Health Insurance 129 views May 10, 2021

HDFC ERGO my: Health Hospital Cash Benefit is a rider that you can add to your existing health insurance plan. Under this add-on cover, you’ll get the benefit of hospital cash if you are hospitalized due to an illness or injury. This policy can be issued on an individual or family floater basis, where you can include your spouse and children. Keep reading this page further and know the benefits of HDFC ERGO my: Health Hospital Cash Benefit – Add On Plan.

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HDFC ERGO my: Health Hospital Cash Benefit – Add On Daily Cash Benefit

If you suffer from an illness or accident during the policy term and are admitted to the ward, the insurer will pay a daily cash amount for each continuous and completed period of 24 hours hospitalization. Whereas if you are admitted to an Intensive Care Unit (ICU), the daily cash amount will be 2X the one you get for admissions in other wards, subject to a maximum of seven days for each hospitalization.

In case your ward is transferred to ICU and vice versa, the daily cash benefit would be as per the limits stated in the policy document. On the day of the ward shift, the insurer will pay the regular hospital cash benefit.

The maximum liability of the insurer shall be restricted to the following amounts as opted by you –

  1. INR 500 per day
  2. INR 1,000 per day
  3. INR 1,500 per day
  4. INR 2,000 per day
  5. INR 2,500 per day

Note – The Hospital Cash Benefit shall be payable for a maximum of 30/60 days per policy year.

Eligibility Criteria for HDFC ERGO my: Health Hospital Cash Benefit – Add On Plan

You can purchase this add-on cover if you meet the following age criteria

  1. Minimum Entry Age – 91 days
  2. Maximum Entry Age – 65 years

Check out the below pointers and know the details of HDFC ERGO my: Health Hospital Cash Benefit – Add On Plan –

  1. Policy Term – 1 Year
  2. Minimum Premium Amount – INR 244 (30 days) & INR 320 (60 days)
  3. Maximum Premium Amount – INR 20,849 (30 days) & INR 23,179 (60 days)
  4. Family Discount – 5% if 2 or more family members are covered under the policy

Note – The premium amount will be based upon the age of the insured person and the sum insured he/she chooses.

Exclusions from HDFC ERGO my: Health Hospital Cash Benefit – Add On Plan

You aren’t eligible for daily cash benefit if your hospitalization is directly or indirectly related to the following –

  1. War, Invasion, Act of foreign enemy, War like operations
  2. Breach of law with criminal intent
  3. Intentional self-injury or attempted suicide whether sane or insane
  4. Participation in naval, military or air force operation
  5. Participation in racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing
  6. Abuse of intoxicants such as drugs and alcohol
  7. Treatment of obesity and any weight control program
  8. Psychiatric, mental disorders, sleep apnoea, Parkinson and Alzheimer’s disease, general debility or exhaustion, external congenital diseases/defects/anomalies, genetic disorders, stem cell implantation/surgery, hormone therapy
  9. Venereal disease, sexually transmitted diseases such as AIDS, HIV, ARC, Lymphomas in the brain, Kaposi’s sarcoma, tuberculosis if associated with HIV infection.
  10. Pregnancy and voluntary termination of the same, maternity/childbirth, except for ectopic pregnancy
  11. Sterility treatment
  12. Dental treatment
  13. Treatment for analysis and adjustments of spinal subluxation
  14. Nasal septum deviation and nasal concha resection, circumcisions unless required for illness or injury treatment
  15. Correction of the eye due to refractive error
  16. Aesthetic or sex change operation
  17. Plastic surgery or cosmetic surgery unless a part of the illness or injury treatment
  18. Experimental, investigational or unproven treatment
  19. Hospitalization for diagnostics purposes
  20. Any non-allopathic treatment
  21. All preventive care, vaccination including inoculation and immunizations, except post-bite treatment in hospital
  22. Treatment from a Medical Practitioner who lives with the insured in the same residence or who is a member of the insured’s family

Waiting Period of HDFC ERGO my: Health Hospital Cash Benefit – Add On

The policy benefits shall be payable to you after the expiry of the following waiting period

  1. A 30-day initial waiting period, except for accidental injuries
  2. A 24-month waiting period for internal congenital diseases, non-infective arthritis, calculus diseases of the gallbladder, and other illnesses or surgeries as mentioned in the policy document.

If you are presently covered under HDFC ERGO health insurance without any lapses, the waiting period shall be reduced or stand deleted. The above-mentioned waiting period shall be reduced by the number of continuous preceding years of coverage under the base policy.

Claim Procedure

You can get the daily cash benefit under HDFC ERGO my: Health Hospital Cash Benefit – Add On by following the steps shown below –

  1. Intimate the insurer about the claim seven days before your hospitalization
  2. Register your claim within seven days post-discharge from the hospital
  3. Submit the duly filled/signed claim form and the necessary documents to the insurer within 15 days of the occurrence of the incident.

Once the required documents are submitted, the insurer will transfer the admissible amount, along with a settlement statement within 30 days from the date of submission of the claim documents.

Note – If there is any deficiency in the documents/information, you’ll receive a deficiency letter within 7 days of submission of the claim documents.

Free Look Period

You have a 15-day free look period from the date of receipt of the policy document, where you can review the terms and conditions of the policy and return the same stating the reasons for cancellation. On such cancellation, the insurer shall refund the paid premiums after deducting the medical check-up cost, stamp duty charges and proportionate risk premium for the period on the cover.

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