Health Insurance 491 views January 11, 2021

HDFC ERGO Total Health Insurance Plan will cover you and your family with a Sum Insured of INR 1-50 lakh. Under this, you will get Inpatient benefits like treatment arising from accidents or illnesses, pre-and post-hospitalization expenses, daycare procedures and more. You can also get an additional benefit of E-Opinion regarding a critical illness. Let’s read this page below and know more about HDFC ERGO Total Health Insurance Plan coverage and benefits.

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Expenses Covered Under HDFC ERGO Total Health Insurance Plan

  1. Treatment of accidents or illnesses 
  2. Hospital room rent, boarding expenses, nursing, Intensive Care Unit charges
  3. Medical Practitioner fees
  4. Cost of anesthesia, blood, oxygen, operation theatre charges, surgical appliances, Cost of Prosthetic and other devices or equipment.
  5. Pré-hospitalization up to 30 days
  6. Post-hospitalization up to 60 days
  7. Day care procedures
  8. Domiciliary Treatment
  9. Organ Donor Expenses
  10. Emergency Ambulance
  11. Daily Cash for choosing a shared Accommodation
  12. Newborn baby cover

Note:- There is an added benefit of E-Opinion for critical illness only.

Non-Claimable Expenses From HDFC ERGO Total Health Insurance Plan

  1. Hospitalization for evaluation and investigation
  2. Treatment outside India
  3. Healthcare facility treatment
  4. Claims that are not admitted regarding inpatient and daycare treatments 
  5. Any conditions which are not the same as the condition for hospitalization
  6. Inadmissible treatment expenses
  7. Outpatient Treatment
  8. Treatment for less than 3 days regarding domiciliary hospitalization 
  9. War or similar situations
  10. Breach of law
  11. Illness or Injury due to Hazardous or Adventure sports
  12. Obesity/Weight control
  13. Rest Cure, rehabilitation and respite care
  14. Change of Gender
  15. Cosmetic or plastic surgery
  16. Any Convalescence, sanatorium treatment, private duty nursing or long-term nursing care.
  17. Preventive care, any physical, psychiatric or psychological examinations or testing 
  18. Vaccination including inoculation and immunisations
  19. Non-Medical expenses

Optional Benefits Under HDFC ERGO Total Health Insurance Plan

On the payment of an additional premium, you can avail of the following benefits to the HDFC ERGO Total Health Insurance Plan

Room Rent/Room Class Limit: Room, boarding expenses are subject to the following, if you opt for this benefit.

ParticularsBenefit
Default optionNo room rent limit under all sum insured options
Room Class based option

  1. Twin sharing basis if the sum insured ranges from INR 1-2 lakh

  2. Single AC room if the sum insured is INR 3-10 lakh

  3. Any room class if the sum insured is above INR 11 lakh

Per day limit option

  1. 1% of the sum insured if it is INR 1-2 lakh

  2. 1% of the sum insured, subject to up to INR 7,500, if it is INR 3-10 lakh

  3. 1% of the sum insured, subject to up to INR 15,000, if it is above INR 11 lakh

The coverage under pre-and post-hospitalization benefits is extended or reduced to a limit as per your preference.

Ayush Benefits: The coverage under the policy will be extended to reimburse the medical expenses incurred for in-patient treatment undertaken in Ayush Hospital under Ayurveda, Unani, Sidha or Homeopathy.

Maternity Expenses: The policy is extended to reimburse medical expenses for a delivery including caesarean section when the insured person is hospitalized.

Outpatient Benefit: Coverage for the expenses incurred on outpatient treatment. And under this, the condition of minimum Hospitalization of 24 hours will stand deleted.

Outpatient Dental Benefit: Coverage for reasonable charges of any necessary dental treatment

Hospital Daily Cash: Payable on an illness or accident during the policy period

Cumulative Bonus: A maximum cumulative bonus of 50% of the Sum Insured in any Policy Year for a claim-free policy year

Spectacles, Contact Lenses, Hearing Aid: Non-medical expenses like Spectacles, Contact Lenses, Hearing Aid will be covered up to the In-patient Sum Insured.

Multiplier Benefit: This benefit will apply after every claim-free policy year, provided the policy is renewed without a break. Under this, a bonus of 50% of the Basic Sum Insured is provided, subject to a maximum of 100%.

Health Checkup Benefit (eye & dental examination): Reimburse the reasonable costs of a health check-up including eye and dental examination.

Co-payment: With this option, you can apply co-payment to your HDFC ERGO Total Health Insurance Plan.

Geographical Limitations: Change your HDFC ERGO Total Health Insurance Plan premium by choosing any one of the zones.

  1. Zone I – National Capital Region (Delhi, Noida, Ghaziabad, Faridabad & Gurgaon), Mumbai ( Mumbai suburbs in the Mumbai Metropolitan region including Thane City).
  2. Zone II – Kolkata, Chennai, Bangalore & Hyderabad.
  3. Zone III – All India excluding National Capital Region (Delhi, Noida, Ghaziabad, Faridabad & Gurgaon), Mumbai ( Mumbai suburbs in the Mumbai Metropolitan region including Thane City) , Kolkata, Chennai, Bangalore & Hyderabad.

Waiting period for Pre-existing diseases: The 48 months waiting period for all Pre-existing Conditions will stand reduced.

Restore Benefit: When the  Basic Sum Insured and Cumulative Bonus/Multiplier Benefit are exhausted due to claims, 100% of the Basic Sum Insured will be automatically available with this Restore Benefit.

Personal Accident: It covers Accidental Death, Permanent Total Disablement, and Permanent Partial Disablement

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