HDFC ERGO Health Suraksha Gold with Regain and ECB
HDFC ERGO Health Suraksha Gold with Regain & ECB is a comprehensive health insurance plan with superior inbuilt benefits and coverage. In addition to the basic covers of hospitalisation and medical expenses, the plan offers Sum Insured Regain Benefit, Enhanced Cumulative Bonus (ECB), Maternity Benefit and E-opinion.
Key Features
Automatic availability of Sum Insured upon its exhaustion during the policy year
Up to 45 years
At 10% per claim free year up to 100% of Sum insured
Lump sum payment of 1% of the sum insured up to a maximumof Rs. 10,000 in an event of hospitalization exceeding 10 continuous and completed days.
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. Additional 5% premium will be charged on the base premium.
Benefits
Covers medical expenses for hospitalization due to an illness or accident. The medical expenses for room rent, boarding expenses, nursing, intensive care unit, medical practitioner(s), medicines or drugs and other related expenses will be paid.
The medical expenses incurred due to an illness in 60 days immediately before the insured person was hospitalized
The medical expenses incurred in 90 days immediately after the insured person was discharged post hospitalization
The medical expenses for 144 day care procedures which do not require 24 hours hospitalization.
he medical expenses incurred by an Insured Person for availing medical treatment at his home which would otherwise have required hospitalization.
The medical expenses for an organ donor's treatment in the event of organ transplantation
Expenses covered for utilizing ambulance service for transporting insured person to hospital
Medical expenses for in-patient treatment taken under Ayurveda, Unani, Sidha or Homeopathy mode of treatment up to the limit of Sum Insured
Medical expenses for maternity including pre-natal and post-natal expenses after a waiting period of 4 years - Rs. 15, 000 for Normal Delivery, 25,000 for LSCS and Rs. 15,000 for termination.
Coverage for newborn from birth
How it works
Regain benefit means the policy will automatically provide you with the basic sum insured upon its exhaustion (inclusive of any cumulative bonus) during the health insurance policy year.
Example –
Policyholder makes a claim of 5 lacs and exhausts the entire sum insured amount for Illness 01. Now within the same year the policyholder is admitted for Illness 02. Under HDFC Ergo Health Suraksha Gold with Regain & NCB the sum insured with automatically go back to 5 lacs and the policyholder can make a claim again.
Notes –
- Basic sum insured will be re-instated only once in health insurance policy year
- If the Regain SI is not utilized in a policy year, it shall not be carried forward to any subsequent insurance policy year.
- Regain benefit cannot be withdrawn at subsequent renewals
- Regain SI can be used for only future claims and not against any claim for an illness/disease (including its complications) for which a claim has been paid in the current policy year
Additional Benefits/Features of HDFC ERGO Health Suraksha Gold with Regain & ECB
- Discount on Health checkup – up to 1% of Sum Insured, maximum up to Rs. 5000 for a Health Checkup after 4 consecutive claim-free year.
- Cashless Treatment at Network Hospital
- Individual and Family Floater option
- No entry age limit
- Coverage period - one year or two years
- Maximum cover up to– 10 lacs
- Tax Benefit under section 80D
- Free look – If the policy holder is not convinced with the Terms and Conditions of the policy, then h/she can cancel the policy within 15 days of receipt of policy document.
Eligibility
| Minimum | Maximum | |
| Sum Insured | 3,00,000 | 10,00,000 |
| Entry Age | 91 days | No Limit |
| Maximum Renewal Age | - | Lifetime |
| Policy Term | 1 year | 2 years |
Exclusions
- Any treatment within first 30 days of cover except any accidental injury
- 2 years waiting period for Particular Diseases and Treatment such as surgery on tonsils and sinuses, cysts, internal tumor etc.
- Pre-existing conditions will not be covered for first 48 months
- Expenses arising from HIV or AIDS and related diseases.
- Mental disorder or insanity, cosmetic surgery, weight control treatment
- Abuse of intoxicant or hallucinogenic substance like drugs and alcohol
- Hospitalization due to war / acts of war, nuclear, chemical / biological weapon & radiation of any kind
- Pregnancy, dental and external aids and appliances unless covered under specific plans
- 2 year exclusions for specific diseases
- Experimental, investigational or unproven treatment, devices and pharmacological regimens
