HDFC ERGO Critical Illness offers lump-sum compensation in one single transaction to cover costs incurred during the medical treatment when an individual is inflicted with an illness or disease. Having such a plan over and above one’s existing health plan i.e. a family or an individual plan can be extremely beneficial as it provides for a larger cover. As per this benefit plan, one gets the lump-sum amount on the first diagnosis itself.
Types of HDFC Critical Illness Policy
Under the Critical Illness Insurance Silver and Platinum plans the following illnesses or diseases are covered:
| Silver | Platinum |
| Heart Attack | Heart Attack |
| Multiple Sclerosis | Multiple Sclerosis |
| Stroke | Stroke |
| Cancer | Cancer |
| Major Organ Transplantation | Major Organ Transplantation |
| Coronary Artery Bypass Surgery | Coronary Artery Bypass Surgery |
| Paralysis | Paralysis |
| Kidney Failure | Kidney Failure |
| Aorta Graft Surgery | |
| Primary Pulmonary Arterial Hypertension | |
| Heart Valve Replacement | |
| Parkinson’s Disease | |
| Alzheimer’s Disease | |
| End Stage Liver Disease | |
| Benign Brain Tumor |
One can choose the sum insured within a range from Rs. 2,50,000 to Rs. 10,00,000.
Eligibility Criteria for HDFC ERGO Critical Illness Policy
Individuals in the age range of 5 years to 45 years are eligible to purchase the policy. The plan automatically covers children within the age range of 5 to 18 years when both the parents are insured under this policy. No pre-policy checks are required for people under the age of 45 years.
Features of HDFC ERGO Critical Illness Policy
The payment of the lump sum will be made to the insurer on the first diagnosis of any of the diseases covered as part of the Critical Illness plan, provided that the insured person survives a period of 30 or 15 days from the date of the first diagnosis.
Condition for payment means –
- The date of confirmed diagnosis and defined severity if any
- Or date of undergoing special surgery as applicable to the specific disease
The policy shall terminate on the occurrence of the first critical illness and the insurer shall receive the sum insured as per the guidelines, thus the policy will cease with no subsequent renewals for the insurer.
The sum of insurance can range between Rs. 100,000 to Rs. 50,00,000.
Benefits of HDFC ERGO Critical Illness Policy
Mentioned below are the important benefits of HDFC ERGO Critical Illness Policy:
- Provides lump-sum amount after the first diagnosis
- The amount can be used for multiple purposes such as
- Medical care and treatment
- Investing in recuperation and aids
- Settling of debts if any
- Can compensate for the lost income due to decreasing ability to earn
- Accommodate changes in lifestyle
- Tax benefits under the section 80D
Points to Consider before Purchasing a Plan
HDFC ERGO Critical Illness Plan offers an opportunity to people and their families to bank on a reliable financial source which means a certain sum assured in case of detection of a critical disease. The purpose for opting for HDFC Critical Illnesses plans may be diverse. It would be a good option for individuals who may have a family history of some illnesses which are covered in the plan. Another consideration is that after crossing the age of 40 years many individuals opt for some kind of health benefits as with age the susceptibility to diseases increases. And individuals sense a need to protect them and their families.
Filing Claim with HDFC ERGO Critical Illness Policy
HDFC ERGO General Insurance company will process and settle all claims under this policy within 14 days of the diagnosis of the first occurrence of the critical illness.
In case of making a claim one needs to inform HDFC ERGO using the helpline number. The request will be registered and the policyholder will be given a unique claim settlement number that can be used for all future communications. The insurer needs to submit all the documents required within 45 days of registering the claim request.
Documents Required
The following documents are required when claiming insurance:
- Submission of the duly-filled claim form
- Original discharge summary
- Relevant treatment papers or consultation reports
- Relevant medical reports along with supporting invoices and requisition from doctor advising the same.
- Original hospitalization bills along with final detailed bill summary
- Pharmacy bills attached with prescriptions
- Other relevant documents required by HDFC ERGO need to be submitted within 10 days of when the request is made.
Exclusions under HDFC ERGO Critical Illness Policy
Exclusions for the Critical Illness Plan are:
- The waiting period of the first 90 days will apply to all claims unless the insured person has been insured under this policy continues and there have been no breaks in the previous policy year.
- A 48 months waiting period for all pre-existing conditions declared and or accepted at the time of application.
- Any illness as a result of engaging in war or any act of war, invasion, the act of foreign enemy or any other warlike operations.
- Any illness because of any criminal or unlawful act, intentionally self-inflicted injury or attempts to suicide while sane or insane
- Any disease or illness while participating or involvement in Naval, military or air force operation or while engaging in activities such as racing, diving, aviation, scuba diving, parachuting, hang gliding, rock or mountain climbing.
- Any illness caused due to intoxicating drugs or alcohol.
- Any kind of venereal diseases such as AIDS i.e. Acquired Immune Deficiency Syndrome, and or infection with HIV is not covered.
- Any treatment that is required during pregnancy. This also includes voluntary termination, miscarriage, maternity or birth issues including caesarean section.
- Any specific time bound or lifetime exclusions applied by HDFC ERGO and specified in the schedule and accepted by the insurer as per HDFC ERGO’s underwriting process.
Claim Processing of HDFC ERGO Critical Illness Plan
After the submission of all documents required by the claimant, the payment should take place within two weeks.
FAQs
Q1. What is a Critical Illness Insurance?
It is a policy that pays out a lump sum amount up to the sum insured when diagnosed with a critical illness covered under the policy.
Q2. Can individuals buy the policy online?
Yes. With HDFC ERGO the policy can be bought online. Individuals have the option of browsing and comparing many available policies by HDFC ERGO when they are online. After careful analysis, they can decide to choose the most suitable policy for them.
Q3. Is there a permit for making multiple claims for the same or other illnesses mentioned in the policy?
No the individual is allowed to make a claim only once in the policy.
Q4. Are there any tax benefits in this policy?
Yes, individuals get a benefit of up to Rs 15,000 under the section 80D, while a senior citizen gets a higher benefit of Rs. 20,000.
Q5. What kind of documents does one need to furnish at the time of buying the policy?
All that is required is to submit a duly filled in proposal form with all relevant details as requested. Individuals need to choose the sum assured as per their budgets and thereby make a payment. The payment can be made through cheque or by using a credit card.
Q6. Do individuals need to take any kind of medical tests when buying the policy?
No pre-policy checks are required for individuals who are below the age of 45 years.
Q7. What are the plans available under this policy?
There are many plans available, individuals can choose a value of the sum insured between a range of Rs. 2,50,000 to Rs. 10,00,000.