Health Insurance 1145 views May 15, 2021

HDFC ERGO Critical Advantage Rider covers eight major illnesses, and you can seek cashless treatment for the same at any of the network hospitals of the insurer. Let’s read further and learn more about the benefits and terms and conditions of HDFC ERGO Critical Advantage Rider.

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HDFC ERGO Critical Advantage Rider Plan Benefits

You will get coverage against the following major illnesses under this plan –

  1. Cancer Treatment
  2. Coronary Artery by-pass surgery
  3. Heart Valve Replacement or repair
  4. Neurosurgery
  5. Live Donor Organ Transplant
  6. Bone Marrow Transplant
  7. Pulmonary artery graft surgery
  8. Aorta Graft Surgery

The policy will cover in-patient treatment, post-hospitalization expenses up to 30 days, accommodation expenses, traveling expenses, repatriation expenses up to the sum insured. You can also seek a second opinion for the diagnosed major illness from the insurer’s panel of Medical Practitioners.

HDFC ERGO Critical Advantage Rider Premium Amount

The minimum and maximum premium amounts are INR 4,833 and INR 30,357, respectively, for this rider plan. The premium will be charged based upon your age and will change at renewal due to the change in your age. You will get a premium discount of 7.5% if you choose a two-year policy tenure.

Note: Premium rates are subject to change with prior approval from the Insurance Regulatory and Development Authority of India (IRDAI).

Exclusions from HDFC ERGO Critical Advantage Rider

The insurer will not cover the following –

  1. Any tumor in the presence of Acquired Immune Deficiency Syndrome (AIDS).
  2. Narrowing or blockage of one or more coronary arteries with by-pass grafts.
  3. Any coronary disease treatment other than Coronary Artery bypass surgery, like any kind of angioplasty surgery.
  4. Liver transplant arises due to alcoholic liver disease
  5. Liver transplant conducted as a self-transplant
  6. Liver transplant when the insured is a donor for a third-party
  7. Liver transplant from a dead donor
  8. Any organ transplant that involves the treatment of stem cells
  9. Transplant made by the purchase of donor organs
  10. Any disease which has been caused due to organ transplant

Waiting period

All the major illnesses mentioned above shall be covered after a 30-day waiting period, except for claims arising due to an accident if the same is covered. The 30-day waiting period shall not apply if you are covered under this policy for more than twelve months. For the following specified disease/procedure, a 24-month waiting period applies –

  1. Sinusitis
  2. Rhinitis
  3. Tonsillitis
  4. Cysts, polyps including breast lumps
  5. Polycystic ovarian disease
  6. Fibroids (fibromyoma)
  7. Noninfective arthritis
  8. Gout and Rheumatism
  9. Osteoarthritis and Osteoporosis
  10. Calculus diseases of gall bladder including Cholecystitis
  11. Pancreatitis
  12. Fissure/fistula in anus, hemorrhoids, pilonidal sinus
  13. Ulcer and erosion of stomach and duodenum
  14. Gastroesophageal Reflux Disorder (GERD)
  15. All forms of cirrhosis (cirrhosis due to alcohol will be excluded)
  16. Perineal Abscesses
  17. Perianal Abscesses
  18. Calculus diseases of Urogenital system like a kidney stone, Urinary bladder stone
  19. Benign Hyperplasia of prostate
  20. Cataract
  21. Internal tumors, cysts, nodules, polyps, skin tumors
  22. Adenoidectomy
  23. Mastoidectomy
  24. Tonsillectomy
  25. Tympanoplasty
  26. Surgery for nasal septum deviation
  27. Nasal concha resection Dilatation and curettage (D&C)
  28. Myomectomy for fibroids
  29. Surgery for prolapsed intervertebral disk
  30. Joint replacement surgeries
  31. Surgery on prostate
  32. Surgery for Hydrocele/Rectocele
  33. Surgery of varicose veins and varicose ulcers

Expenses related to pre-existing disease and its direct complications shall be excluded until the expiry of a 48-month waiting period.

Note – The above-mentioned waiting periods will be waived on renewal.

Free Look Period

The free look period of 15 days shall apply to new individual health insurance policies and not renewals or porting/migrating policies. During this free look period, you can review the terms and conditions of the policy and return the same if not acceptable. On such cancellation, you’ll be entitled to the following –

  1. A refund of the paid premium less medical examination expenses and stamp duty charges, provided you haven’t claimed during the free look period
  2. A deduction towards the proportionate risk premium will be made for the period on the cover if the risk is already commenced
  3. If only a part of the insurance coverage has commenced, such proportionate premium commensurate with the insurance coverage will be refunded

Terms & Conditions of HDFC ERGO Critical Advantage Rider Plan

  1. This policy covers the person who falls under the age group – 91 days to 65 years
  2. The minimum and maximum entry age is 18 years and 65 years
  3. The minimum and maximum entry age for a child is 91 days and 25 years
  4. There is no maximum cover ceasing age
  5. The sum insured options under this rider plan are USD 250,000; USD 500,000
  6. The rider can be issued for 1 or 2 years
  7. You can purchase this rider plan on an individual or family floater basis
  8. This rider will be offered with HDFC ERGO Easy Health, HDFC ERGO Optima Restore, or other HDFC ERGO health insurance plans where the base policy sum insured is INR 10 Lakh or above.
  9. This rider is not offered to NRI/ PIO
  10. The sum insured of the dependent parent and children should be equal to or less than the sum insured of the primary insured member.
  11. The rider covers only planned treatment abroad
  12. All general exclusions will be the same as the base plan

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