HDFC ERGO Health Insurance Products Review

All of us need to earn, save and invest wisely in order to live a happy life. Similarly, the importance of providing for a few emergencies also calls for proper planning. Health and life insurance are very important and should be given due consideration. Lately the importance of having a good insurance policy is known to all because of the Covid-19 crisis. Especially the second wave of Corona virus has been an eye opener in India and people are understanding the importance of health insurance.  

It is imperative to study the policy before getting one. The significance of coverage of all our family members against all odds needs a thorough survey of which kind of health insurance policy should we choose to protect ourselves. Coronavirus is here to stay, and it is necessary that we are careful enough to provide for all kinds of future medical emergencies. Many are regretting either because they had no insurance cover, or they chose something that was not sufficient to cover their expenses, or that the policy had certain clauses which kept them away from fully enjoying the benefits of the health insurance they took.  

Today we shall discuss one such health insurance plan known as HDFC ERGO which is new and introduced mainly to take care of the ever-increasing medical inflation and offer quality healthcare.  

Why HDFC ERGO and what does it cover? 

Firstly, if we look at our primary motive, that is coverage against COVID-19, the policy looks affirmative. It offers hospitalization coverage against coronavirus treatment, subject to policy conditions. The following medical expenses for hospitalization are paid during the policy period for treatment of COVID-19: 

  • Stay charges (Isolation Room/ICU) 
  • Nursing charges 
  • Treating Doctor Visit Charges 
  • Investigations (Labs/Radiological) 
  • Oxygen/Mechanical Ventilation Charges (if required) 
  • Blood/Plasma Changes 
  • Physiotherapy, if required 
  • Pharmacy (except non-medicals/consumables) 
  • PPE Kit charges (as per government guidelines) 

Cashless claims can be made at any of the insurer’s network hospitals. Corona Kavach policies do cover home care treatment also. A claim for medical treatment undertaken at a hospital or nursing home can be made in that case. The treatment should be on the advice of and be actively managed by a qualified doctor. Even the expenses related to AYUSH treatment for COVID-19 are covered by the government’s approved methods of treatment. Home quarantine expenses are however not covered as it is meant to restrict the movement of individuals who may have been exposed to the virus but don’t have a confirmed diagnosis. 

When the hospitalization of all the family members is covered under the policy, the COVID testing charges of the other family members shall be covered when one of them is found positive. Vaccination charges too are covered for up to 2 doses for each insured member over 60 years in all the health policies. But when a medical practitioner recommends hospitalization for treatment of COVID-19, then only a claim can be made for the prescribed medication, otherwise not. When it comes to room rent, it differs from policy to policy, and you need to pay attention to it as many times the doctor’s visiting fees, nursing, and other diagnostic expenses too are proportionately equal to room rent or type. If the room rent is higher, so will be these expenses. 

If you already have a health insurance plan with HDFC ERGO, you don’t have to pay any extra premium for the coverage of COVID-19. 

Features of few of the important policies launched by HDFC ERGO as well as the inclusions and exclusions under each policy cover- 

1.Optima Restore 

100% Restore Benefit: Your cover gets restored after making the first claim. Optima restore is a unique health plan that restores your sum insured on partial or complete utilization of your health cover, for your future needs. Auto restoration of sum insured if unutilized during the year, 100% no claim bonus after 2 claim free years. Though a single claim in a Policy Year cannot exceed the sum of Basic Sum Insured and Multiplier Benefit, if any. 

2X Multiplier Benefit: If no claim is filed even once in the claim year, the policy offers renewal incentives. Up to 100% cover enhancement is available as no claim bonus. There will be a 50% increase in your basic sum insured for every claim year, subject to a maximum of 100%. In case a claim is made during a policy year, the limit under this benefit would be reduced by 50% of the basic sum insured in the following year. This reduction will not reduce the Sum Insured below the basic Sum Insured of the policy.  

Complementary Health Check-up: To track your well-being and help in early diagnosis of illness, a preventive health check-up is offered up to Rs.10,000 with this policy at the time of renewals. The health check-up benefit is available once in 2 years on a sum insured of Rs. 5 lakhs and once every year on a sum insured Rs 10 lakhs and above. 

