HDFC Ergo Energy (Gold)

HDFC Ergo-Energy (Gold) is a health insurance policy offered by HDFC ERGO General Insurance Company Limited. 

HDFC Ergo's Energy (Gold) is a specialised plan crafted exclusively for individuals with diabetes and hypertension. With this plan, you can focus on your well-being without worrying about finances as it is quite pocket friendly. The comprehensive coverage goes beyond just hospitalisation and related costs, extending to immediate coverage for diabetes and hypertension. Moreover, it encompasses the expenses for HbA1C tests and rewards individuals for maintaining optimal health based on medical test results and health indicators like BMI, BP, cholesterol levels, and more.

It is important to note that while this plan offers numerous benefits, it does not accommodate monthly premium payments. Our research shows that the insurer has received fewer claims-related complaints, indicating a positive claims experience. However, there have been a higher number of complaints regarding policy purchases, suggesting a less satisfactory purchasing experience.

What are the benefits offered by the HDFC Ergo Energy (Gold) Plan?

• Inpatient hospitalisation coverage: Similar to other health insurance plans, the HDFC Ergo Energy (Gold) plan offers coverage for costs related to being admitted to a hospital. These expenses include charges for your hospital stay, nursing care, medical consultations, prescribed medications, intensive care unit expenses, and other relevant costs.
• Pre-hospitalisation coverage: Pre-hospitalisation charges are the medical expenses you may encounter before being admitted to the hospital. These charges include consultation fees, lab tests, checkups, medical reports, etc. It's important to note that your insurer will only cover these expenses if they are directly related to the medical condition that leads to hospitalisation and your claim is approved as part of your inpatient hospitalisation coverage. Fortunately, with the HDFC Ergo Energy (Gold) plan, you can rest easy knowing that pre-hospitalisation expenses are covered up to the sum insured for 30 days prior to hospitalisation.
• Post-hospitalisation coverage: Once you are discharged from the hospital, you may incur additional medical expenses known as post-hospitalisation costs. These costs include consultations with your doctor, medical check-ups, rehabilitation programs, physical therapy, and more. In order for these expenses to be covered, they must be related to your hospital stay and your claim must be approved under inpatient hospitalisation coverage. The HDFC Ergo Energy (Gold) plan offers comprehensive coverage for post-hospitalisation expenses up to 60 days after you leave the hospital up to the sum insured.
• Daycare treatment coverage: A daycare treatment is a medical treatment or procedure that traditionally required a prolonged hospital stay, but can now be efficiently carried out within a mere 24 hours, thanks to remarkable advancements in medical technology. With the HDFC Ergo Energy (Gold) plan, you can rest assured knowing that expenses associated with all daycare procedures are covered up to the sum insured.
• Domiciliary treatment coverage: Domiciliary treatments refer to medical treatments for illnesses or injuries that necessitate urgent hospital care but are administered at home due to the seriousness of your medical condition or the unavailability of hospital beds nearby. This benefit is not available under the HDFC Ergo Energy (Gold) plan.
• Organ donor coverage: The HDFC Ergo Energy (Gold) plan fully covers organ donor expenses up to the sum insured. This includes all costs associated with harvesting the organ from the donor in case of an organ transplantation surgery, where you are the recipient. The donor’s pre and post-hospitalisation expenses related to organ harvesting will not be covered.
• Modern treatment coverage: As medical technology continues to progress, previously unimaginable innovative treatments are now within reach. Stem cell therapy, radio surgeries, and other modern treatments are challenging the notion of incurable ailments. In recognition of these advancements, the HDFC Ergo Energy (Gold) plan is tailored to provide coverage for expenses associated with these modern treatments, up to the sum insured.
• Non-medical expenses coverage: Non-medical expenses refer to the expenses incurred for consumables like gloves, nebulization kits, oxygen masks etc. The HDFC Ergo Energy (Gold) plan does not provide coverage for non-medical expenses.
• No Claim Bonus: The HDFC Ergo Optima Restore Plan rewards you with a No Claim Bonus, which is a bonus given to you if you don't make any claims in a policy year. It offers 10% of the sum insured as a No Claim Bonus every year subject to a maximum of up to 100% of the sum insured. However, if you make a claim during the policy year, the accumulated bonus will not reduce. 
• Super No Claim Bonus: The Super No Claim Bonus is an accelerated version of the standard No Claim Bonus and works similarly. The HDFC Ergo Energy (Gold) plan does not include this feature.
• Restoration Benefit: The Restoration Benefit is a unique feature that replenishes the sum insured after it has been used during a policy year. The refill benefit comes into effect when both the sum insured and the No Claim Bonus are partially exhausted. This benefit can be utilised once in a policy year from the first paid claim for both related and unrelated illnesses.

