Health Insurance 206 views January 13, 2021

HDFC ERGO iCanEnhance Health Insurance Plan offers coverage for only cancer provided it occurs to the insured person for the first time during the policy period. Under this policy, expenses related to cancer such as the Second Opinion, Chemotherapy, Radiotherapy and other such procedures will be covered. HDFC ERGO iCanEnhance Health Insurance Plan comes with the following sum insured options – INR 5,00,000, INR 10,00,000, INR 15,00,000, INR 20,00,000, INR 25,00,000, INR 50,00,000. This is a 1-year policy which can be renewed before the expiry as long as you want to stay covered. Read this page and know more about the HDFC ERGO iCanEnhance Health Insurance Plan.

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Cover of Expenses Under HDFC ERGO iCanEnhance Plan

The company will be liable to pay for the following as mentioned in the policy schedule:-

  1. Second Opinion, upon the first diagnosis of Cancer, is provided through HDFC ERGO panel of medical practitioners who may access artificial intelligence, deep analytics & cognitive software. Such an opinion will be sent directly to the insured by the medical practitioner. And this benefit can be availed once on the first occurrence of Cancer.
  2. Inpatient Treatment, Outpatient (OPD) Treatment or Daycare Treatment of cancer
  3. Covered treatments may include Chemotherapy, Radiotherapy Organ transplantation (if part of Cancer treatment), surgeries for excision of cancerous tissue or removal of organs/tissues (Onco-surgery) under the standard plan. Whereas under the advanced plan, Proton beam therapy, Immunotherapy including the immunology agents, Personalised & Targeted therapy, Hormonal Therapy or Endocrine manipulation, Stem cell transplantation will be covered along with the standard plan coverage.
  4. Pre-hospitalization Medical expenses up to 30 days
  5. Post- hospitalization Medical expenses up to 60 days
  6. Ambulance transportation cover
  7. Follow Up care Post-treatment where the expenses incurred on medical examination twice a year if the cancer treatment has been discontinued based on the recommendation of a Medical Practitioner for at least six months with “No Evidence of Disease (NED)”.

HDFC ERGO iCanEnhancePlan CritiCare Benefit

This benefit is for Cancer of Specified Severity only and the eligible claim amount under this benefit is over and above the ‘My Care’ Sum Insured. It will be payable to you only once under the policy, including the renewals. And it is for the insured person who is 18 years and above on the policy commencement date.

CritiCare Benefit will be admissible on the first diagnosis of Cancer of specified severity during the policy period, Under this, the company will pay the insured person a lump sum equal to 60% of the Sum Insured.

Note- If the first diagnosis of Cancer of Specified Severity is identified as Advanced Metastatic Cancer, the Insured person will be eligible for Family Care Benefit and no payment shall be made under Criti Care benefit.

HDFC ERGO iCanEnhance Plan FamilyCare Benefit

A lump sum benefit equivalent to 100% of the Sum Insured becomes payable on the occurrence of either Advanced metastatic Cancer (Stage IV) or Recurrence of Cancer during the policy period. Under this, the Sum Insured will be over and above “MyCare” Sum insured and is payable only once under the policy including the renewals.

The FamilyCare Benefit is applicable under HDFC ERGO iCanEnhance Health Insurance Plan for only those insured persons who are 18 years and above on the policy commencement date.

Note- If the company has made payment under Cancer of Specified Severity, the amount paid under CritiCare benefit shall be subtracted from FamilyCare benefit payout.

Note – MyCare Sum Insured is equivalent to HDFC ERGO iCanEnhance Health Insurance Plan Sum Insured.

Waiting Period

There will be a waiting period of 120 days under the HDFC ERGO iCanEnhance Health Insurance Plan from the commencement date of the policy to all the claims in the policy, provided you have been covered continuously without any break. Also, the expenses related to the treatment of a pre-existing disease and its direct complications will be excluded until the expiry of 48 months of continuous coverage starting from the date of inception of the first policy.

Note – In case of enhancement of sum insured, provided you are continuously covered without any break as defined under the portability norms of the extant IRDAI regulations, the waiting period would be reduced to the extent of prior coverage. While the coverage for any pre-existing disease is subject to being declared at the time of application and accepted by the insurer.