Daily Hospital Cash: When someone gets admitted to a hospital, we get concerned about the bills daily, especially out-of-pocket expenses. Optima restore offers Rs.1000 per day and maximum of Rs. 6,000 per hospitalization on choosing shared accommodation for insurance cover worth Rs. 20 lakh and more. For the policy below Rs. 15 lakh it shall be Rs. 800 per day with a maximum of Rs. 4,800. 

What is included in the policy? 

The policy covers hospitalization expenses due to illnesses and injuries. Costs for diagnosis and follow up consultations are covered. Pre-hospitalization admission expenses up to 60 days and post-discharge expenses till 180 days are included. Urgent surgeries and treatments which get wrapped up in 24 hours are included as a part of all your daycare procedures. In case if you need to rush to the hospital out of an emergency, your ambulance costs are covered up to Rs.2000 per hospitalization. 

The medical and surgical expenses of the organ donor is covered when harvesting a major organ transplant. There is no sub-limit on room rent. When you stay at the hospital, you may choose a comfortable and convenient room for yourself without bothering about bills. The policy provides a complete coverage on room-rent, up to the sum insured. If you stay in a hospital for more than 10 days at a stretch, then a lump-sum payment of Rs.10,000 is made for other financial losses that might have happened due to your absence at home.  

Optima Restore covers advanced procedures like robotic surgeries, stem cell therapy and oral chemotherapy. Treatment of genetic disorders, injury or illness associated with hazardous activities, neurodegenerative disorders like Parkinson, Alzheimer, Peritoneal dialysis are also covered. One can continuously renew the health plan even after the age of 65 as the plan offers a life-long protection. Also, get an additional 10% off on premiums if you add 2+ members in a single Optima Restore-individual policy.  

Tax Benefit: The premium amount paid under this policy qualifies for deduction u/s 80D of the Income Tax Act, subject to applicable tax laws. 

What is excluded?

Adventure sport injuries, self-inflicted injuries resulting from the use and abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol are excluded from the policy cover. War related disasters, AIDS/HIV, Venereal or sexually transmitted diseases, treatment of obesity or cosmetic surgery are not covered. 

Waiting Periods

Few illnesses and treatments are covered after two years of policy insurance. Declared and accepted pre-existing conditions at the time of application will be covered after the first three years of continual renewals. Only accidental hospitalizations are admissible in the first 30 days from the date of policy issuance. 

In case of Coronavirus treatment, the situation is regarded as a medical emergency and the affected person can settle the claim via cashless treatment or reimbursement.

2.my: Health Suraksha

No Medical Test up to 45 years: It is better to secure your health while you are young to avoid medical tests. Get a policy under this plan when you are below the age of 45.

Free preventive health-checkups: my: Health Suraksha offers free health checkups.

Cumulative Bonus: Your health insurance plan is still useful even if you don’t make any claim. It rewards you with an additional 10% to 25% sum insured up to a maximum of 200% depending on the plan opted at the time of renewal.

Why my: health Suraksha Insurance-Silver Smart plan?

My: health Suraksha is a delight for individuals, families, and senior citizens looking for the right health cover ranging from 3 lacs to 5 lacs.

There is no room rent capping under this plan. With sum insured rebound, you get additional sum insured up to the base sum insured even if existing sum insured exhausts in a policy year. This acts like a magical back-up, which recharges your exhausted health cover to treat the next hospitalization of a new illness or injury. If the doctor recommends, you can avail medical treatment at home without paying for it. It shall be a cashless care facility. Your medical hospitalization due to illnesses and injuries are covered like every other health insurance plan. 

Pre-hospitalization expenses up to 60 days of admission and post discharge expenses till 180 days get covered like the costs for diagnostics, investigation etc. Again, those surgeries and treatments which take less than 24 hours are covered. AYUSH benefits, organ donor expenses and recovery benefits for your stay in a hospital for more than 10 days at a stretch are considered. The financial losses that might have happened due to your absence at home are paid. Expenses incurred for treating mental illnesses, and a free health check-up within 60 days after policy renewal done by HDFC ERGO at the time of renewing your policy will be covered by this plan. 

