs to be in place for a planned hospitalization.
For Cashless Service:
At the time of hospitalization, submit the completed Pre-Authorization form at the TPA desk
The TPA representative will then forward the form to HDFC Ergo General Insurance for an approval along with necessary doctor's report
The request is then reviewed by the Claim Experts at HDFC Ergo General Insurance and an approval is then issued. Please note that the insurance company can raise queries, if required
In case of rejection of the authorization, initiate the required treatment and claim for reimbursement later
For Re-imbursement of Claim:
Post hospitalization, complete the claim form and submit the same to the insurance company along with other documents like Discharge Summary issued by the hospital, Prescriptions, Bills and Invoices for medicines/treatments, etc.
In case, insurance company needs any further clarification/information, it will be duly notified to you
Similarly, if the claim is rejected, a detailed rejection letter will be shared with you along with the reasons for denial
HDFC Ergo General Insurance takes pride in their claim settlement process. They claim to have settled 95% of the claims within 30 days.
Note: If you are a Coverfox customer, you can directly reach out to us for all your claim-related issues and queries.
The company’s website offers the facility of calculating your premium online with an online premium calculator. Using this calculator is simple as all you need to do is follow a few simple steps. Select the policy, choose the location from the drop down, provide the family size, the sum insured, age of the eldest member as well as the deductible amount. Now, this calculator will provide you with the base premium, gross premium and discounted premium amount per year. Based on this, you can take an informed decision of whether or not to buy the policy.
HDFC Ergo General Insurance offers lifetime renewability for all its health insurance policies. To renew the policy, you need to make a renewal payment atleast 60 days before the expiration date. The amount of renewal is based on the age of the policyholder at the time of renewal. In case you miss out on renewing the policy within the grace period, then you will have to buy a new policy altogether.
To renew the policy online, simply visit the official website of HDFC Ergo General Insurance and login with your registered email id and password, pay the renewal premium and your policy will be renewed instantly. There is also a possibility to login with your policy number. However, the health insurance policy has a policy number that shall change every time during renewal.
The documents required to buy HDFC Ergo General Insurance’s health insurance policy is same as buying any other health insurance policy. The documents are as follows:
Age Proof- Birth certificate, 10th or 12th passing certificate, Passport, Aadhaar, etc.
Identity Proof- Aadhaar card, Passport, Driving License
Address Proof- Electricity bill, Ration Card, Driving License
Medical check-up for policyholders above the age of 45
Passport Size Photographs
HDFC Ergo General Insurance has a highly acclaimed list of HDFC Ergo General Insurance Network Hospitals that provide world class service. The insurance provider is registered with 4650+ hospitals PAN India who are devoted to help patients with their cashless claim facility.
HDFC Ergo General Insurance has a well-trained customer service staff and a robust website that answers all your queries. Simply log on to the official website and visit the ‘Customer Service’ tab. Following options shall be visible to you:
Contact Us: As a policyholder, you can either fill out a simple form on the website and get your queries answered or call on number- 022-6234-6234. Alternatively, you can reach out to the customer service team on care@hdfcergo.com
Branch Offices: You can also reach out to any of the offline branches of HDFC Ergo General Insurance and get your queries resolved in person.
Grievance Redressal: In case you want to reach out to the grievance redressal cell, you can walk in or write a letter to HDFC ERGO General Insurance Company Limited, 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020.
80% of HDFC Ergo General Insurance's prevailing customers renew their policies each year
Over 95% of the claims being settled within 30 days from the point of initiation of the claim with 15 days being the average claim settlement period
Cashless authorizations happening within 2 hours from the point of claim intimation
With such inspiring statistics, the company has the determination, the recognition and the assets to upraise itself on top of the health insurance domain in India. Do contact Coverfox at 1800-209-9930 if you are looking to buy a new Health Plan or considering porting from your current insurer.
While HDFC Ergo General Insurance does not cover pregnancy in standard insurance plans, the Easy Health Family Floater Premium plan provides maternity benefits to the mother and the new born child.
If you want to cancel or terminate your policy, you can give a written notice at any HDFC Ergo General Insurance branch or call on 022-6234-6234.
Yes, Optima Vital, a health insurance plan by HDFC Ergo General Insurance covers 37 critical illnesses, including cancer. Read More About HDFC Ergo General Insurance iCan Cancer Insurance Plan
The expenses or benefits can be claimed or indemnified by reimbursement or by availing cashless services at the hospitals.
For all retail policies, HDFC Ergo General Insurance has an in-house claim settlement team. For group policies, the company’s major TPA is Family Health Plan Limited (FHPL). However, the firm also uses some other TPAs depending on the company’s requirement.
By Pre-existing Condition, HDFC Ergo General Insurance refers to any condition, injury or ailment etc. for which you had signs or symptoms, and / or were diagnosed, and / or received medical advice/ treatment, within 48 months prior to the first policy issued by the insurer.
To avail cashless benefit, you need to show the HDFC Ergo General Insurance Card to the treating doctor when you get hospitalized at the network hospital. The Network Hospital would contact the responsible TPA (Third Party Administrator mentioned on the card) and fill up the pre-authorization form. Then it would send the same to TPA with estimation and approval of expenses.
To add a family member to your existing policy, you will be required to fill the Change Request Form. Submit the form to HDFC Ergo General Insurance’s nearest branch along with the revised premium. Please note that a mid-policy term addition will be available only for a new born and a newly-wed spouse.
A Restore benefit in HDFC Ergo General Insurance is a benefit that which reinstates your sum insured when it gets exhausted. This happens within a policy period and is dependent on the terms and conditions of the plan.
