HDFC ERGO Health Insurance

Policy Period : From March 29, 2025 to March 28, 2026
Policy No:2999207297222200000

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Group Mediclaim Insurance Policy

We will provide Insurance coverage to the Insured Person(s) under this Policy up to Sum Insured including Restore/Double Restore, Cumulative Bonus as applicable and subject to waiting periods, limits, Sub-limits, Co-payment, Deductible, Aggregate Deductible as specified in Schedule of Coverage on the Policy Schedule/Certificate of Insurance. The Policy is based on statements, disclosures, declarations made in the Proposal form/Enrollment form and Medical reports.

Certain words used in the Coverage description have specific meanings which are mentioned in Definitions and which impacts the Coverage. All such words are mentioned in Bold to enable You to identify that the particular word has a specific meaning for which You need to refer Section – D, Definitions.

We will pay for Medically Necessary Hospitalization of an Insured Person due to Illness or Injury sustained or contracted during the Period of Insurance, subject to terms and conditions.

  • Room Rent and boarding charges
  • Intensive Care Unit charges
  • Consultation fees & Nursing charges
  • Anesthesia, blood, oxygen, operation theatre charges, surgical appliances charges
  • Medicines, drugs, and consumables
  • Diagnostic procedures related to admissible hospitalization claim
  • Cost of prosthetic and other Medical devices or equipment if implanted internally during a Surgical Procedure

We will pay for Pre-Hospitalization Medical Expenses incurred during the 30 days immediately before Hospitalization of an Insured Person. Limits may be modified as per the Schedule of Coverage.

We will pay for Post-Hospitalization Medical Expenses incurred up to 60 days from the date an Insured Person is discharged from Hospital. Limits may be modified as per the Schedule of Coverage.

We will pay the Medical Expenses incurred on Domiciliary Hospitalization of the Insured Person prescribed by a treating Medical Practitioner.

We will pay Medical Expenses towards organ donor’s Hospitalization for harvesting of the donated organ where an Insured Person is the recipient, subject to conditions:

  • The organ donor complies with The Transplantation of Human Organ (Amendment) Act, 2011, and related regulations.
  • Hospitalization claim for the Insured Person is admissible.
  • Organ Donor’s Pre- and Post-Hospitalization Medical Expenses are excluded.
  • Other Medical Expenses or Hospitalization consequent to harvesting are excluded.

We will pay for Medical Expenses on Hospitalization of an Insured Person in a Hospital or Day Care Centre for Day Care Treatment.

We will pay for expenses incurred on Road Ambulance Services for an Insured Person if required:

  • To transfer to the nearest Hospital following an emergency (sudden, urgent event requiring immediate medical attention).
  • From one Hospital to another Hospital.
  • From Hospital to Home (within the same city) following Hospitalization.

Limits may be modified as per the Schedule of Coverage.

Want to know more about HDFC ERGO guidelines and brief details? Please download the full policy document.

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