HDFC ERGO Health Suraksha Gold Plan

GST rate of 18% applicable for all financial services effective July 1, 2017.

Coverage Offered Under the HDFC ERGO Health Suraksha Gold Plan

1. In-patient treatment - Offers coverage for hospitalisation expenses incurred due to death or illness up to the sum insured. This includes boarding expenses, room rent, doctor's fees, cost of medicines, nursing expenses, etc.
2. Pre and post-hospitalisation expenses - Provides coverage for medical expenses for up to 60 days before hospitalisation and 90 days after hospitalisation.
3. Domiciliary treatment - Expenses incurred for availing treatment at home is also covered as approved by the physician and up to the sum insured.
4. Daycare procedures - Procedures that do not require the patient to be hospitalised are also covered by the plan. Under this, 144 day care procedures are covered.
5. AYUSH treatments - The policy also covers treatments taken under Ayurveda, Unani, Siddha, or Homeopathy.
6. Ambulance charges - If the policyholder requires emergency ambulance services, the costs incurred will be covered under the policy. For sum insured of Rs.3 lakh, Rs.4 lakh, and Rs.5 lakh, a sum of Rs.2,000 will be provided while for sum insured of Rs.7.5 lakh and Rs.10 lakh, ambulance charges of up to Rs.3,500 will be provided.
7. Maternity expenses - Pre and post-natal expenses are covered after 4 years waiting period. Normal deliveries are eligible for coverage up to Rs.15,000 while for c-section deliveries, Rs.25,000 coverage will be offered.
8. Organ donor - In case of organ transplantation, the expenses incurred for the treatment of the organ donor will also be covered by the policy.
9. Newborn baby - Newborn babies will be provided coverage up to 90 days from birth.
10. E-opinion - Policyholders suffering from critical illness can avail a second opinion through the online medium from medical experts.
11. Convalescence benefit - If there is a need for the policyholder to be hospitalised for more than 10 days, he/she will receive a lump sum amount of 1% of the sum insured as a convalescence benefit. This amount shall not exceed Rs.10,000.
12. Cumulative bonus - Every claim-free year will make the policyholder eligible for a bonus of 5% of the sum insured. The maximum amount of bonus that can be availed is 50% of the sum insured. In cases where the policyholder makes a claim, the cumulative bonus will be reduced by 5% of the basic sum insured.
13. Health checkup - Policyholders will be eligible for a health checkup after 4 years of no claims. The maximum liability under this policy will be 1% of the sum insured for the policy year or the successive policy years up to an upper limit of Rs.5,000.

Exclusions

1. Except for injuries due to an accident, the cost of treatment for hospitalisation will not be borne by the insurer within the first 30 days of the policy purchase date.
2. For the initial 4 years, no pre-existing diseases will be offered coverage.
3. Diseases related to AIDS/HIV will not be covered by the policy.
4. Cosmetic surgeries, mental disorders, and weight loss treatments will not be offered coverage.
5. Hospitalisation expenses incurred due to war, nuclear/biological/chemical weapon, radiation, will not be covered.
6. Cost of any dental, pregnancy, or any external aids will not be covered.
7. Treatments arising out of drug or alcohol or hallucinogenic substance abuse will be excluded from the coverage.

Please note that the above-mentioned exclusions are not exhaustive. It is advised that policyholders go through the policy wordings carefully before purchasing a policy.

Free-Look Period on the HDFC ERGO Health Suraksha Gold Plan

Policyholders have a period of 15 days after he/she receives the policy document to review the terms and conditions of the policy. He/she will have the option to cancel the policy if he/she has any objections to any clause mentioned in the terms and conditions. On cancellation, the premium amount will be refunded to the policyholder's account after adjusting the amount spent on health checkup, stamp duty charges, and risk-adjusted premium.

GST rate of 18% applicable for all financial services effective July 1, 2017.