Once you get yourself secured with your health insurance plan, it continues for your entire lifetime on break free intervals without exiting it. It is available for all above 18 years of age.

Tax benefits: You can save up to Rs.75,000 with this plan under the income tax provisions. 

What is excluded?

Adventure sport injuries are not covered as they result from adrenaline rush and are hazardous in nature. Self-inflicted injuries, war related unfortunate outcomes too are not covered. Accidents that happen while participating in defense (Army/Navy/Air Force) operations, venereal or sexually transmitted diseases, treatment of obesity or cosmetic surgery too are excluded. 

Waiting periods are the same as in the case of Optima Restore.

3.Health Koti Suraksha

50 Lacs and 1 crore cover options: Health cover from two options of sum insured can be chosen by you.

No room rent capping: The benefit offered is to choose any room up to a standard private AC Room. In case of admission to a room exceeding the aforesaid category, the reimbursement or payment of Room Rent charges including all Associated Medical Expenses incurred at Hospital shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent charges.

Wider Pre & Post hospitalization: There is wider coverage of 60 days for pre￾hospitalization and 180 days for post-hospitalization expenses towards investigations, therapies and consultation charges. 

Cumulative Bonus: An additional 10% of the sum insured on every claim-free renewal is available which can go up to a maximum of 100%. When 2 or more members buy my: health Koti Suraksha on an individual sum insured basis a 10% family discount is given. 

My health Koti Suraksha plan also covers treatment for COVID-19.

Why should you choose 1 Crore health insurance plan?

The average healthcare inflation for India was 7.14% for 2018-19, witnessing a steep rise from 4.39% in previous year. To tackle this steep rise in medical expenses due to the rise in medical inflation is possible through a 1 crore health insurance plan. 

My: health Koti Suraksha plan is wide enough to cover you and your family without compromising on the quality of healthcare facilities. Those who are the whole and sole bread earner in the family need to take care of all financial aspects like home, car, child’s education etc. A single hospitalization may put a pause to your financial commitments. Medical emergencies may drain you. With this plan the over reliance on bank savings will not be needed anymore. At the same time, this high sum insured health insurance plan offers a health cover up to Rs.1 crore at pocket-friendly prices. 

In case your family has any history of critical illness like cancer, heart ailments etc.then this plan is very useful to you. We often ignore our health while chasing our deadlines and targets. Various lifestyle diseases are nowadays seen bothering even the younger generation. Unexpected medical expenses can hinder your progress and make your life stressful. If you get my: health Koti Suraksha, you will end up investing your hard-earned money in fulfilling your life goals instead of paying medical bills. 

If we look at the benefits offered by the policy, it covers Home Health Care for Medically Necessary Treatment of illnesses, if prescribed by a treating medical practitioner. Domiciliary Hospitalization too is covered subject to conditions. Alternative treatments like Ayurvedic, Unani, Siddha and Homeopathy are also covered. 

Moreover, Health coaching services are provided for disease management, activity and fitness, nutrition, weight management and psychological counselling. 

Then there are other wellness services, preventive health check-up and fitness discounts which are offered under this scheme.

Tax benefits: The amount of premium is deductible under section 80D of the Income Tax Act, according to the applicable limits. 

What is excluded?

There are certain expenses which are not covered under my: health Koti Suraksha plan. They are investigation and evaluation expenses, for just diagnostic purposes. Rest, cure, rehabilitation and respite care either at home or in a nursing facility for personal care such as help with activities of daily bathing, dressing, moving around either by skilled nurses or assistants or non-skilled persons. This includes any services for people who are terminally ill to address physical, social, emotional and spiritual needs. Various expenses regarding Obesity or weight control are listed which are not covered. 

Payment of premium can be made on a yearly, half yearly, quarterly or monthly basis.  

Waiting periods: For all illnesses except accidents, it is 30 days in the first year and is not applicable in subsequent renewals. Specific illnesses and treatments take 24 months in the first two years and are not applicable in subsequent renewals. In case of Pre-existing diseases coverage starts after a waiting period of 48 months. 

