HDFC ERGO Health Insurance Claim Settlement Ratio (CSR) & Claim Process

HDFC ERGO Claim Settlement Ratio

99.39%

HDFC ERGO

94.21%

Industry Average

Health claim settlement ratio is the percentage of claims settled against the total claims received by the insurance company in a given fiscal year. HDFC ERGO has a claim settlement ratio of 99.39%, as compared to the industry average of 94.21%.

HDFC ERGO Claim Process

HDFC ERGO supports both cashless claims and reimbursement claims. This section covers the information on how to check HDFC ERGO health insurance claim status, fill HDFC ERGO health insurance claim form, and the claim settlement process.

Hospitalization : Find out to locate nearest network hospital
Avail Cashless Hospitalization & Submission of Documents by showing your health card and valid photo ID
Preauthorization: Hospital will send the cashless request to HDFC ERGO and coordinate with with Network Hospital for the Pre-authorisation form
At the time of Discharge & Settlement of claim : HDFC ERGO/ TPA will scrutinize all the received documents and convey the final stand on the claim
Status Update: You will receive an update through SMS/Emails at every stage of the claim on your registered mobile number or email id
Cashless authorisation & Approval of Claim: Hospital shall send the final bill to HDFC ERGO for authorisation and HDFC ERGO shall scrutinize the same and give final authorization in case of approved transactions to the hospital. Any inadmissible expenses, copayments, deductions will have to be paid by Customer

Hospitalisation: You need to pay the bills initially and preserve the original invoices
Register A Claim: Post hospital discharge send us all your invoices and treatment documents
Verification: verify your claim related invoices and treatment documents
Claim Settlement: We send the approved claim amount to your bank account.

HDFC ERGO Premium Calculator

Use the HDFC ERGO health insurance premium calculator to estimate your health insurance premiums.

Premium Calculator

Enter just a few details to calculate your health insurance premium within 30 seconds.

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FAQs

If you already have existing health insurance coverage and are looking to increase it without paying expensive premiums, you can choose top-up and super top-up health insurance plans. These plans have a deductible and a sum insured. Claims above the deductible limits are paid and so the premiums are low. When you have existing coverage, you can choose a deductible matching the existing plan’s sum insured so that any excess claim would be paid by the top-up or super top-up plan

You can get numerous tax benefits when you buy a health insurance plan. These benefits are allowed under Section 80D of the Income Tax Act, 1961 and are as follows

Premiums paid for a plan covering you, your spouse and dependent children would be allowed as a deduction up to INR 25,000
If you are a senior citizen, the deduction limit would increase to INR 50,000
Premiums paid for a plan covering your dependent parents would be allowed as an additional deduction for up to INR 25,000
If your parents are senior citizens, the deduction limit would increase to INR 50,000
If you buy two policies, one for yourself and your family and the other for your parents, you can claim a deduction of up to INR 50,000. If you or your parents are senior citizens, the limit increases to INR 75,000. If both you and your parents are senior citizens, the limit would be INR 1 lakh

Yes, a free-look period of 15 days is allowed from the date of policy issuance under HDFC Ergo health insurance plans. During this period you can cancel the policy if you want and avail the refund of the premium paid

The claim process of HDFC Ergo health insurance plans has been explained earlier. You need to intimate the insurance company of your claim and then follow the above-mentioned steps to get the settlement of your claims faster

You can buy HDFC Ergo health insurance plans online either from the website of the company or from Turtlemint itself. When you buy through Turtlemint, you can compare HDFC Ergo’s plans with other health insurance plans and then choose the best one. The process of buying the policy has been explained earlier above

HDFC Ergo’s health insurance plans do not cover specific illnesses and treatments some of which include the following

Self-inflicted injuries
Cosmetic treatments
Congenital illnesses
HIV, AIDS and venereal diseases
Pre-existing conditions during the waiting period
Injuries suffered due to war or nuclear perils
Unproven or experimental treatments, etc.

There are online premium calculators offered both by HDFC Ergo as well as by Turtlemint which allows you to calculate the premium of HDFC medical insurance plans. You can enter the relevant details which affect the premium calculation and find the premium rates. These details include the following

Age
Sum insured
Number of members to be covered
Medical history
Pre-existing illnesses
Term of the plan
Add-ons if needed

Based on these factors, the premiums would be calculated and displayed

A health card is issued for all insured members when you buy HDFC Ergo health insurance plans. This health card is needed at the time of cashless claims as the card contains a unique customer identification number. When you are admitted to a networked hospital, you need to present the health card to avail cashless treatments. Thus, you should get a health card from HDFC Ergo health insurance

HDFC Ergo is a leading name in the general insurance segment and its health insurance plans are comprehensive plans at affordable premiums. The company offers a range of health insurance plans for your coverage needs and you can find a suitable policy easily. The plans offered by the company offer optimal coverage levels and benefits and are also light on your pockets. So, HDFC Ergo health insurance is a good choice for your health insurance needs.