Health Insurance 343 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.

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List of HDFC ERGO Day2Day Care Coverages

  1. Outpatient Consultations by a general medical practitioner, specialist medical practitioner in a network hospital. Under the policy, there are up to five consultations available in a policy year for general or specialized consultation along with a co-pay of 20% if outpatient consultation happens in non-network centers.
  2. Consultation services under Allopathy, Ayurveda, Unani, Siddha and Homeopathy
  3. Outpatient diagnostic tests including pathology and radiology
  4. Administration of vaccination by a medical practitioner
  5. Physiotherapy
  6. Pharmacy expenses for treatment under Allopathy, Ayurveda, Unani, Siddha and Homeopathy
  7. Annual Health Check-Up within the range of network hospitals.
  8. In non-network centers, the insured can get health check-up coverage up to INR 2,000 per member in an Individual policy and up to INR 4,000 per policy in a family floater plan.

List of Exclusions from the HDFC ERGO Day2Day Care

  1. Treatment for Alcoholism, drug or substance abuse including any addictive condition and its consequences
  2. Inpatient treatment
  3. Daycare procedures;
  4. Treatments at heath hydros, nature cure clinics, spas or similar establishments including private beds registered to a nursing home attached to such establishments.
  5. Breach of law with any intent of a criminal activity
  6. Intentional self-injury or attempted suicide

Claim Procedure of HDFC ERGO Day2Day Care

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.

Eligibility for HDFC ERGO Day2Day Care

The company puts forth the following eligibility criteria for this insurance plan.

  1. Entry age 18-65 years for adult
  2. Entry age for children 91 days to 25 years
  3. No maximum cover ceasing age
  4. Policy period of 1 or 2 years
  5. Issued on an Individual or Family basis

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.NoFamily Combination
11 adult plus 1 child
21 adult plus 2 children
31 adult plus 3 children
42 adults
52 adults plus 2 children
62 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.NoCombination for an Individual Plan
11 adult
21 adult plus 1 child
31 adult plus 2 children
41 adult plus 3 children
51 adult plus 4 children
61 adult plus 5 children
72 adults
82 adults plus 1 child
92 adults plus 2 children
102 adults plus 3 children
112 adults plus 4 children
123 adults
133 adults plus 1 child
143 adults plus 2 children
153 adults plus 2 children
164 adults
174 adults plus 1 child
184 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.

Discounts Available on the HDFC ERGO Day2Day Care

  1. 5% discount on published premium if you buy the policy through HDFC ERGO direct channels
  2. 7.5% discount on premium if you are paying a premium of 2 years in advance
  3. 10% discount on premium if purchased this policy along with Easy Health, Optima Restore or Total Health Plan whose sum insured is INR 3 lakhs and above at renewal or purchased as a new policy.
  4. 5% discount on premium if purchased along with Optima Super with deductible options of INR 1-3 lakh at renewal or as a new policy. This discount will be available to insured persons under HDFC ERGO Day2Day Care policy only if you are covered under Optima Super.

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