Health Insurance 750 views January 20, 2021

HDFC ERGO Health On Plan offers financial protection to the insured and his/her family in case of health risk during the policy term. Under this policy, you will get sum Insured options ranging from INR 3-15 lakh and INR 20-50 lakh. The sum insured is the amount payable to you in case you or any of your insured family members require medical treatment for diseases/illnesses. And if the sum insured exhausts in a policy period, you can restore it for future claims. In this policy, expenses such as in-patient, pre-and post-hospitalization, daycare, etc. will be covered. In this post, we will discuss HDFC ERGO Health On Plan coverage and exclusions.

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Covers Under HDFC ERGO Health On Plan

  1. In-Patient Treatment
  2. Pre-Hospitalization
  3. Post-Hospitalization
  4. Day Care Procedures
  5. Domiciliary Treatment
  6. Organ Donor
  7. Ambulance Cover
  8. Daily Cash
  9. E-Opinion

Conditions for HDFC ERGO Health On Plan Coverage

  1. In-Patient Treatment will be covered if it arises from an accident or illness and the insured person requires hospitalization for more than 24 hours. This will cover your room rent, boarding expenses, nursing, ICU, medical practitioner’s charges, anesthesia, blood, oxygen, OT, surgical appliances, medicines, drugs, consumables and other diagnostic procedures. The in-patient treatment will not be admissible under the policy if it requires prosthetics and other devices not implanted internally by surgery, hospitalization for evaluation and investigation only, holter monitoring, sleep study, etc.
  2. Expenses for consultations, investigations and medicines incurred pre-and post-hospitalization will be covered up to 60 (before the date of hospitalization) and 180 days (post-discharge from the hospital).
  3. Medical treatment or surgeries that are undertaken under general or local anesthesia in a hospital or a daycare center for less than 24 hours will be covered under the policy daycare expenses. On the other hand, treatments that are normally taken on an outpatient basis will not be covered in this policy.
  4. Medical treatment for an illness, disease or injury under the circumstances such as a condition where the insured can’t be moved into a hospital or the insured needs to take treatment at home on account of non-availability of rooms.
  5. Expenses for the treatment of an organ harvesting for the organ transplant of the insured person will be covered.
  6. Ambulance coverage is subject to INR 2,000 per hospitalization
  7. Daily cash will be available to you per day as mentioned in the policy schedule when the insured person is hospitalized in shared accommodation at a network hospital, for each continuous and completed 24 hours if the hospitalization is above 48 hours. This benefit may not apply to ICU stay and other inadmissible in-patient treatment.
  8. HDFC ERGO will arrange a second opinion for the insured person if he/she suffers a critical illness during the policy period. The list of critical illnesses valid for the second opinion includes Cancer, Open Chest CABG, First Heart Attack, Kidney Failure, Major Organ/Bone Marrow Transplant, Multiple Sclerosis, Permanent Paralysis of Limbs and Stroke. You can select the medical practitioner from the list of HDFC ERGO panels and receive a second opinion directly from the concerned practitioner.

Exclusion from HDFC ERGO Health On Plan

  1. War or any act of war
  2. Nuclear, chemical and biological weapons or radiation of any kind
  3. Breach of law with criminal intent
  4. Intentional or attempted suicide
  5. Participation or involvement in naval, military or air force operation
  6. Racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing related illness or injury treatment
  7. Abuse of intoxicants or substances like drugs and alcohol
  8. Treatment of obesity and weight control program
  9. Psychiatric or mental disorder treatments
  10. congenital external diseases, defects or anomalies
  11. Genetic disorders
  12. Sleep apnoea
  13. Expenses of HIV, AIDs and other related diseases treatment
  14. Sterility, infertility, fertility, infertility treatments
  15. Surrogate or vicarious pregnancy
  16. Birth control
  17. Circumcisions
  18. Refractive error
  19. Plastic surgery or cosmetic surgery

Benefits Under the HDFC ERGO Health On Plan

Multiplier Benefits – If you make no claim in a year, in respect of in-patient treatment, and renew the policy without any break, the company will provide you a bonus in the next year. With this benefit, your sum insured will be increased by 50% of the basic sum insured.

Note – The multiplier benefit won’t exceed 100% of the basic sum insured in a policy year. And if you claim in a policy year post the multiplier benefit application, the multiplier benefit will be reduced at the same rate at which it is accrued in the subsequent year.

Health Check-Up Benefits – At the end of each policy year at renewal, the company reimburses the incurred expenses of preventive health check-ups.

Restore Benefits – When HDFC ERGO Health On Plan basic sum insured and multiplier benefit exhaust due to claims made in a policy year, a Restore Sum Insured equal to 100% of the basic sum insured will be available to you for the particular policy year.

Note – No multiplier bonus will apply to the Restore Sum Insured. And this benefit will apply only once for an insured person during a policy year. And if the restore sum insured is not utilized, it shall not be carried forward to the subsequent policy year.

Waiting Period On HDFC ERGO Health On Plan

Some of the illnesses or treatments shall be covered under the HDFC ERGO Health On Plan only after a certain period, known as the waiting period in health insurance. So let’s have a look at this HDFC ERGO plan waiting period.

  1. 30 days waiting period for any illness from the date of policy commencement
  2. 36 months waiting period for all the pre-existing conditions

And 24 months waiting period for the following list of illnesses and treatments

  1. Sinusitis
  2. Rhinitis
  3. Tonsillitis
  4. Adenoidectomy
  5. Mastoidectomy
  6. Tonsillectomy
  7. Tympanoplasty
  8. Surgery for nasal septum deviation
  9. Nasal concha resection
  10. Cysts, polyps including breast lumps
  11. Polycystic ovarian disease
  12. Fibroids (fibromyoma)
  13. Dilatation and curettage
  14. Myomectomy for fibroids
  15. Non-infective arthritis
  16. Gout and Rheumatism
  17. Osteoarthritis and Osteoporosis
  18. Surgery for prolapsed intervertebral disk
  19. Joint replacement surgeries
  20. Calculus diseases of gall bladder
  21. Cholecystitis
  22. Pancreatitis
  23. Fissure and fistula in anus
  24. Hemorrhoids
  25. pilonidal sinus
  26. Ulcer
  27. Erosion of stomach
  28. Duodenum
  29. Gastro Esophageal
  30. Reflux Disorder
  31. Cirrhosis
  32. Perineal Abscesses
  33. Perianal Abscesses
  34. Cholecystectomy
  35. Surgery of hernia
  36. Cataract
  37. Calculus diseases of the Urogenital system
  38. Benign Hyperplasia of prostate
  39. Surgery on prostate
  40. Surgery for Hydrocele or Rectocele
  41. Internal tumors, cysts, nodules, polyps, skin tumors
  42. Surgery of varicose veins and varicose ulcers

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