HDFC Ergo My Health Suraksha

Let's Get To Know The Product Better!

HDFC Ergo My Health Suraksha is a health insurance plan crafted by HDFC ERGO General Insurance Company Limited. It offers assurance and financial security, ensuring that you and your loved ones can access necessary medical care without the anxiety of unexpected expenses. This health insurance policy is designed with a comprehensive array of features, benefits, and discounts, adding to its overall cost-effectiveness. It presents three distinct variants – Silver Smart, Gold Smart, and Platinum Smart, tailored to meet diverse healthcare needs.

Are You Eligible?

• Minimum Age Of Entry:

  • Adults- 18 years
  • Dependent children - 91 days
• Maximum Age Of Entry:
  • Adults - 65 years.
  • Dependent children - 25 years.
     

A Comprehensive Overview Of The Product's Benefits And Limits

Beyond addressing inpatient hospitalisation costs, encompassing room and boarding charges, nursing fees, medical practitioner's expenses, prescribed medicines and drugs, ICU charges, and related expenses for hospital stays exceeding 24 hours, the HDFC Ergo My Health Suraksha Plan extends coverage to various other essential expenses, including -

• Pre- & Post-Hospitalisation Expenses
  Before and after your hospital stay, there could be various medical procedures like doctor consultations, diagnostic tests, check-ups, physiotherapy, and more that you might need. The policy covers these expenses up to the sum insured for a significant period – 60 days before you get admitted and 180 days after you're discharged. It's important to note that these expenses qualify for coverage only if they are related to the medical condition that resulted in your hospitalisation, and the claim is approved under the inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Daycare treatments refer to medical procedures or surgeries that, due to advancements in healthcare technology, can now be completed within 24 hours, eliminating the need for prolonged hospital stays. The HDFC Ergo My Health Suraksha Plan offers coverage for all daycare procedures without any limit, ensuring financial protection up to the selected sum insured.
   
• Domiciliary Treatment Coverage
  Domiciliary treatments are medical treatments rendered for illnesses or injuries that necessitate urgent hospital attention but can be given at the comfort of your home if you are too sick to be moved to the hospital or there is an unavailability of hospital beds nearby. And, the good news is that the HDFC Ergo My Health Suraksha Plan provides coverage for domiciliary treatments up to the sum insured.
   
• Organ Donor Coverage
  The HDFC Ergo My Health Suraksha Plan has your back when it comes to organ transplantation. If you're the recipient, the plan covers the inpatient expenses of the organ donor up to the sum insured you choose under your policy.
   
• Modern Treatment Coverage
  As healthcare continues to advance rapidly through innovative technologies, modern treatments that were once considered impossible are now becoming a reality. The HDFC Ergo My Health Suraksha Plan is crafted to stay in step with these breakthroughs, providing coverage for expenses linked to these cutting-edge treatments up to the sum insured.
   
• Cumulative Bonus (No Claim Bonus)
  If you stay healthy and don't make any claims in a policy year with the HDFC Ergo My Health Suraksha Plan, you'll receive an annual bonus. This bonus boosts the sum insured for each year without claims, up to a specific limit determined by your chosen plan variant. It's worth noting that if a claim is made in the future, the accumulated bonus will decrease at the same rate at which it was earned.
  Here is a table outlining the allocation of No Claim Bonus based on the variant type, along with the corresponding maximum limit -

• Sum Insured Rebound (Restoration Benefit)
  This feature ensures that your sum insured is replenished when it's exhausted within a policy year. The restore benefit comes into play when you fully or partially utilise your base sum insured, making it available for subsequent claims throughout the policy year. You have the flexibility to use this benefit once each policy year for both unrelated and related illnesses, provided you consistently renew your policy. Opting for an add-on expands this advantage, allowing you to utilise the benefit an unlimited number of times in a policy year. It's important to note that for chemotherapy and dialysis, the restore benefit applies only once in a lifetime.
   