Exclusions from HDFC ERGO iCanEnhance Plan

  1. Pre-existing disease and its direct complications until the expiry of the waiting period
  2. Non-allopathic treatment
  3. Cosmetic or plastic surgery expenses or any treatment to change appearance unless required for reconstruction following an accident, burn or Cancer (if it is a part of medical treatment)
  4. Unproven treatment expenses, services and supplies
  5. Investigation and evaluation expenses related to an admission which is primarily for diagnostics and evaluation purposes and not related or not incidental to the current diagnosis and treatment.
  6. Rest cure, rehabilitation, and respite care expenses are related to any admission primarily for enforced bed rest and no treatment is provided. It also includes custodial care (at home or nursing facility) and any services for people who are terminally ill to address physical, social, emotional and spiritual needs.
  7. Preventive care
  8. Any external appliance/device used for diagnosis or treatment except when it is used intra-operatively.
  9. Non-medical expenses such as food charges (other than patient’s diet), laundry charges, attendant charges, ambulance collar, ambulance equipment, baby food, baby utility charges and other such expenses.
  10. Dietary supplements and the substances which are purchased without a prescription
  11. Prosthetic and self-detachable or removable devices
  12. Congenital external diseases, defects or anomalies
  13. Specified healthcare providers
  14. Treatment by a medical practitioner outside of his/her discipline or the discipline for which he/she is licensed to practice.
  15. Treatment offered by a medical practitioner who is your family member or stays with you
  16. Treatment that is not of a reasonable charge or not medically necessary
  17. Treatment for alcoholism, drug, substance abuse or any addictive condition
  18. Treatment arising from war or any act of war, invasion, an act of foreign enemy, civil war, public defense, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind.
  19. If an accident arises from Nuclear Contamination, radioactive explosion or hazardous nature of nuclear fuel materials.

Free Look

The Free Look Period will apply to new individual policies and not on renewals, porting, migrating of the policy. Under the free look period of fifteen days that starts from the date of receipt of the policy, you can read the terms and conditions of the policy and return the same if not acceptable.

As stated in the HDFC ERGO iCanEnhance Health Insurance Plan if the insured has not made any claim during the Free Look Period, the insured shall be entitled to a refund of the paid premium after the deduction of medical examination and stamp duty charges, if any.

In case the risk has already commenced and the option of return is exercised, a deduction towards the proportionate risk premium for a period of cover will be provided. If only a part of the insurance coverage has commenced, such proportionate premium commensurates with the insurance cover.

Notification of Cancer Treatment

You must inform HDFC ERGO if any event or occurrence may give rise to a claim under this policy –

  1. Within seven days of completion of treatment, consultation or procedure
  2. Within 14 days of the Date of Diagnosis of the first occurrence of Cancer of specified severity
  3. Within 14 days of the Date of Diagnosis of Advanced metastatic cancer or Recurrence of Cancer.

List of Documentation

  1. Original bills with a detailed break-up of charges including but not limited to pharmacy bills, consultation bills, diagnostic bills.
  2. Original payment receipts
  3. All original reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries.
  4. Original Discharge Summary
  5. Medical certificate confirming the diagnosis/treatment of cancer
  6. Original Prescriptions
  7. Medical Practitioner’s Invoice
  8. Indoor case papers, if required

Claim Procedure

Submit the duly signed claim form and all the information/documents within 15 days of the occurrence of the incident. You can claim the HDFC ERGO iCanEnhance Health Insurance Plan either via cashless facility or reimbursement. For cashless, you need to be admitted to a network hospital. Whereas in case of reimbursement, you need to pay the hospital bills upfront and later when you are discharged, you can seek reimbursement from the company. For the claim approval, you need to undergo a medical examination by HDFC ERGO authorized Medical Practitioner, as and when required.

The insurer is under no obligation to make any payment under this Policy unless they receive all premium payments in full. The claim payment will be made if your receipt is considered as a complete discharge of the company’s liability against any claim under this policy. In the event of Your death, the payment will be made to your Nominee.

In case of delay in the claim payment, the insurance company will pay interest at a rate of 2% above the bank rate to the policyholder. However, if the circumstances of a claim warrant an investigation in the opinion of the company, it will initiate and complete at the earliest, in any case not later than 30 days from the date of receipt of the last necessary document.

Note:- HDFC ERGO shall settle or reject a claim within 30 days from the date of receipt of the last necessary document.

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