Toggle Location Modal

HDFC ERGO Health Insurance Covered & not Covered Diseases

WhatsApp
Medically Reviewed by Dr. Aman Priya Khanna
Written by Rajath R Prabhu, last updated on 9 March 2023| min read
HDFC ERGO Health Insurance Covered & not Covered Diseases

Quick Summary

HDFC ERGO Health Insurance Exclusions

Here are some of the exclusions under the HDFC ERGO health insurance policy:

  • Pre-existing diseases
  • Cosmetic surgeries
  • Maternity expenses
  • Dental treatments
  • Loss of income

It is important to note that these are just some of the exclusions under the HDFC ERGO health insurance policy. For a complete list of exclusions, please refer to the policy document.

People usually encounter situations where they buy a health insurance plan to get coverage for a specific disease but are unaware that the disease is part of the exclusions. So, if you are buying HDFC ERGO insurance, you must be aware of the HDFC ERGO health insurance not covered diseases list. It can help you prevent claim denials and reduced payout terms. 

While health insurances cover unforeseen medical emergencies, there are some limitations to what is covered and excluded under an insurance policy. The following blog discusses HDFC health insurance policy, its exclusions and inclusions. Continue reading to know more. 

What is HDFC ERGO Health Plan?

HDFC ERGO Health Insurance is the pioneer in the insurance industry, offering several health insurance plans. HDFC health insurance policy covers diseases within a broad spectrum, falling under home care, daycare, and critical illnesses. With nearly 13000+ cashless network hospitals and an impressive claim settlement ratio of 97%, HDFC ERGO health plans are the ideal choice for seeking treatment. 

Several diseases are covered under the HDFC health policy. However, you should also know about the HDFC ERGO health insurance not covered diseases list. 

get the appget the app

Health Insurance Plans Offered by HDFC ERGO

HDFC ERGO health insurance provides various plans to meet the needs of its customers in terms of comprehensive coverage, flexibility, and affordability. The top health insurance individual and family floater plans of HDFC ERGO include:

  1. HDFC ERGO Optima Secure
  2. HDFC ERGO Optima Restore
  3. HDFC ERGO my: health Suraksha
  4. HDFC ERGO Koti Suraksha

The top health insurance disease-specific plans of HDFC ERGO include:

  1. HDFC ERGO Energy Diabetes
  2. iCan Cancer Insurance

HDFC ERGO’s critical illness, bonus-oriented, top-up, and women-oriented health plans include:

  1. HDFC ERGO Critical Illness Policy
  2. Health Wallet Family Floater
  3. My: health Medisure Super Top-Up
  4. My: health Women Suraksha

Diseases Not Covered Under HDFC ERGO Health Insurance

Not knowing HDFC ERGO critical illness and other diseases could result in surprises when your medical bills for exclusions are not covered. This means you will have to bear the expenses from your pockets. To spare yourself from these unpleasant situations, you must go through inclusions and exclusions before investing in a policy. HDFC ERGO health insurance not covered diseases list include:

  1. Adventure Sports Injuries: Injuries caused by adventure sports, such as base jumping, paragliding, snowboarding, etc., are not covered under the HDFC ERGO health plan. 
  2. Self-Inflicted Injuries: An insured will not be covered under the HDFC ERGO policy if they harm themselves intentionally as an act of suicide.
  3. War-Related Injuries: Damages or injuries caused due to war, nuclear weapons, invasion, or similar activities are excluded from the policy.
  4. Venereal or Sexually Transmitted Diseases: Next disease on the HDFC ERGO health insurance not covered diseases list includes sexually transmitted diseases like HIV or AIDS.  
  5. Cosmetic Surgery: HDFC health insurance policy does not cover cosmetic surgeries like liposuction, botox, etc., as these are not life-threatening and do not affect the well-being of an individual. 
  6. Obesity/Weight Control: The policy does not cover expenses related to treating obesity. 
  7. Change of Gender Treatments: Expenses related to any treatment, such as surgical management, to change body characteristics to the opposite sex is not included. 
  8. Hospitalisation due to alcohol and drug abuse: HDFC ERGO health plan does not cover treatment for alcoholism, drug or substance abuse or any other addictive condition. 
  9. Maternity: Treatment related to childbirth (including emergency caesarean section), except ectopic pregnancy, is not covered under the policy. 
  10. Participation in Defense Operations: HDFC ERGO policy does not cover any insured person’s participation or involvement in naval, military, or air force operations.  
  11. Supplements: Nutritional and electrolyte supplements taken externally (not as part of the treatment) are not covered under the insurance policy. However, health insurance covers these supplements when given by a physician as part of the healing process or treatment during hospitalisation. 
  12. Corrective Devices and External Durable Medical Equipment: Expenses related to hearing aids, spectacles, contact lenses, artificial limbs, wheelchairs, crutches, etc., are excluded. 

