Health Insurance 177 views January 13, 2021

HDFC ERGO Dengue Care Health Insurance Plan covers individuals who fall under the age group of 91 days to 65 years and are affected by dengue. The company puts no maximum cover ceasing age on renewals of the subject policy. HDFC ERGO Dengue Care Health Insurance Plan will be issued for one year on an individual Sum Insured basis. It covers in-patient expenses, pre-and post-hospitalization expenses, and provides wellness packages as well. You will also get a discount up to 10% on the published tariff if you buy Dengue Care through HDFC ERGO Direct channels. HDFC ERGO Dengue Care Health Insurance Plan Sum Insured ranges from INR 50,000 to INR 1 Lakh. For more information, let’s read this page further.

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List of Expenses Covered Under The HDFC ERGO Dengue Care Plan

When you buy this HDFC ERGO health insurance policy, the company will pay for the following expenses –

  1. In-Patient Treatment for Dengue Fever (Hospitalization is more than 24 hours). It includes room rent, boarding expenses (Single private A/c room), nursing, Intensive Care Unit, Medical Practitioner fees, anesthesia, blood, oxygen, operation theatre, medicines, drugs, consumables, diagnostic procedures.

Note:- In case of admission to a room exceeding the aforesaid category, the reimbursement or payment of room rent charges including the associated medical expenses incurred at the hospital shall be done in the proportion same as that of an admissible rate per day and actual rate per day regarding room rent charges.

  1. Pre-hospitalization expenses up to 15 days before admission
  2. Post-hospitalization expenses up to 15 days after discharge from hospital
  3. Shared accommodation benefit, under this, if the insured is hospitalized in a Network Hospital, the exclusion of any treatment or part of a treatment that is not reasonable or medically necessary will be waived off.

Outpatient Benefits of HDFC ERGO Dengue Care Plan

The following benefits are available to insured persons during the policy period if NS1 (non-structural protein 1) or any equivalent test as described by HDFC ERGO is found positive:-

  1. Outpatient Consultations for the treatment of Dengue fever
  2. Diagnostic Tests for Dengue fever
  3. Pharmacy medicines if they have been prescribed for the treatment of Dengue Fever
  4. Home Nursing expenses will be reimbursed for necessary medical treatment of Dengue fever

Note:- Any claims made under this section will be subject to Outpatient Sum Insured.

Wellness Offers from HDFC ERGO Dengue Care Plan

Periodically, HDFC ERGO will let you purchase items or services related to the prevention of Dengue from the HDFC ERGO official website or through other means. These items or services are provided to you from HDFC ERGO or its select partners with a discount or as part of a special scheme.

Waiting Period On HDFC ERGO Dengue Care Plan

HDFC ERGO is not liable for any claim arising due to treatment and admission within fifteen days from the date of policy commencement. And if the insured person is presently covered and has been continuously covered without any lapses, the waiting period of the policy stand deleted.

Otherwise, if the proposed Sum Insured for an insured person is more than the Sum Insured applicable under the previous HDFC ERGO health insurance, the waiting period shall be reduced only to the extent of the Sum Insured and any other accrued sum insured under the previous policy.

General Exclusions Under HDFC ERGO Dengue Care Plan

  1.  Any Treatment other than Dengue fever
  2. Treatment by a Medical Practitioner which is outside his/her discipline or the discipline for which he/she is licensed to practice.
  3. Treatment by a Medical Practitioner who is a member of the Insured Person’s family or stays with him.
  4. Any treatment or part of a treatment that is not reasonable and medically necessary
  5. Charges related to Hospital stay that is not precisely mentioned as being covered under HDFC ERGO Dengue Care Health Insurance Plan
  6. Expenses incurred towards treatment in any hospital or by any Medical Practitioner who is specifically excluded by the insurer
  7. Non-Medical expenses like food charges other than the patient’s diet, laundry charges, attendant charges, ambulance collar, ambulance equipment, baby food, baby utility charges and other such items

Free Look

The Free Look period will apply to new individual health insurance policies and not on renewals, porting or migrating. Here, you will have fifteen days from the date of receipt of the policy document to review its terms and conditions and return the same if not acceptable.

And if you have not made any claim during the Free Look Period, you will be entitled to a refund of the paid premium less any expenses incurred by the company on medical examination and stamp duty charges.

Where the risk has already commenced and the option of return of the policy is exercised by you, a deduction towards the proportionate risk premium for the period of cover will be provided. However, if only a part of the insurance coverage has commenced, such a proportionate premium commensurates with the insurance coverage.

Claim Procedure For HDFC ERGO Dengue Care Plan

HDFC ERGO General Insurance processes claim under this Dengue Health Insurance policy as follows:-

Step 1: Intimation & Assistance – Contact the company at least seven days before hospitalization. Whereas if it is an emergency, contact within 24 hours of the event.

Step 2: Choose From Reimbursement or Cashless

For Reimbursement

Inform HDFC ERGO no later than seven days of completion of Dengue Fever treatment, consultation or procedure, submit the duly signed claim form and all the documents to HDFC ERGO. For this, a period of 15 days is provided from the occurrence of the incident. The company may accept claims after a delayed interval only in special circumstances. If there is any deficiency in the documents or information, the company will send you a deficiency letter within 7 days of receipt of the claim documents.

Any payment to the policyholder, insured or his/ her nominees/legal representative/assignee/hospital, as the case may be, will be a valid discharge towards payment of a claim. HDFC ERGO can settle or reject a reimbursement claim, as the case may be, within 30 days from the date of receipt of the last necessary document.

And if there is a delay in claim payment, the company is liable to pay interest at a rate of 2% above the bank rate to the policyholder from the date of receipt of the last necessary document to the date of claim payment. However, where the circumstances of a claim warrant an investigation in the opinion of the company, it will initiate and complete such investigation at the earliest. The reimbursement of the claim amount will be made in the name of the policyholder.

Cashless Facility

Inform the company within 24 hours of hospitalization if it remains an emergency admission. Whereas any planned hospitalization can be informed at least 48 hours before the hospitalization.

HDFC ERGO General Insurance checks your coverage under HDFC ERGO Dengue Care Health Insurance Plan as per the eligibility and sends an authorization letter to the network provider hospital. If there’s a discrepancy in the documentation, the same will be communicated to the hospital within six hours of its receipt.

You just need to pay the non-medical and the expenses that are not covered under the policy before discharge from the hospital. In case the ailment or treatment is not covered under the policy, a rejection letter would be sent to the network provider within six hours.

Note: You will be entitled to cashless coverage only in HDFC ERGO empaneled hospitals. So, dial the customer care number 022 6234 6234/0120 6234 6234 and inform HDFC ERGO about the claim.

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