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Health Insurance


HDFC Ergo Health Insurance Group Assurance Health Plan (GAHP)

GAHP offered by HDFC Ergo Health Insurance Company Ltd. is a comprehensive plan designed to protect you and your family against expenses incurred in case of hospitalization. This health insurance policy can be customized to suit your requirements and budget.


Eligibility

  • The customer can buy the policy for self and/or any family member(s), children, parents
  • The insured should be above 3 months in case of floater and 6 years in case of individual. To cover children aged between 3 months to 5 years, the policy must also cover at least 1 adult
  • The Proposer needs to be aged above 18 years
  • Individual(s) proposed for Insurance whose age is 46 years & above have to undergo medical tests at designated diagnostic centers
  • The policy offers guaranteed lifetime renewability.
  • Income Tax benefits u/s 80D can only be availed for policies bought for Self, Spouse, Parents and Dependent children.

For details, kindly refer to the exclusion details and the waiting period of different types of disease.


Product Features:

  • Sum Insured Options: 2 Lakh, 3 Lakh, 4 Lakh, 5 Lakh, 7.5 Lakh, 10 Lakh & 15 Lakh
  • In-patient hospitalisation upto Sum Insured
  • Pre-hospitalisation 90 days
  • Post-hospitalisation 180 days
  • Day care procedures: 183-Day Care procedures
  • Daily Cash Benefit – Daily cash benefit of Rs. 1000 per day for upto maximum of 15 days
  • Restore Benefit Equal to 200% of basic Sum Insured
  • Preventive Health Check-up 1% of sum insured per policy at each renewal irrespective of claim, subject to max of Rs. 7500
  • Ambulance Cover Rs. 2000/- per hospitalisation
  • Double Sum Insured for 4 Critical Illness
  • Cumulative Bonus 10% for every claim free year subject to max 100% of the base SI

    Key Benefits:


    1. Double Sum Insured for Critical Illness (Indemnity based) -
    Increase in sum insured by 100% if the insured person is diagnosed as suffering from the below listed critical illnesses.
    • Cancer of Specified severity
    • Myocardial Infarction (First Heart Attack of specific severity)
    • Stroke resulting in Permanent Symptoms
    • Major Organ/Bone Marrow Transplant

    2. Double Restore Benefit
    Restoration of 100% of Basic Sum Insured if exhausted within the policy year. Subsequently, if the Restored Sum Insured as stated above gets exhausted due to claims made during the Policy Year then a Double Restore Sum Insured (equal to 100% of Base Sum Insured) will be automatically available for the particular Policy Year.

    3. Hospital Daily Cash
    Daily cash amount Rs. 1000 per day for a maximum of 15 days for each continuous & completed 24 hours of hospitalisation due to an Illness or an Accident during the Policy Period.

    4. E-Opinion in respect of Critical Illness - Second opinion by a Medical Practitioner from Our panel, for a Critical Illness suffered during the policy period.

 

Benefits

Product Offering

Inpatient Treatment

Pre Hospitalisation

90 days

Post Hospitalisation

180 days

Domiciliary Treatment

Day Care Treatment

Organ Donor

Ambulance Cover

AYUSH Benefit

Preventive Health Check up

Double Sum Insured for Critical Illness

Cumulative Bonus

Double Restore Benefit

Hospital Daily Cash

Rs. 1000 per day; max 15 days

E-Opinion in respect of Critical Illness

Freelook Cancellation


GENERAL/MEDICAL EXCLUSIONS

HDFC Ergo Health will not make any payment for any claim in respect of any Insured Person directly or indirectly for, caused by, arising from or in any way attributable to any of the following including their associated complications unless expressly stated to the contrary in this Policy:

  1. War or similar situations: Treatment directly or indirectly arising from or consequent upon war or any act of war, invasion, act of foreign enemy, war like operations (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defense, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind.
  2. Any Insured Person committing or attempting to commit a breach of law with criminal intent.
  3. Intentional self-injury or attempted suicide while sane or insane.
  4. Dangerous acts (including sports): An Insured Person’s participation or involvement in naval, military or air force operation, racing, diving, aviation, scuba diving, parachuting, hang-gliding, rock or mountain climbing in a professional or semiprofessional nature.
  5. Treatment of illness or injury as a consequence of the use of alcohol, tobacco, narcotic or psychotropic substances. vi. Prosthetic and other devices which are self-detachable /removable without surgery involving anesthesia.
  6.  Treatment availed outside India or treatment at a healthcare facility which is NOT a Hospital.
  7. Treatment of obesity and any weight control program
  8. Treatment for correction of eye sight due to refractive error.