Please note that the limits and conditions mentioned in the above benefits and features are for Rs. 10 Lakhs sum insured.

HDFC Ergo Energy (Gold): Financial Limits

• Room rent limit: It is the maximum amount your insurance provider will pay for the hospital room you stay in during your hospitalisation. Choosing a room within this limit means you won't have to pay any extra costs. But if you opt for a room with a higher rent than what you’re eligible for, a deduction will be applied proportionally. Essentially, this implies that you will be responsible for paying a proportionate portion of the total bill rather than just covering the room rent difference. With the HDFC Ergo Energy (Gold) plan, you can choose any room type without limitations.
• ICU rent limit: The HDFC Ergo Energy (Gold) plan offers comprehensive coverage for the expenses associated with your ICU stay, without any limit, up to the sum insured. This means you can receive top-quality medical care without worrying about any financial strain.
• Copayment: The copayment is a set percentage of the approved claim amount that you are responsible for paying before your insurance provider covers the rest. With the HDFC Ergo Energy (Gold) plan, there is a copayment of 20%. Please note that this is optional.
• Deductible: The deductible is a certain amount that you are required to pay before your insurance company starts covering your medical expenses. The HDFC Ergo Energy (Gold) plan does not have a deductible limit. 
• Limits on surgeries/treatments: It refers to the maximum coverage provided by a health insurance policy for specific medical procedures or treatments. While some plans impose restrictions on the amount they will cover for certain procedures, others do not. The HDFC Ergo Energy (Gold) plan covers important surgeries and treatments such as cataract treatment and joint replacement surgery up to the sum insured without any limit.

Please note that the above financial limits are taken for a 30-year-old individual, opting for a sum insured of Rs. 10 Lakhs.

HDFC Ergo Energy (Gold) Plan : Waiting Periods & Exclusions

👉Waiting period

A waiting period refers to a specific time frame following the purchase of a health insurance policy, during which certain illnesses and medical conditions are not covered. These conditions can only be claimed once the waiting period has concluded. Here are  some of the types of waiting periods -

• Initial waiting period: The HDFC Ergo Energy (Gold) plan has an initial waiting period of 30 days for all medical conditions, except accidents. This means that during this period, you won't be able to claim any hospitalisation expenses unless they are due to an accident. However, once the initial waiting period is over, you can claim for all covered medical conditions without any restrictions.
• Waiting period for pre-existing diseases: If you have experienced any medical conditions or illnesses within the 36 months prior to applying for a health insurance policy, they are classified as pre-existing diseases. With the HDFC Ergo Energy (Gold) plan, there is a waiting period of 24 months. During this waiting period, you will not be eligible to claim for expenses associated with your pre-existing disease. However, please note that diabetes and hypertension are covered from day 1.
• Waiting period for specific diseases: The HDFC Ergo Energy (Gold) plan imposes waiting periods for specific medical conditions, apart from any pre-existing diseases you may have. These waiting periods are determined by the insurer and are not influenced by your current health status. It's important to note that a waiting period of 24 months is applicable for specific diseases under the plan.

👉Exclusions
Health insurance policies have certain exclusions, which refer to situations or medical conditions that are not covered. Some of the exclusions are as follows -

• Standard permanent exclusions: Insurance companies in India must adhere to a set of 'standard permanent exclusions' mandated by the Insurance Regulatory and Development Authority of India (IRDAI). Some of the exclusions are as follows:

1. Investigation and evaluation: Hospitalisation for monitoring or observation purposes.
2. Rest cure, rehabilitation, and respite care: Admission to a facility for rest or respite where no active medical treatment is given.
3. Obesity/weight control: Any surgical or medical procedures intended for weight control or obesity.
4. Change of gender treatment: Medical treatment aimed at altering the body's characteristics to that of the opposite gender.
5. Plastic/cosmetic surgery: Surgical or medical procedures intended for modifying appearance or body characteristics.
6. Profession in hazardous or adventure sports: Any medical expenses incurred while participating as a professional in adventure activities such as mountaineering, river rafting, scuba diving, horse racing, etc.
7. Breach of law: Any expenses related to the treatment of a person who has committed or attempted to commit a criminal act.
8. Excluded providers: Treatment from medical practitioners or hospitals excluded by the insurance company.
9. Narcotics: Treatment for addictive conditions like alcohol addiction, drug usage, etc.
10. Treatments in establishments arranged for domestic purposes: Treatment expenses incurred in health spas, nursing homes, or similar establishments arranged entirely or partially for domestic reasons.
11. Dietary supplements, substances purchased without prescription: Expenses on vitamins, minerals, and other dietary supplements not prescribed by a medical practitioner.
12. Refractive error: Expenses associated with correcting refractive errors up to 7.5 diopters for improved eyesight.
13. Unproven treatments: Any surgeries, medical procedures, or treatments that are not proven to be effective.
14. Expenses related to birth control, sterility, infertility: Contraception, sterilisation, artificial insemination, advanced reproductive technologies such as IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
15. Maternity expenses: Costs related to pre/post-natal care, childbirth, and related hospitalisation expenses.