• Room Rent Limit
  The maximum coverage provided by your insurance company for the hospital room you choose is referred to as the room rent limit. Opting for a room within this limit ensures that you won't face any additional out-of-pocket expenses. However, if you decide on an expensive room with a higher rent than your eligibility allows, you will encounter a proportionate deduction. This means you are responsible for paying a proportionate share of the entire bill, instead of just the difference in room rent. With HDFC Ergo My Health Suraksha Plan, you have the flexibility to choose any room, be it a shared room, single room, deluxe room, or any available option. It doesn't impose restrictions on room rent, giving you the freedom to select the room that suits your preferences.
   

Check Out Some Highlighting Features Of The Product!

• My Health Active
  This is an incredible feature under the HDFC Ergo's HDFC Ergo My Health Suraksha Plan that introduces a compelling fitness and health initiative. If you engage in physical activities, such as walking or exercises, you can enjoy renewal premium discounts, subject to the terms and conditions specified in the policy document. Moreover, maintaining a normal BMI and managing listed pre-existing conditions like diabetes, hypertension, etc. can lead to discounts on medical underwriting loading during renewal. The initiative goes beyond mere coverage, offering various wellness services, including access to a health coach, diet consultation, monthly newsletters, stress management, and more.

• Mental Healthcare
  The policy encompasses inpatient expenses for medical illnesses or disorders, offering coverage up to the chosen sum insured. This provision is designed to empower individuals grappling with mental health challenges to access professional assistance without financial constraints. It's crucial to emphasise that this coverage applies specifically when treatment is administered in a mental health establishment and is governed by the provisions outlined in the Mental Health Care Act, 2017.
   
• No Financial Limits On Treatments/Disease
  If the insurer has not explicitly excluded coverage for a particular illness, you are eligible to claim the full amount up to the chosen sum insured, regardless of the specific ailment you’re facing. This policy stands out by not imposing restrictive treatment or disease-wise sub-limits, ensuring that procedures such as cataract treatments, joint replacement surgeries, etc. are not subject to predetermined financial constraints.
   

Understanding Waiting Periods

When you secure health insurance, there's a waiting period before it starts covering certain illnesses or diseases. It's essentially the time you have to patiently wait before you can claim for these specific conditions. Now, let's dive into the different types of waiting periods –

• Initial Waiting Period
  Except for accidents, all medical conditions come with an initial 30-day waiting period. In simpler terms, you won't be able to make a claim for hospitalisation within the first 30 days, unless it's a result of an accident.

• Pre-Existing Diseases Waiting Period
  A pre-existing disease is essentially any medical condition or illness you've dealt with in the 48 months before applying for a health insurance policy. With the HDFC Ergo My Health Suraksha Plan, there's a waiting period of 48 months for pre-existing conditions. Throughout this time, the policy won't cover any expenses related to your pre-existing disease.
• Waiting Period For Specific Diseases
  Insurers typically maintain a list of specific medical conditions or illnesses, distinct from your pre-existing conditions, that come with a waiting period. This waiting period is applied irrespective of whether you've had those diseases before or not. Importantly, this waiting period is solely set by the insurer and is not affected by your current health status. Under the HDFC Ergo My Health Suraksha Plan, there's a waiting period of 24 months in place for specific diseases as outlined by the insurer.
   

What The Plan Doesn’t Cover?

Exclusions are those situations that are not covered in your health insurance and are of many types –

• Standard Permanent Exclusions: Standard permanent exclusions are set by IRDAI, which all insurance companies must adhere to. Some of them include –