  9. Cosmetic, aesthetic and re-shaping treatments and surgeries
    • a. Plastic surgery or cosmetic surgery or treatments to change appearance unless necessary as a part of medically necessary treatment certified by the attending Medical Practitioner for reconstruction following an Accident, cancer or burns
    • b. Circumcisions (unless necessitated by Illness or injury and forming part of treatment); aesthetic or change-of life treatments of any description such as sex transformation operations.


  10. Types of treatment, defined illnesses/conditions/supplies:
    • a. Non allopathic treatment (Would be covered in case claimed under AYUSH BENEFIT)
    • b. Conditions for which treatment could have been done on an outpatient basis without any Hospitalisation.
    • c. Charges related to peritoneal dialysis, including supplies
    • d. Admission primarily for administration of monoclonal antibodies or IV immunoglobulin infusion.
    • e. Experimental, investigational or unproven treatment devices and pharmacological regimens.
    • f. Admission primarily for diagnostic and evaluation purposes only.
    • g. Any diagnostic expenses which is not related and not incidental to any illness which is not covered in this Policy.
    • h. Convalescence, rest cure, sanatorium treatment, rehabilitation measures, respite care, long-term nursing care, custodial care, safe confinement, de-addiction, general debility or exhaustion (“run-down condition”).
    • i. Preventive care, vaccination including inoculation and immunizations (except in case of post-bite treatment);
    • j. Admission for enteral feedings (infusion formulas via a tube into the upper gastrointestinal tract) and other nutritional and electrolyte supplements
    • k. Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and associated expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips, and similar products.
    • l. Psychiatric, mental disorders (including mental health treatments), Parkinson and Alzheimer’s disease.
    • m. Sleep-apnoea.
    • n. External congenital diseases, defects or anomalies
    • o. Stem cell therapy or surgery, or growth hormone therapy.
    • p. Venereal disease, sexually transmitted disease or illness;
    • q. “AIDS” (Acquired Immune Deficiency Syndrome) and/or infection with HIV (Human Immunodeficiency Virus) including but not limited to conditions related to or arising out of HIV/AIDS such as ARC (AIDS Related Complex), Lymphomas in brain, Kaposi’s sarcoma, tuberculosis.
    • r. Any expense attributable directly or indirectly to pregnancy (including voluntary termination), miscarriage (except as a result of an Accident or Illness), maternity or child birth (including caesarean section), except in the case of ectopic pregnancy in relation to a claim for In-patient Treatment only.
    • s. Treatment for sterility, infertility (primary or secondary), assisted conception or other related conditions and complications arising out of the same.
    • t. Birth control, and similar procedures including complications arising out of the same.
    • u. The expense incurred by the Insured Person on organ donation.
    • v. Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure; muscle stimulation by any means except treatment of
    • w. fractures (excluding hairline fractures) and dislocations of the mandible and extremities.
    • x. Dental treatment and surgery of any kind, unless requiring Hospitalisation.

  11. Any non-medical expenses mentioned on our website(http://www.hdfcergohealth.com/downloadforms/List-of-Non-Medical-Expenses.pdf)

  12. Healthcare providers (Hospitals /Medical Practitioners)
    • a. Any Medical Expenses incurred using facility of any Medical Practitioners or institution that We have told You/Insured Person (in writing) is not to be used at the time of renewal or at any specific time during the Policy Period.
    • b. Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed.
    • c. Treatments rendered by a Medical Practitioner who is a member of the Insured Person’s family or stays with him, however proven material costs are eligible for reimbursement in accordance with the applicable cover.
  13. Any treatment or part of a treatment that is not of a reasonable charge and not Medically Necessary. Drugs or treatments which are not supported by a prescription.
  14. Admission for administration of Intra-articular or Intra-lesional injections, Monoclonal antibodies like Rituximab/Infliximab/Tratsuzumab, etc (Trade name Remicade, Rituxan, Herceptin, etc), Supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc) or IV immunoglobulin infusion.
  15. Any kind of service charge, surcharge, admission fees, registration fee levied by Hospital.

WAITING PERIODS

All Illnesses, treatments and their associated complications shall be covered subject to the waiting periods specified below:

  1. not liable for any claim arising due to condition for which appearance of signs/symptoms, consultation, investigation, treatment or admission started within 30 days from Policy Commencement Date, except for the claims arising due to an Accident. However, if the condition is one of the illnesses / diagnoses or surgical procedures mentioned in section B ii) below, then such coverage within 30 days would not be available even if arising out of an Accident.
  2. A waiting period of 24 months from the first Policy Commencement Date will be applicable to the medical and surgical treatment of illnesses / diagnoses or surgical procedures mentioned in the following table. However, this waiting period will not be applicable where the underlying cause is cancer(s).

