HDFC ERGO Health Suraksha Silver Plan

Introduction

Hdfc Ergo Health Suraksha Silver Plan is an inpatient hospitalization policy. The plan has been established as extraordinary and different than the other health plans because it safely secures you against high-end medical costs through comprehensive coverage and gives great precedence to health.

The strong and clear intention of this health plan successfully protects families, individuals, and senior citizens who seek health plans between the range of Rs. 3 – 5 Lakhs. This distinct health plan also offers renewal bonuses as rewards, if claims aren’t made for one complete year.

So, here is an in-depth review of the HDFC ERGO Health Suraksha Silver Plan.

Features Of HDFC ERGO Health Suraksha Silver Plan

1. Individuals aged less than 45 years don’t need to undergo any medical check-ups to buy this policy.

2. It offers cashless treatment in all the network hospitals.

3. On each renewal of the Policy, a bonus of 5% on the sum insured is provided for every year if, you do not make a claim. This bonus can be accumulated upto 50% of the Basic Sum Insured(an optional 100% bonus can be availed by paying an extra premium).

4. There are no sub-limits on any disease, doctor fees, and hospital charges.

5. If 2 or more family members have covered under the same policy on an individual sum insured basis, you can avail of a family discount of 10% on the premium.

6. The policy term can be 1 or 2 years based on your preference.

7. Pre-hospitalisation expenses are covered for 60 days before the date of hospitalization and Post-hospitalisation expenses are covered upto 90 days after getting discharged from the hospital.

8. This policy also covers daycare procedures to receive compensation for upto 144 days that does not require hospitalization.

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9. There is a waiting period of 30 days before making any claims under this policy. But, does not apply in case of accidental injuries.

10 The policyholder has a time of 15 days the free-look period to review the terms and conditions of the policy.

11. Health Suraksha Silver Plan gives the lifelong renewability option. So, it can be renewable at any point in your life.

12. There is the option of availing cashless treatments from any of the network hospitals listed by the insurance company.

13. According to Section 80D of the Income Tax Act, 1961, the amount paid as a premium for this policy is eligible for tax benefits.

14. This policy cover is available in multiple sums insurance options such as Rs. 3, 4, and 5 Lakhs.

Benefits of HDFC ERGO Health Suraksha Silver Plan

1. The coverage provided for hospitalization expenses is up to the entire sum insured limit.

2. The policy covers all the costs you may incur during organ transplantation.

3. All the expenses incurred due to an emergency ambulance can be reimbursed under this policy.

4. The plan covers all the expenses in case of in-patient treatment taken under Homeopathy, Sidha, Ayurveda, or Unani.

5. Up to 1% of the sum insured can be used for health checkups after not making any claims for 4 consecutive years. This 1% can be a maximum of Rs.5,000.

6. Maternity Benefits Covered( Optional).

Eligibility For HDFC ERGO Health Suraksha Silver Plan

1. Minimum entry age – 91 days.
2. Maximum age – No limit.
3. Renewal age – Lifetime.
4. Family definition –
Individual(spouse, dependent children, dependent parents).
Family Floater(Self, Spouse, dependent children, Father, Mother).

Add-on benefits of HDFC ERGO Health Suraksha Silver Plan

Critical Illness Lumpsum(Optional cover by paying extra premium)

A lump sum amount is provided for the identified 11 critical illnesses diagnosed during the policy period and if, the Insured survives 30 days after the diagnosis.
Critical Illness covered are,

  • Cancer of specified severity,
  • Coronary Artery(Bypass) Surgery,
  • First Heart Attack (Myocardial  Infarction), 4. Kidney Failure requiring regular dialysis,
  • Major Organ/Bone Marrow Transplant,
  • Multiple Sclerosis with Persisting Symptoms,
  • Permanent Paralysis of Limbs,
  • Stroke resulting in Permanent Symptoms,
  • Aorta Graft Surgery,
  • Primary Pulmonary Arterial Hypertension,
  • Heart Valve Replacement.

Hospital daily cash(Optional cover by paying extra premium)

Daily allowance for every continuous and consecutive 24 hours for inpatient hospitalization (Maximum upto 30/60 days).

Regain Benefit (Optional cover by paying extra premium)

Automatic availability of the basic sum insured if, the basic sum insured inclusive of the no claim bonus has been exhausted during the policy year. The basic sum insured will be re-instated only once in a policy year.

Enhanced Cumulative Bonus (Optional cover by paying extra premium)

The cumulative bonus shall automatically increase to 10% and the maximum cumulative bonus shall not exceed 100% of Basic Sum Insured. Thus, the Applied Cumulative bonus would automatically decrease by 10% of the Basic Sum Insured in the following Policy Year in case of a claim.

Co-pay(Optional Cover getting discount on base premium)

If an insured opts for 10%/20% co-pay, then it will be applicable on all claims
admissible under the following benefits.

  • In-patient Treatment,
  • Pre-Hospitalisation,
  • Post-hospitalisation,
  • Day Care Procedures,
  • Domiciliary Treatment,
  • Organ Donor,
  • Emergency Ambulance,
  • Ayush Benefit,
  • Newborn baby,
  • Maternity Expenses.

Exclusions of HDFC ERGO Health Suraksha Silver Plan

1. Any treatment done in the first 30 days from the policy commencement date is not covered (This doesn’t include accidental injuries).

2. Any pre-existing health condition before you availed of the policy will not be covered for the first 48 months.

3. Mental disorders and other treatments related to mental health, pregnancy, dental treatments, nuclear radiation are not covered.

4. Expenses are not covered that incurred from any type of cosmetic treatment, HIV, or Aids.

5. Exclusion of hospitalization expenses due to war or acts of war.

6. There are some exclusions for specific diseases for 2 years from the policy commencement date

7. Expenses incurred from unproven and investigational treatment are also not covered.

Claim Procedure

The insurance company should be intimated before the completion of 7 days from the date of hospitalization, the commencement of any treatment, procedure, or consultation. The insurer should pre-authorize these procedures.

Need to submit All the necessary documents and reimbursement claims to the company before the completion of 15 days from the date of discharge or completion of treatment(whichever is earlier). The insurance company will then pay the reimbursed amount to the policyholder.

Requirements documents to claim

1. Duly filled and signed claim form, along with HDFC ERGO policy number.

2. Original documents such as Discharge summary, bills with appropriate breakups, receipts, and medical invoices along with prescriptions, investigation reports like blood tests, X-rays, etc.

3. Any documents of treatments done in the past.

4. Medico-Legal Certificate (MLC) or FIR(In case of an accident).

5. NEFT details, canceled cheque, or passbook copy attested by the bank for payment.

6. For claim up to Rs. 1 Lakh and above, KYC form as well as a photocopy(KYC document such as Passports, Aadhaar card, Driver’s license, voters ID, etc).

On receiving all the documents correctly, the claim will process within 7 days of receiving the last document.

Contacts

Call –

022 6242 6242 (To buy policy)
022 6234 6234/0120 6234 6234 (For claim, renewal, and other services)

E-mail –

[email protected] (for network hospital issues)
[email protected] (for authorization issues)

Address –

D-301, 3rd Floor, Eastern Business District(Magnet Mall), LBS Marg, Bhandup(West) Mumbai-400098.

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