Quote Form

Our representative will call you within few minutes
Health Insurance 840 views January 15, 2021
HDFC ERGO Maxima Insurance Plan covers both in-patient and outpatient treatments. Any person aged between 91 days to 65 years will be covered under this policy. HDFC ERGO Maxima Insurance Plan tenure is of one year, but as per his/her requirements, the insured can renew the policy before the expiry. You can buy this HDFC ERGO health insurance policy either on an individual or family floater basis. Let’s know about HDFC ERGO Maxima Insurance Plan coverage, exclusion, premium rates and more on this page.
Table of Contents
The company will provide insured both in-patient and out-patient benefits whether they seek treatment at a network or a non-network hospital. Check out the table below and know what expenses will be covered under in-patient and outpatient benefits.
Outpatient Benefits | In-patient Benefits |
---|---|
Outpatient Consultations by a general medical practitioner or a specialist medical practitioner | In-patient treatment includes room rent, boarding expenses, nursing expenses, ICU charges, cost of anesthesia, blood, oxygen, OT charge, surgical appliances, medicines, drugs and other prescribed consumables, diagnostic procedures, prosthetic & other devices or equipment if implanted internally during surgery. |
OPD Diagnostic Tests at a diagnostic center (Not necessary to be prescribed by the Network Medical Practitioner) | Pre-hospitalization expenses up to 30 days. However, it can be increased up to 60 days if a claim is intimated five days before the hospitalization. |
Pharmacy expenses including the medicines prescribed by the medical practitioner | Post-hospitalization expenses up to 60 days. However, it can be increased up to 90 days if a claim is intimated five days before the hospitalization. |
Outpatient Dental Treatment except for the cosmetic treatment | Daycare procedures that don’t need 24 hours of hospitalization due to technology advancement. |
Annual Health Checkup within the specified network provider if the insured age is between 18-45 years. | Domiciliary Treatment at the insured house, which would otherwise need hospitalization. |
- | Organ Donor expenses for organ harvesting. |
- | Emergency Ambulance up to INR 2,000 per hospitalization |
- | Maternity expenses that also includes pre-and post-natal expenses after the expiry of the waiting period (4 years) |
- | Newborn baby cover starts from day 1 to 90 days. |
- | Daily cash benefit for shared accommodation |
- | Daily cash benefit for accompanying an insured child. It is payable when the insured child under 12 years is hospitalized and the hospitalization is up to 72 hours |
Note – HDFC ERGO will issue an Entitlement Certificate for availing Outpatient benefits for OPD consultation, diagnostic tests, pharmacy, outpatient dental treatment, as well as spectacles and Contact Lenses.
You can add an optional benefit of Critical Illness under your HDFC ERGO Maxima Insurance Plan if you pay an extra premium. The benefit amount is payable once the critical illness is diagnosed to the insured person during the policy period, and if the insured survives 30 days after the diagnosis. This optional benefit applies to all family members on an individual sum insured basis equaling INR 3 lakh. And you should know that this benefit will not be renewed beyond 70 years of age. Critical Illness Benefit Sum Insured per insured is INR 3 lakh.
Outpatient Benefit:- If any available Entitlement Certificates were not used by the insured in a Policy Year, the company will carry forward 50% of these certificates to the next Policy Year, except for the annual health check-up. For this process, you need to send all unused entitlement certificates to HDFC ERGO before renewal. You will also be given a grace period of 15 days from the renewal due date to submit these certificates. After verifying the entitlement certificates and checking the admissibility of the Carry Forward Bonus, fresh entitlement certificates will be issued by HDFC ERGO within 30 days of the receipt of the unused certificates.
In-patient Benefit:– A cumulative bonus of 10% of the sum insured for every claim-free year, maximum up to 50%. If a claim is made during a policy year, the cumulative bonus will be reduced by 10% of the sum insured on renewal.
Check out the table below and know what could be your starting annual premium in HDFC ERGO Maxima Insurance Plan as per your entry age.
Age at Entry | For an Individual (In INR) | For Two Insured Members (In INR) | Two Adult Insured Members and up to Two Insured Children (In INR) |
---|---|---|---|
0-17 | 12,682 | - | - |
18-45 | 13,795 | 19,135 | 25,810 |
46-60 | 16,910 | 23,585 | 30,705 |
>60 | 24,831 | 35,778 | 42,720 |
Note:- Above-mentioned premium rates exclude Goods & Services Tax & Cess, if any.