 

Sl No

Organ / Organ System

Illness/diagnoses (irrespective of treatments medical or surgical)

Surgeries/procedures (irrespective of any illness / diagnosis other than cancers)

a.

Ear, Nose and Throat (ENT)

Sinusitis
Rhinitis
Tonsillitis

Adenoidectomy
Mastoidectomy
Tonsillectomy
Tympanoplasty
Surgery for nasal septum deviation
Surgery for Turbinate hypertrophy
Nasal concha resection
Nasal polypectomy

b.

Gynaecological

cysts, polyps including breast lumps
Polycystic ovarian disease
Fibromyoma
Adenomyosis
Endometriosis
Prolapsed Uterus

Hysterectomy

c.

Orthopaedic

Non infective arthritis
Gout and Rheumatism
Osteoarthritis
Ligament, Tendon and Meniscal tear
Prolapsed inter vertebral disk

Joint replacement surgeries

d.

Gastrointestinal

Cholelithiasis
Cholecystitis
Pancreatitis
Fissure/fistula in anus, Haemorrhoids,
Pilonidal sinus
Gastro Esophageal Reflux Disorder (GERD), Ulcerand erosion of stomach and duodenum
Cirrhosis (However Alcoholic cirrhosis ispermanently excluded)
Perineal and Perianal Abscess
Rectal Prolapse

Cholecystectomy
Surgery of hernia

e.

Urogenital

Calculus diseases of Urogenital system including Kidney, ureter, bladder stones
Benign Hyperplasia of prostate
Varicocele

Surgery on prostate
Surgery for Hydrocele/ Rectocele

f.

Eye

Cataract
Retinal detachment
Glaucoma

NIL

g.

Others

NIL

Surgery of varicose veins and varicose ulcers

h.

General
( Applicable to all organ systems/organs whether or not described above)

Benign tumors of Noninfectious etiologye.eg. cysts, nodules, polyps, lump, growth, etc.

NIL


36 months waiting period from Policy Commencement Date for all Pre-existing Conditions declared and/or accepted at the time of application. If the Policy is renewed for three consecutive years, the pre-existing diseases will be covered. To avail of this product and to continue with the product, it is essential to have a Banking account relationship with any branch of Bandhan Bank.

How to Renew Health Insurance?

Your health insurance policy needs to be renewed annually for you to continue availing its benefits. Nowadays, renewal has turned into a quick and easy process and should ideally be done 15 days prior to the expiry of your health insurance policy. In case, something unfortunate happens and medical expenses arise, it is always better to have the benefits your health insurance policy offers.
Health Insurance can simply be renewed by signing out a mandate form at the time of taking the policy. You need to maintain the required premium amount in your Bandhan Bank account at the time of renewal. The Bank account will be debited by the requisite premium amount 15 days prior to the renewal date. You will be receiving the renewed policy document in your registered E mail ID maintained with the Bank.
Moreover, for each year if no claims are made, a no claim bonus will be added to the total sum insured up to a maximum amount of the sum insured opted at the time of taking the policy.


How can a Health Insurance Claim be reported?

To report your claim:

Disclaimer:

For more details on risk factors, terms, conditions and exclusions, please read the sales brochure carefully before taking a policy. Insurance is underwritten by HDFC Ergo Health Insurance Co. Ltd. (HDFC Ergo Health) having Registered office at 101, First, Inizio,Cardinal Gracious Road, Chakala, Oppposite P & G Plaza, Andheri (East), Mumbai - 400069 IRDA Reg. No.131,  Toll Free no.     1800-102-0333.CIN (U66030MH2006PLC331263).

Bandhan Bank Limited (Bandhan Bank) with registered office at DN 32, Sector-V, Salt Lake, Kolkata 700001 (CIN: U67190WB2014PLC20462) is a Corporate Agent (Composite, IRDAI Regn No.: CA0530 valid till 19th November 2020) of HDFC Ergo Health. Insurance is underwritten by HDFC Ergo Health. Purchase by Bandhan Bank’s customer of any insurance products is purely voluntary, and is not linked to availment of any other facility from Bandhan Bank

BEWARE OF SPURIOUS / FRAUD PHONE CALLS!

  • IRDAI is not involved in activities like selling insurance policies, announcing bonus or investment of premiums.
  • Public receiving such phone calls are requested to lodge a police complaint.