HDFC Ergo Group Health Insurance Policy – Features, Benefits, Exclusions, Claim Process, Eligibility Criteria, Free Quote Online

What is HDFC Ergo Group Health Insurance Policy?

HDFC Ergo Group Health Insurance Policy is a comprehensive Group Health Insurance Plan purchased by employers to insure their employees against Hospitalisation Expenses incurred because of unexpected illnesses, injuries or accidents. The Policy covers expenses incurred by the Insured towards Room Rent, Doctor’s Fees, Surgery, Medicines etc. HDFC Ergo General Insurance Company is one of the leading Insurance Company for Group Health Insurance Policy for employees. A Group Health Insurance Policy provides reimbursement for the hospitalisation expenses incurred by the employees during the Policy Period. Group Health Insurance Policies are a popular choice for many companies as they provide coverage for a group of people at affordable premiums.

About HDFC Ergo General Insurance Company

HDFC ERGO General Insurance Company is a joint venture between HDFC Ltd. and ERGO International AG. HDFC Ergo is the 4th largest General Insurer in India with a Market Share of 6.5% and the second largest Private General Insurer.

What are the Key Features of HDFC Ergo Group Health Insurance Policy?

HDFC Ergo Group Health Insurance Policy is comprehensive Group Health Insurance Policy providing the following coverages:

1. Coverage for Hospitalization Expenses: HDFC Ergo Group Health Insurance Policy provides coverage for Hospitalization Expenses including expenses for Room Rent, Doctor’s Fees, Nursing Charges, Pharmacy Charges, Surgery Charges, and other medical expenses.
2. Coverage for Pre and Post-Hospitalization Expenses: In addition to Hospitalization Expenses, HDFC Ergo Group Health Insurance Policy Coverage includes cover for Pre and Post-Hospitalisation Expenses incurred for the Insured Employee for a period of 30 days and 60 Days respectively.
3. Coverage for Domiciliary Hospitalization: HDFC Ergo Group Health Insurance Policy provides coverage for expenses incurred towards Domiciliary Hospitalization.
4. Coverage for Pre-Existing Diseases: HDFC Ergo Group Health Insurance Policy covers Pre-Existing diseases without any waiting period. Pre-Existing Diseases are covered from Day 1, which is a big benefit of Group Health Insurance Policy.
5. Maternity Benefits: HDFC Ergo Group Health Insurance Policy provides coverage for maternity expenses including pre and postnatal care, delivery expenses and new-born baby cover. The Employer can choose various Sum Insured options for Maternity Coverage, from Rs35,000 to Rs1 lakh, under the Policy. Maternity Coverage under a Group Mediclaim Policy is very helpful for female employees as well as spouses of male employees.
6. Coverage for Day Care Procedures: HDFC Ergo Group Health Insurance Policy covers a wide range of daycare procedures like cataract surgery and tonsillectomy that do not require hospitalization.
7. Global Emergency Hospitalization Cover (outside India only): HDFC Ergo Group Health Insurance Policy has an option for the employer to opt for a Global Emergency Hospitalization Cover. This cover provides Medical Expenses coverage and Daycare Procedures to employees requiring Emergency Hospitalisation outside India. This cover is very useful for employees who travel frequently.
8. Tax Benefits: Employers can claim deduction for the Premiums Paid towards HDFC Ergo Group Health Insurance Policy for Employees. The Tax Benefits of a Group Health Insurance Policy make it an attractive option to provide employee benefits for employers. Additionally, the Insurance Claim amount received by employees is also Tax-Free.

What are the Major Exclusions in HDFC Ergo Group Health Insurance Policy?

The major exclusions in HDFC Ergo Group Health Insurance Policy are as follows:

1. Change of gender treatments or cosmetic surgeries/procedures are not covered by the Policy
2. Expenses relating to treatment of obesity or treatment for weight control are not covered unless the conditions mentioned in the policy are covered
3. Expenses incurred for any treatment required due to injuries caused by participation in hazardous or adventure sports will not be covered by HDFC Ergo Group Health Insurance Policy
4. Expenses incurred for admission mainly for investigation or diagnostic purposes are excluded under the HDFC Ergo Group Health Insurance Policy
5. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof

What is the Claim Process for HDFC Ergo Group Health Insurance Policy?