• Additional permanent exclusions:  In addition to the permanent exclusions mandated by the IRDAI, insurance companies have the authority to apply additional exclusions for specific illnesses and situations. In cases where a certain illness is considered high-risk, insurers can choose to permanently exclude it from coverage. However, it is important to note that insurers are limited to the diseases on the pre-approved list of illnesses established by the IRDAI for applying permanent exclusions.
• Non-standard exclusions (Specific exclusions): The HDFC Ergo Energy (Gold) plan applies specific exclusions on certain medical conditions or circumstances other than the standard exclusions set by the IRDAI. These exclusions may differ between insurance providers and are based on the specific terms and conditions of the plan. Below are some specific exclusions that apply to this plan -

1. Injury or disease caused by war, invasion, acts of foreign enemies, warlike operations, etc.
2. Injury or illness resulting from a nuclear, chemical, or biological attack, the use of weapons, etc.
3. Treatment for injuries or illnesses resulting from intentional self-inflicted harm or attempted suicide.
4. Injury or illness caused by self-harm or involvement in naval, military, air force operations, etc.
5. Treatment for sleep disorders, general weakness, or exhaustion.
6. Expenses for treatment of external birth defects.
7. Treatment for spinal injuries, skeletal structure issues, muscle stimulation, etc. excluding treatment for fractures (excluding hairline fractures).
8. Costs associated with stem cell harvesting.
9. Circumcision, unless deemed necessary for treating a specific disease or injury.
10. Hospitalisation expenses for nutritional and electrolyte supplements.
11. Expenses related to any convalescence, sanatorium treatment, private duty nursing or long-term nursing care.
12. Vaccination, inoculation, and immunisation expenses (excluding post-animal bite treatment).
13. Provision of hearing aids, spectacles, contact lenses, and similar products.
14. Costs associated with hair loss treatments and products/
15. Prosthesis and external durable equipment used for diagnosis or treatment, unless required due to an accident.
16. Self-detachable or removable prosthetics and other devices that do not need invasive surgical procedures or anaesthesia.
17. Any treatment that falls outside the scope of allopathic medicine.
18. Dental treatment, unless it is necessary due to an accident.
19. Expenses related to pancreatic islet transplantation.

What to expect in terms of claims experience if you buy from HDFC ERGO General Insurance Company Limited?

• Speed of claims: HDFC ERGO General Insurance Company Limited has shown a satisfactory level of efficiency in claim settlement, processing 95.31% of claims within 30 days. This indicates that you can expect a seamless claim settlement process.
• Claim-related complaints: Based on our research, HDFC ERGO General Insurance Company Limited has a lower frequency of complaints related to claims compared to other insurance providers accounting to just 0.07%. This suggests that their claim settlement process is efficient and streamlined.
• Claims incurred ratio: It is a measure of an insurer's financial performance. It is the total claims paid out in proportion to the premiums received in a given fiscal year. HDFC ERGO General Insurance Company Limited has a claims incurred ratio of 80.98%.
• Claim settlement ratio: HDFC ERGO General Insurance Company Limited has a claim settlement ratio of 95.30%. It represents the ratio of total claims received to the total claims settled by the company in a given fiscal year.
• Network hospitals: HDFC ERGO General Insurance Company Limited offers access to a vast network of over 13,000+ hospitals. This extensive network enables customers to receive cashless treatment at various locations without any financial constraints.

How is the customer service of HDFC ERGO General Insurance Company Limited?

• Policy purchase-related complaints: Based on our research, HDFC ERGO General Insurance Company Limited has received a higher number of complaints regarding their post-sales service as compared to other insurers, accounting for 0.01%.
• Response on Toll-Free: During our research, we found that HDFC ERGO General Insurance Company Limited’s response rate on their toll-free number is average compared to other insurance providers.
• Response on Twitter: HDFC ERGO General Insurance Company Limited’s response rate on Twitter is also average.

About HDFC ERGO General Insurance Company Limited

HDFC ERGO General Insurance Company Limited, founded in 2002, is a joint venture between HDFC Limited and ERGO International AG. The company offers a range of general insurance options to retail customers. These include motor insurance, health insurance, travel insurance, home insurance, and personal accident insurance. In addition to its core offerings, the company also provides a range of other insurance products, such as property insurance, marine insurance, and liability insurance tailored specifically for corporate clients. Based in Mumbai, Maharashtra, the company’s CEO is Mr. Ritesh Kumar.