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Health Insurance 378 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
HDFC ERGO Maxima Insurance Plan Features & Benefits
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.
Optional Benefits Under HDFC ERGO Maxima Insurance Plan
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.
Renewal Benefits on HDFC ERGO Maxima Insurance Plan
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.
General Exclusions from HDFC ERGO Maxima Insurance Plan
- Investigation & Evaluation
- Rest Cure, rehabilitation and respite care
- Obesity/Weight control
- Change of Gender
- Cosmetic and plastic surgery
- Injury/Illness due to hazardous or adventure sports
- Breach of law with a criminal intent
- Treatment of illness/injury at excluded providers
- Treatment for alcoholism, drug abuse and other addictive substance abuse
- Treatment of illness/injury at health hydros, nature cure clinics, spas and other such establishments
- Dietary supplement and other substances that can be purchased without the prescription of a medical practitioner
- Refractive error < 7.5 dioptres
- Unproven Treatments
- Sterility and Infertility
- Maternity
- War or any act of war
- Intentional self-injury/attempted suicide/suicide
- Dental Treatment (except in case it requires hospitalization)
- Circumcisions
- Non-medical expenses
- Any convalescence, sanatorium treatment, private duty nursing or long-term nursing care.
- Preventive care
- Any physical, psychiatric or psychological examinations or testing not requiring hospitalization
- Nutritional and electrolyte supplements, unless certified to be required by the attending Medical Practitioner
- Vaccination including inoculation and immunizations (not applicable in case of a post-bite treatment)
- Treatment from a medical practitioner outside of his/her discipline
- Treatment from a medical practitioner who is providing medical treatment under the discipline for which he/she is not licensed
- Treatments from a medical practitioner who is a member of the insured family or stays with him.
- Outpatient Treatment
- Provision or fitting of hearing aids, spectacles or contact lenses
- Treatment and associated expenses for alopecia, baldness, corticosteroids and topical immunotherapy wigs, toupees, hairpieces, any non-surgical hair replacement method, Optometric therapy.
- Any treatment or part of a treatment that is not of a reasonable and customary charge
- Expenses for artificial limbs or device
- Any claim arising due to non-disclosure of pre-existing illnesses or material fact that is needed to be declared on the proposal form.
Premium Rate Under HDFC ERGO Maxima Insurance Plan
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.
Conditions on Premium
- Premium will be decided considering the age of the eldest insured member (if there is more than one insured person)
- The premium remains the same for the policy period as shown in the policy schedule
- The premium may change at renewal due to a change in the insured age or changes in the applicable taxes.
- Premium rates are subject to change with prior approval from IRDAI
- Avail tax benefits on the premium paid towards HDFC ERGO Maxima Insurance Plan under section 80D of Income Tax Act.