The claim process for HDFC Ergo Group Health Insurance Policy is listed below:

HDFC Ergo Group Health Insurance Reimbursement Claims Process

1. Intimate the Insurance Claim to the HDFC Ergo General Insurance Company. The Insurance Company will provide a Claim Intimation Number so that the Claim Status can be tracked.
2. Make the payment to the hospital for the medical expenses incurred and keep original copies of all the Invoices.
3. Submit the required documents to the Insurance Company
4. HDFC Ergo will verify the Claim Details, ask for additional documents if required and will approve or reject the Claim.
5. The approved Claim Amount gets credited directly to the Bank Account of the Insured

What are the documents Required for a Reimbursement Claim under a Health Insurance Policy?

The Insured needs to submit the following documents to HDFC Ergo to avail Reimbursement Claim Settlement under the Policy:

1. ID Proof and Mediclaim Card
2. Duly Filled and Signed Claim Form
3. Diagnostic Reports
4. Prescriptions and Pharmacy Bills
5. Pre and Post-Hospitalisation Bills
6. Final Hospital Bills
7. Discharge Summary

HDFC Ergo Group Health Insurance Cashless Claims Process

The Cashless Claim Settlement Process under HDFC Ergo Group Health Insurance Policy is as follows:

1. The Insured Employee approaches the nearest Network Hospital covered by the Company.
2. Show the Health Card issued by the Insurance Company to the insurance desk at the hospital and fill the Pre-Authorization Claim Form provided by the hospital
3. The Hospital sends the Claim Form alongwith other relevant documents to HDFC Ergo for Claim Settlement
4. HDFC Ergo will inspect the details and inform the Insured about the approval or rejection of the Claim
5. Once the Claim gets approved, the hospital sends the expenses and receipts to the Insurer and the hospital gets reimbursed for the treatment expenses directly by HDFC Ergo General Insurance Company.

The advantage of cashless claim settlement is that the Policyholder does not need pay any amount from his own pocket as the Group Health Insurance Company directly settles the claim with the hospital. You can view the list of HDFC Ergo network hospitals at this Link – HDFC Ergo Network Hospital List

How to purchase a HDFC Ergo Group Health Insurance Policy for Employees?

Qian is a licensed Group Health Insurance Broker and can assist you to purchase a Comprehensive Group Health Insurance Policy for Employees. Employers need to follow the below mentioned steps to purchase a HDFC Ergo General Insurance Policy for employees:

1. Contact Qian: If you wish to purchase a HDFC Ergo Group Health Insurance Policy for Employees, contact the Group Health Insurance Team at Qian by mailing them at insurance@qian.co.in. Provide them with employee data details such as employee name, date of birth and gender.
2. Finalise Coverage and Quote: The second step is to finalise the Policy Coverage based on the budget and requirements. The team at Qian will provide you with quotes from top Group Health Insurance Companies in India so that you can finalise the policy
3. Onboard Employees: After purchasing HDFC Ergo Group Health Insurance Policy, the team at Qian will assist you with the onboarding process for employees, share E-Cards and also assist you with the entire Claims Process in Group Health Insurance Policy.

What are the Benefits of HDFC Ergo Group Health Insurance Policy?

1. Affordable Premiums: The Premiums for HDFC Ergo Group Health Insurance Policy are affordable and much lesser than Individual Health Insurance Policies.
2. Comprehensive Coverage: HDFC Ergo Group Health Insurance Policy provides comprehensive coverage for hospitalization expenses, including pre and post-hospitalization expenses, ambulance charges, and maternity benefits.
3. Cashless Hospitalization: The policy offers cashless hospitalisation facilities across a network of more than 13,000 hospitals across India. This means that the Insured Employee can avail cashless treatment across all major hospitals in India and does not have to worry about arranging cash for hospitalization expenses.

Is Medical Check-up Required Before Buying HDFC Ergo Group Health Insurance Policy?

HDFC Ergo Group Health Insurance Policy does not require pre-medical check-up for any of the Insured Employees. This is a big advantage of HDFC Ergo Group Health Insurance Policy.

Download HDFC Group Health Insurance Policy Wordings

HDFC Group Health Insurance Policy Wordings can be downloaded at the following link: HDFC Group Health Insurance Policy Wordings

Download HDFC Group Health Insurance Policy Claim Form

HDFC Group Health Insurance Policy Claim Form can be downloaded at the following link: HDFC Group Health Insurance Claim Form

Buy HDFC Ergo Group Health Insurance Policy With Qian!

HDFC Ergo Group health Insurance Policy offers comprehensive coverage at very reasonable premiums. At Qian, we can customize the features of Group Health Insurance Policy as per the needs and the budgets of the employer and also assist in providing a hassle-free claim settlement process. If you wish to purchase a Group Mediclaim Policy for employees, you can email us at insurance@qian.co.in or call us on 022-35134695. We would be glad to assist you