Health Insurance January 9, 2021

HDFC ERGO Group Mediclaim Insurance covers a person aged 91 days to up to 65 years. This is an HDFC ERGO health insurance policy that can be availed either on an individual or family floater basis. HDFC ERGO Group Mediclaim Insurance will be issued for one year and the insured can renew the policy if he/she wants. This will cover a. Inpatient treatment, Pre-and Post-hospitalisation, Daycare procedures, Domiciliary Treatment, etc. Read this page to know more about the HDFC ERGO Group Mediclaim Insurance coverage and exclusions.

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HDFC ERGO Group Mediclaim Insurance Coverage

The policy will cover the following medical expenses

  1. Room rent, Boarding and Nursing Expenses
  2. Intensive care unit charge
  3. Medical Practitioner fees
  4. Cost of anesthesia, blood, oxygen, operation theatre, surgical appliances, medicines, drugs and consumables.
  5. Diagnostic procedures
  6. Cost of prosthetic & other devices or equipment
  7. Pre-hospitalization expenses up to 30 days before the date of admission to the hospital
  8. Post-hospitalization expenses up to 60 days after the date of discharge from the hospital
  9. 144 Day care procedures
  10. Domiciliary treatment – Medical expenses incurred by you for availing medical treatment at home which would otherwise require hospitalization.

Optional Benefits From HDFC ERGO Group Mediclaim Insurance

You will get the following optional benefits if you pay an additional premium or choose a selective plan under HDFC ERGO Group Mediclaim Insurance.

  1. Waiver of pre-existing diseases exclusion via which there will be no longer a waiting period for your pre-existing illnesses.
  2. Waiver of thirty days exclusion under HDFC ERGO Group Mediclaim Insurance. It means you will get the cover for any illness during the first thirty days of the policy, which does not remain the case otherwise.
  3. Waiver of the first-year exclusion, which means all the specified illnesses or injuries that have a waiting period of 12 months, will start to get covered from the date of inception.
  4. Newborn baby cover by which the newly born child of yours will be covered from the date of his/her birth.
  5.  Maternity expenses will begin to get covered
  6. Pre-and post-natal expenses related to maternity expenses if mentioned in the policy schedule

Exclusion from HDFC ERGO Group Mediclaim Insurance

The company will not pay for the following medical expenses under the HDFC ERGO Group Mediclaim Insurance:-

  1. Any illness or injury that falls under the category of a pre-existing condition
  2. Cataract
  3. Benign prostatic hypertrophy
  4. Hysterectomy for menorrhagia or fibromyoma
  5. Hernia
  6. Hydrocele
  7. Congenital internal disease or defects
  8. Fistula in anus
  9. Piles
  10. Sinusitis and related disorders
  11. Investigations
  12. operation/treatment of cosmetic, obesity, pregnancy, impotence or to improve potency
  13. Injury or Illness due to war, invasion or warlike operations
  14. Circumcision
  15. cost of spectacles, contact lenses, hearing aids, etc.
  16. Dental treatment or surgery
  17. Convalescence, general debility, run-down condition or rest cure
  18. Congenital external disease or congenital internal defects or anomalies
  19. Sterility
  20. Venereal disease
  21. Intentional self-injury
  22. Drugs/alcohol abuse
  23. Any condition directly or indirectly caused to or associated with HTLB-111, LAV, Mutants Derivative or Variations Deficiency syndrome or any other syndrome of a similar kind such as AIDS.
  24. Charges incurred at hospital primarily for diagnostic, x-ray, laboratory examination or other studies that are not related to your covered illness or injury.
  25. Expenses on vitamins and tonics unless forming part of treatment as certified by the attending medical practitioner.
  26. Injury or Illness due to nuclear weapons or materials
  27. Loss, damage, cost or expense that are directly or indirectly caused by any act of terrorism.
  28. Treatment traceable to childbirth, pregnancy and voluntary termination of pregnancy
  29. Baby’s expenditure

Free Look

Within 15 days from the date of receipt of the HDFC ERGO Group Mediclaim Insurance document, you can read its terms and conditions and return the same if you don’t like the policy. On cancellation during the free look period, the paid premiums will be refunded after a deduction of medical check-ups, stamp duty charges and proportionate risk premium.

Claim Procedure for HDFC ERGO Group Mediclaim Insurance

The following are the types of claim procedures available at HDFC ERGO General Insurance

Cashless Claims – By opting for this type of claim, you do not have to pay from your pocket. Here, your insurer would directly interact with the network hospital and take care of the medical expenses. This can be used when you or your family member is diagnosed with an illness or injury during the policy period. In this, the hospital you visit should be in the list of network hospitals of HDFC General Insurance.

Reimbursement Claims – If you are hospitalized in a non-network hospital, you will have an option of reimbursement claims. In this, you need to pay your hospitalization expenses directly to the hospital. And once you get discharged, reach out to HDFC General Insurance at the earliest and submit a duly filled claim form along with all the relevant hospital documents. After that, HDFC Ergo will verify the documents, and if they are found to be true, the insurer will approve the claim amount and reimburse it to your bank account.

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