Knowledge Centre

What you should know about your health insurance policy?

The need of health insurance may arise anytime as diseases often come in like a bolt from the blue. HDFC ERGO has curated a range of flexi health insurance plans to suit the varying needs of customers. Here are some of the various facets of insurance claims that customers should know:

HDFC ERGO health insurance

Our health insurance - the Health Suraksha - offers maximum coverage to customers and is reasonably priced. The plan covers hospitalization in case of illness or accident, pre-hospitalization as well as post-hospitalization expenditure, expenses made in day-care procedures, organ donations and domiciliary treatments. For every claim-free year, customers will get the perk of renewal bonus too.

HDFC ERGO claim policy

Our claim policy is fast and hassle free and you only need to ensure the non-suppression of facts and provision of correct documents. Provide original discharge summary, original investigative reports, medico legal certificate (in case of accidents), past treatment records and original final hospital bill with breakups and prescription. The KYC form duly filled and photocopy of AADHAR card/ passport etc. are also needed. HDFC ERGO acts swiftly and conveys claim decision within 24 hours of receiving documents.

Claim procedure

Usually the norm is to get the specific medical treatment, tests, and procedures done and then claim for the total amount from your insurer. The insurer then processes the claim and reimburses the claim amount to insured. Here, we make the process simpler. One can contact the toll free number (1800 2700 700) for registering claim up to 7 days of discharge. After all the documents and claim forms are submitted, our health insurance claim process smoothly processes the claim and ensures zero stress.

The cashless process ensures that the insurer directly pays the hospital and medical facility. The insured does not have to make any upfront payment. This relieves the insured of mental and financial pressure.

HDFC Health insurance uses a smarter process where you only have to select the network hospital from a list of special hospitals and show your valid photo ID and health card. The hospital sends a request to HDFC ERGO and the documents are scrutinised before the claim is processed. The insured is sent a chain of SMS/e-mails conveying status of claim and there is zero hassle involved.

Claim status: Know whether your claim will get accepted or denied

Generally claims made get accepted and the amount gets reimbursed. But in certain cases, medical insurance claim may get rejected. Some of the reasons for claim rejection are: 

1. Incomplete, inaccurate documents

2. Insufficient medical reasons

3. Diagnostic procedures not done as per protocol

4. Non-capture of procedures

In such cases do not lose hope, rectify the mistake and re-apply. We, at HDFC ERGO, respond positively and ensure that the claim process is smooth.

Disclaimer: The above information is for illustrative purpose only. For more details, please refer to policy wordings and prospectus before going ahead with the sales.

To know more buy and explore health insurance plans and its benefits click here

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