  • Investigation And Evaluation: Hospital admission solely for observation or monitoring purposes.
  • Rest Cure, Rehabilitation, And Respite Care: Admission specifically for bed rest without undergoing any active treatment.
  • Obesity/Weight Control: Treatment or surgery designed for weight control or obesity.
  • Change Of Gender Treatment: Treatments meant to alter the body's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Procedures designed to modify body characteristics or appearance.
  • Profession In Hazardous Or Adventure Sports: Treatment expenses for professional participation in adventurous activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Breach Of Law: Expenses for treating individuals who have committed or attempted a criminal act.
  • Excluded Providers: Treatment taken from medical practitioners or hospitals not covered by the insurance company.
  • Narcotics: Treatment designed for addictive conditions like alcohol, drug addiction, etc.
  • Treatments In Establishments For Domestic Purposes: Expenses for treatment in health spas, nursing homes, or similar places arranged for domestic reasons.
  • Dietary Supplements, Unprescribed Substances: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Expenses for correcting refractive errors up to 7.5 diopters for better eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments which are not proven to be effective.
  • Expenses Related To Birth Control, Sterility, Infertility: Contraception, artificial insemination, sterilisation and advanced reproductive technologies like IVF, GIFT, ZIFT, ICSI, gestational surrogacy, etc.
  • Maternity Expenses: Costs associated with pre/post-natal care, childbirth-related hospitalisation, etc.

• Additional Permanent Exclusions
  Beyond the standard permanent exclusions mentioned earlier, insurance companies might add extra exclusions for specific situations or medical conditions. If you have certain diseases or serious medical conditions that insurers find risky to cover, they may decide to permanently exclude them from your policy. It's crucial to bear in mind that insurers can only apply a permanent exclusion based on a list of illnesses enclosed by the Insurance Regulatory and Development Authority of India (IRDAI).
• Non-Standard Exclusions (Specific Exclusions)
  These are specific exclusions that go a step further than the standard permanent exclusions provided by the IRDAI. The specifics of these exclusions can differ between insurance companies and may hinge on the terms and conditions of the policy. Below are some of the specific exclusions under the HDFC Ergo My Health Suraksha Plan -
  • Participation or involvement in naval, military, air force operation, etc.
  • Expenses related to investigative treatment for sleep-apnoea, general debility or exhaustion (“run-down condition”).
  • Expenses related to congenital external diseases, defects or anomalies
  • Expenses related to stem cell harvesting
  • Circumcisions unless deemed necessary for an illness or injury and forms a part of treatment.
  • Expenses related to vaccination including inoculation and immunisations except in case of post bite treatment
  • Expenses related to hearing aids, spectacles or contact lenses
  • Type of non-allopathic treatment except Ayurveda, Unani, Siddha and Homoeopathy
  • Expenses related to treating alopecia, baldness including corticosteroids and topical immunotherapy wigs, toupees, hair pieces, any nonsurgical hair replacement method.
  • Expenses associated with optometric therapy
  • Expenses related to investigative treatment for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure or for muscle stimulation by any means except in case of fracture treatments (excluding hairline fractures) and dislocations of the mandible and extremities.

Summary

Here’s Your Reading Material!

• Brochure Link: https://www.hdfcergo.com/docs/default-source/downloads/brochures/myhealth-suraksha-brochureaddfd5a1e98c4e25a83076f1e9cd856e.pdf

• Policy Wording Link: Revised PW (For policy issued after 30th November 2023)- HDFC ERGO General Insurance Company Limited Policy Wordings my:health Suraksha

FAQs

1. Does HDFC Ergo My Health Suraksha Plan have room rent restrictions?
   No. HDFC Ergo My Health Suraksha Plan gives you the freedom to choose any room available in the hospital - single private room, share room, deluxe room, etc.

2. Does HDFC Ergo My Health Suraksha Plan cover AYUSH treatments?
   Yes, the HDFC Ergo My Health Suraksha Plan provides coverage for alternative or AYUSH or non-allopathic treatments like Ayurveda, Unani, Siddha and Homeopathy up to the sum insured.
    
3. Under HDFC Ergo My Health Suraksha Plan, what is the maximum cover you can opt for?
   The maximum cover you can choose depends on the specific plan variant you opt for -
    

4. Does HDFC Ergo My Health Suraksha Plan cover domiciliary treatments?
   Yes, HDFC Ergo My Health Suraksha Plan provides coverage for domiciliary treatments up to the sum insured.
    
5. What are the entry age restrictions under HDFC Ergo My Health Suraksha Plan?
   The plan is open for enrollment to adults starting from 18 years up to a maximum of 65 years. And, dependent children within the age range of 91 days to 25 years can also be enrolled in the policy.