4.My: Health Medisure Super Top-up

It works on Aggregate Deductible: When your all round total claim amount reaches the aggregate deductible, this health plan comes into action. Unlike other top-up plans, there is no condition for a single claim to meet the deductible.

No health checkups upto age 55: All those who are below 55 years of age should secure themselves using this health plan as there are no check ups required for getting it. When you are young, you can avoid medical tests and thereby avoid many other complications. 

Pay less, Get more: If you go for a long-term policy, say of 2 years, then you will get a 5% discount. If a family of more than 2 members on Individual Sum Insured basis are covered, a 10% discount is offered. 

Other important features-

This particular policy takes care of all your loved ones. It covers all encompassing and provides health cover to your parents, in-laws, niece, nephew, spouse and children.

The best health cover is assured by this health plan by paying constant premiums post 61 years. 

What is included?

Full coverage is ensured upto the sum insured without any sub-limits under this plan. Pre and post hospitalization are given fully without compromising health care.Pre hospitalization covers expenses incurred 30 days prior to admission in a hospital and for post hospitalization, it extends to 60 days after you have been discharged from hospital.

Expenses incurred towards your hospitalization on room rent/ICU/Therapeutic Unit, Medical Practitioner fees, Anaesthetist fees, nurse fees, blood, oxygen and anaesthesia are covered. Some of the most advanced surgeries are now covered under day care. With this plan the entire family can get full coverage upto sum insured. The policy covers expenses for the treatment of diseases that you have before taking the policy.  However, this is covered only after 3 continuous renewals.

Higher Sum Insured at a low premium with option of choosing from a wide range of deductibles. 6 hours response guarantee on every cashless claim or a penalty is paid by the insurer. 

What is excluded?

There are conditions for all pre-existing diseases and a detailed description of the same is given by the insurer. Just like the other policies described earlier, adventure sport injuries, self-inflicted injuries, war related claims, accidents while participating in defense operations, venereal or sexually transmitted diseases and expenses related to treatment of obesity or cosmetic surgery are not covered by this plan. 

Doubts regarding whether any discounts shall be available on health insurance policy premiums after getting vaccinated.

There is a certain amount of uncertainty prevailing about discounts being offered on health insurance policy premiums for those who have been vaccinated. As the effectiveness of the vaccines are still not clear, there are chances that the insurers will not offer any discounts on normal premiums for those who get vaccinated. Currently the health policy does not have provisions for discounts over the approved rates.  Moreover, those who have been vaccinated continue to carry a risk and the insurer is thereby not expected to remove the coll-off waiting period or charge a lower premium.

Vaccination discounts on premium may become a practical reality only if the world is again hit by the virus and masses are affected by it. Insurers might put weightage on vaccination to decrease the rapid claims made by the holders of the policy. 

However, the individuals who have co-morbidities and have already been vaccinated will have a milder loading/copay than a person with same co-morbidities and is not vaccinated. The reason being, a vaccinated person’s hospitalization bill could get reduced to a large extent because of the vaccines he has taken.

In near future the waiting period for policyholders who get Covid-19 may get waived if the insurance buyer is vaccinated. Waiting periods were introduced due to higher amounts of Covid-19 related claims. Before issuing the policy it ranges from 3 months for Covid recovered insurance buyers who did not need hospitalization and six months for those who had to be hospitalized.

There are probable long-term effects of Covid-19, and the insurers are extremely careful while issuing policies to even those individuals who have recovered from the disease. To decrease the losses arising out of the claim outgo, the insurers are already working out to underwrite more healthy lives. Underwriting in order to carry out the risk assessment process in future to decide whether the policy can be issued to you or not and at what price. 

The silver line being some of the insurers saying that covid claims will not result in a reduction of the no-claim bonus. And there will be a marginal amount of relaxation as the Insurance Regulator has already mandated to cover Covid-19 claims under the regular on-going health policies, which include coverage for various other diseases/ailments.

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Krishna Rath is a SEBI Registered Investment Adviser, and since 2015 has been educating netizens on investments and insurance. Krishna is a fee only SEBI RIA and is Odisha's first SEBI RIA. With background in IT, Krishna is changing the advisory space with new innovations in AdvisoryTech.

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