HDFC ERGO Health Insurance Claim Settlement
HDFC ERGO General Insurance has a fast and efficient team that handles all claims directly, without using a third-party administrator (TPA). Because of this, the company successfully settled 86.90% of health insurance claims in the financial year 2023-24.
Documents Needed for HDFC ERGO Health Insurance Claims
Here are the important documents required to file a claim for HDFC ERGO health insurance:
1Filled Claim Form
You need to submit a properly filled and signed HDFC ERGO health insurance claim form.
2Hospital Bills and Payment Receipts
All original hospital bills with a proper cost break-up along with the receipt for payment need to be submitted.
3Medical Reports and Prescriptions
You have to submit original reports like X-rays, blood tests, and pharmacy invoices supported by a doctor's prescription.
4Discharge Summary
The original discharge summary from the hospital must be submitted.
5Bank Details for Payment
You need to provide NEFT details to receive the claim amount directly in your bank account.
6KYC Documents for Large Claims
For claims of ₹1 lakh and above, you must submit a KYC form along with a photocopy of any one KYC document.
7Accident-Related Claims
In the case of an accident, an FIR or Medico Legal Certificate is to be submitted.
8Previous Medical History
If there are any past treatment records, they should also be included in the claim submission.
9Legal Documents (if needed)
If the policyholder passes away, then nominee details are required. If the proposer is a minor, then a legal heir certificate is required.
10Other Supporting Documents
Any additional relevant documents may be required depending on the nature of the claim.
How to Claim HDFC ERGO Health Insurance
You can file a health insurance claim in two ways: cashless claims and reimbursement claims. Below is the step-by-step process for both:
1Cashless Claim Process
Follow these simple steps to get cashless treatment at a network hospital:
Step 1: Inform the Insurance Company
- If your hospital stay is planned, inform HDFC ERGO at least 48 hours before admission
- If it's an emergency, notify them within 24 hours after getting admitted.
Step 2: Show Your Health Card & ID
- At the hospital, show your HDFC ERGO health card and a valid photo ID to start the cashless treatment process.
Step 3: Hospital Sends Approval Request
- The hospital will send a pre-authorization form to HDFC ERGO and request approval for cashless treatment.
Step 4: Claim Approval
- The insurance company will check the documents and either approve or reject your cashless claim request.
Step 5: Final Document Submission
- If approved, the hospital will send your final bill and other necessary documents to HDFC ERGO after your treatment.
Step 6: Bill Payment
- HDFC ERGO will verify the documents and approve the claim within 2 hours of receiving all documents.
- The bill amount will be paid directly to the hospital, so you don’t have to pay from your pocket.
2Reimbursement Claim Process
Follow these simple steps to get your medical expenses reimbursed:
Step 1: Inform the Insurance Company
- Tell HDFC ERGO about your hospital stay as soon as possible. Then, get your treatment.
Step 2: Pay Your Hospital Bills
- When leaving the hospital, pay all your medical bills and collect your hospital documents (bills, reports, and prescriptions).
Step 3: Submit Your Documents
- Upload all required documents on the HDFC ERGO website for claim approval.
Step 4: Get Your Money Back
- HDFC ERGO will review your documents and process your claim within 7 days. The approved amount will be sent to your bank account.
FAQs
You can file a claim in two ways: cashless (at a network hospital) or reimbursement (pay first, then get your money back).
For cashless claims, the claim is approved in 2 hours after the document submission. The reimbursement claims get approved usually after 7 working days from the date of submission of complete documents.
You may need hospital bills, medical reports, doctor's prescriptions, discharge summary, and payment receipts. If it’s a reimbursement claim, you must also provide your bank details.
Yes, you can follow up on your claim status by visiting the website of HDFC ERGO or by simply contacting their customer service for follow-up.
HDFC ERGO will inform you of the rejection reason if your claim is declined. You will also contact customer support, submit missing documents, or file an appeal as required.
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