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Health Insurance 1345 views January 23, 2021
HDFC ERGO Day2Day Care offers financial security to you and your family in case a health risk arises. You can include your spouse, dependent children, dependent parents or parents-in-law under HDFC ERGO Day2Day Care plan. You can buy this health insurance plan either on an individual or a family floater basis. How does it work? In case you or any of your family members who are covered under the policy are ill or injured and require outpatient service, the HDFC ERGO Day2Day Care will pay your medical bills that include doctor fees, prescribed diagnostic tests, vaccination and other charges. So let’s read this page further and grab more information about the HDFC ERGO Day2Day Care coverage and exclusions.
Table of Contents
HDFC ERGO Health Insurance Ltd. will process or settle all the claims received under this plan. You can seek a claim amount in two ways – one is cashless while the other is reimbursement.
For Cashless Claims
You should approach the HDFC ERGO network center and present your HDFC ERGO Health Insurance Ltd. id card. The network hospital will check the eligible limit and settle the outpatient service/consultation expenses via cashless transactions.
For Reimbursement Claims
You can seek reimbursement if you get general & specialized consultation, diagnostics, vaccination, physiotherapy, pharmacy and health check-up expenses at a non-network center. To intimate a reimbursement claim, please send the duly signed claim form and all the essential information or documents such as original invoices, payment receipts, original prescription by the attending medical practitioner. If there is any deficiency in the documents or information, the company will send the deficiency letter to you within 7 days of receiving the claim documents.
A claim can be settled or rejected within 30 days from the date of receipt of the last necessary document. And if there is a delay in the payment of a claim, a rate of 2% above the bank rate will apply to your claim payment as penalty interest.
Note: Payment will be made for covered expenses only. In the case of a non-network center, a co-pay of 20% would apply to all your claims except for the health check-up benefit.
The company puts forth the following eligibility criteria for this insurance plan.
Up to four members can be covered in a single-family floater plan with a maximum of two adults and three children. Check out the eligible family combinations below –
S.No | Family Combination |
---|---|
1 | 1 adult plus 1 child |
2 | 1 adult plus 2 children |
3 | 1 adult plus 3 children |
4 | 2 adults |
5 | 2 adults plus 2 children |
6 | 2 adults plus 1 child |
Note – The 2 adults can be self and spouse while the dependent parents or parents-in-law will have to be covered in a separate policy.
Up to six members can be covered in a single individual plan on an individual sum insured basis with a maximum of four adults and five children. Check out the eligible combinations below –
S.No | Combination for an Individual Plan |
---|---|
1 | 1 adult |
2 | 1 adult plus 1 child |
3 | 1 adult plus 2 children |
4 | 1 adult plus 3 children |
5 | 1 adult plus 4 children |
6 | 1 adult plus 5 children |
7 | 2 adults |
8 | 2 adults plus 1 child |
9 | 2 adults plus 2 children |
10 | 2 adults plus 3 children |
11 | 2 adults plus 4 children |
12 | 3 adults |
13 | 3 adults plus 1 child |
14 | 3 adults plus 2 children |
15 | 3 adults plus 2 children |
16 | 4 adults |
17 | 4 adults plus 1 child |
18 | 4 adults plus 2 children |
Note – The 4 adults can be a combination of Self, Spouse and either a set of dependent parents or parents-in-law.