HDFC ERGO’s Waiting Period Clause

Apart from the HDFC ERGO health insurance not covered diseases list, certain illnesses and ailments are only covered once the waiting period ends. The waiting period applies to diseases under two heads: pre-existing diseases and specified diseases/procedures.  

  1. Pre-Existing Diseases: A pre-existing disease is an illness a policyholder already suffers from before buying the health insurance policy. Under the HDFC ERGO health plan, the waiting period for pre-existing diseases is 48 months. 
  2. Specified Diseases/Procedures: The waiting period for expenses related to specified diseases/treatments under the HDFC ERGO plan is 24 months. If any specified disease/procedure falls under a pre-existing disease, the longer of the two waiting periods will apply. 

The following table includes some specified diseases/procedures subject to a waiting period under the HDFC ERGO health policy.

Diseases

Procedures
  1. Cataract
  2. Pilonidal sinus
  3. Skin tumours
  4. Non-infective arthritis
  5. Cirrhosis
  6. Fibroids
  7. Osteoarthritis and osteoporosis
  8. Benign hyperplasia of prostate
  9. Polycystic ovarian diseases
  10. Gastro-oesophageal reflux disorder (GERD), etc. 
  1. Endometriosis
  2. Glaucoma
  3. Hernia
  4. Retinal detachment
  5. Prolapsed uterus
  6. Ligament, tendon, and meniscus tear
  7. Surgery for prolapse intervertebral disc
  8. Rectal prolapse
  9. Joint replacement surgeries
  10. Hysterectomy, etc.

To know more about the exclusions and waiting period under the HDFC health insurance policy, you can download HDFC ERGO’s prospectus from the HDFC ERGO website. 

HDFC ERGO Health Insurance Covered Diseases List

HDFC ERGO caters to the need of every individual by offering health insurance plans that cover major illnesses and diseases. HDFC ERGO’s critical illness plan can protect you against several critical illnesses.

The following is the HDFC ERGO health insurance covered diseases list to help you understand what you will be covered for if you invest in this policy:

  1. Mental health illnesses
  2. COVID-19
  3. Diabetes
  4. Cancer
  5. Heart attack
  6. Kidney failure
  7. Alzheimer’s disease
  8. Parkinson’s disease
  9. Multiple sclerosis
  10. Stroke
  11. Major organ transplantation
  12. Coronary artery bypass surgery
  13. Aorta graft surgery
  14. Heart valve replacement
  15. Paralysis
  16. Primary pulmonary arterial hypertension
  17. End-stage liver disease
  18. Benign brain tumour

Benefits of Investing in an HDFC ERGO Health Plan

HDFC ERGO health insurance policy offers several benefits to its customers. The vast HDFC ERGO critical illness list helps policyholders avail of treatment benefits for major diseases without worrying about the expenses. The benefits of HDFC ERGO health insurance include the following:

  1. Cashless treatment across 13000+ network hospitals
  2. A dedicated in-house claim settlement team
  3. Cashless claim approval in just 20 minutes
  4. Sum insured upto two crores
  5. Lifelong renewability
  6. Free health check-up within 60 days after renewal
  7. Additional benefits such as wellness programs to keep you healthy
  8. Covers expenses upto 60 days of pre-hospitalisation and 180 days post-discharge
  9. Tax benefits upto Rs 1 lakh

Takeaway

While buying a health insurance plan, it is crucial to check the diseases covered under it to select the policy that best suits your needs. So if you are looking to buy HDFC ERGO health insurance, make sure to know about the diseases covered under the policy. However, it is equally important to check the HDFC ERGO health insurance not covered diseases list to avoid any surprises during medical billing. 

Buy the right health policy as per your needs and requirements TODAY and protect yourself and your family from emergencies in the future! To learn more about HDFC ERGO health plans, you can contact an expert at HexaHealth. Our team will gladly guide you through the inclusions, exclusions, benefits, and policy buying process.

Frequently Asked Questions

You can find HDFC ERGO health insurance not covered diseases list on HDFC ERGO’s official website. Or, you can contact an HexaHealth expert to learn about HDFC ERGO health plans and their inclusion and exclusion criteria.

Critical illness HDFC ERGO policy has been designed carefully to suit people diagnosed with a critical illness, such as benign brain tumour, end-stage liver disease, major organ transplant, etc. The best critical illness policies by HDFC ERGO include:

  1. HDFC ERGO Critical Illness Plan
  2. iCan Cancer

HDFC health insurance policy offers several plans to meet the needs of every individual. The benefits of HDFC ERGO insurance plans include 

  1. Cashless treatment across 13000+ network hospitals
  2. A dedicated in-house claim settlement team
  3. Cashless claim approval in just 20 minutes
  4. Sum insured up to two crores
  5. Lifelong renewability
  6. Free health check-up within 60 days of renewal
  7. Additional benefits such as wellness programs to keep you healthy
  8. Covers expenses up to 60 days of pre-hospitalisation
  9. 180 days post-discharge, and tax benefits up to Rs 1 lakh.
You can get HDFC ERGO health insurance covered diseases list on HDFC ERGO’s official website. Some major diseases covered under the list include mental health illnesses, COVID-19, diabetes, cancer, heart attack, kidney failure, Alzheimer’s disease, Parkinson’s disease, multiple sclerosis, stroke, benign brain tumor, etc.
An insurance premium is a money paid by the policyholder for availing of a health insurance policy. Health insurance premium differs on several factors, such as the sum insured amount, policy tenure, the lifestyle of the applicant, etc. You can use the HDFC health insurance premium calculator to calculate your premium online. The average annual premium under the HDFC ERGO health plan is ₹ 13,497.
Critical illnesses are long-term, life-threatening conditions that can negatively impact a person’s lifestyle and incur considerable treatment costs. Critical illnesses covered under HDFC ERGO include heart attack, stroke, multiple sclerosis, cancer, major organ transplantation, paralysis, kidney failure, coronary artery bypass surgery, heart valve replacement, aorta graft surgery, primary pulmonary arterial hypertension, end-stage liver diseases, benign brain tumor, etc.

 The salient features and benefits of the critical illness HDFC ERGO insurance plan include:

  1. Covers upto 15 critical illnesses in a single plan.
  2. Provides a lump sum payment in a single transaction.
  3. Offers two comprehensive critical illness plans.
  4. Plans are available for one and two years with easy lifetime renewability.
  5. Tax savings of upto ₹ 50,000.
  6. No medical check-ups are required up to 45 years of age.

While several diseases are covered under the critical illness HDFC ERGO insurance plan, there are also some exclusions. These exclusions include adventure sports injuries, self-inflicted injuries, war, participation in defence operations, sexually transmitted diseases, obesity treatment, cosmetic surgery, etc. 

The waiting period under HDFC ERGO critical illness insurance plan is 90 days. This means that all claims for critical illnesses covered under the list are accepted after 90 days from the day of policy inception. Furthermore, the survival period for HDFC ERGO critical illness plan is 30 days. The insured must survive for 30 days before receiving the lump sum payment.

Any healthy person can buy HDFC ERGO critical illness insurance plan for themselves and their family. The policy covers individuals in the age group of 5 to 65 years. Individuals up to 45 years do not require medical check-ups to enrol on this policy. 

Last Updated on: 9 March 2023

Disclaimer: The information provided here is for educational and learning purposes only. It doesn't cover every medical condition and might not be relevant to your personal situation. This information isn't medical advice, isn't meant for diagnosing any condition, and shouldn't replace talking to a certified medical or healthcare professional.

Reviewer

Dr. Aman Priya Khanna

Dr. Aman Priya Khanna

MBBS, DNB General Surgery, Fellowship in Minimal Access Surgery, FIAGES

12 Years Experience

Dr Aman Priya Khanna is a well-known General Surgeon, Proctologist and Bariatric Surgeon currently associated with HealthFort Clinic, Health First Multispecialty Clinic in Delhi. He has 12 years of experience in General Surgery and worke...View More

Author

Rajath R Prabhu

Rajath R Prabhu

MSc. Clinical Research I PG Diploma in Public Health Services Management

3 Years Experience

His work in medical content writing and proofreading is noteworthy. He has also contributed immensely to public health research and has authored four scientific manuscripts in international journals. He was assoc...View More

get the appget the app
aiChatIcon