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HDFC Group Health Insurance

Health Insurance - stay protected, always

Stay safe and healthy with HDFC Group Health Insurance

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Stay safe and healthy with HDFC Group Health Insurance

MAKING LIFE EASIER ONE BENEFIT AT A TIME.

Claims processing- fully online! Claim settlement promptly!

Claims processing- fully online! Claim settlement promptly!

Cover yourself, your spouse and up to 4 dependent children

Cover yourself, your spouse and up to 4 dependent children

No medical test if you are between 18 and 55 years

No medical test if you are between 18 and 55 years

Heal in a room you feel comfy in. No room rental caps.

Heal in a room you feel comfy in. No room rental caps.

  • Higher limit of 60 and 180 days of pre and post-hospitalisation expense, compared to the usual 30 and 60 days

  • No more unanswered questions, with 24X7 call centre support in 10 languages

  • 100% sum assured restored on partial or complete utilisation, at no cost. 

ELIGIBILITY CRITERIA
  • Exclusive for GIGA customers.

    Exclusive for GIGA customers.

  • Cover age for those from 18 to 55 years of age

    Cover age for those from 18 to 55 years of age

  • 16,000+ cashless healthcare providers across India*
  • 1.6 crore+ happy customers**
  • 2 claims processed every minute***
  • ₹18,940+ crore health claims settled ^

 

Acceptance Criteria & Documents Required

Straightforward process for individuals up to age 55 years with Good Health Declaration

Click here to buy the policy

Sr.No

Coverage

HDFC Group Health Insurance - Gold Plan  

HDFC Group Health Insurance - Platinum Plan  

1

Base sum insured (₹) lakh

5, 10 and 15

5, 10 and 15

2

In-patient hospitalisation

Covered up to the Sum Insured

Covered up to the Sum Insured

3

Room rent limit - (per day)

up to 1% of SI, maximum ₹3,000 per day

No restriction 

4

 ICU limit - (per day)

up to 2% of the sum insured per day 

No restriction 

5

Pre-hospitalisation medical expenses cover

60 days

60 days

6

Post-hospitalisation medical expenses cover

90 days

180 days

7

Day care procedures

All day care 

All day care

8

Domiciliary hospitalisation

Covered 

Covered 

9

Road ambulance cover

Up to ₹2,000

Up to ₹2,000

10

Organ donor expenses

Covered 

Covered 

11

Alternative treatments (AYUSH) 

Covered up to Sum Insured

Covered up to Sum Insured

12

Hospital cash 

₹500 per day, max 30 days 

₹1000 per day, max 30 days

13

Restore benefit

Not available 

Restore 100% of the basic sum insured 

 

Renewal Benefits 

1

Preventive health check-up 

1% of SI, maximum ₹2000/- at the end of each block of continuous 3 policy years

1% of SI, maximum ₹7500, every claim free year

2

Cumulative bonus

10% of SI at each claim free year, max up to 50% 

10% of SI at each claim free year, max up to 50% 

 

Waiting Periods 

1

Initial waiting period 

First 30 days

First 30 days

2

Specific illness waiting periods 

2 years 

2 years

3

Pre-existing waiting period

3 years

3 years

  • In-patient hospitalisation:
    • Covers hospitalisation expenses without any disease sub limit
    • Room Rent Limit up to 1% of Base Sum Insured, subject to maximum of ₹ 3,000/- per day
    • The intensive care unit charges up to 2% of the sum insured
  • Pre-Hospitalisation Medical Expenses Cover: 60 Days
  • Post-Hospitalisation Medical Expenses Cover: up to 90 Days
  • Day care procedures: This covers all day care procedures
  • Domiciliary hospitalisation: Covered up to the Sum Insured
  • Alternative Treatments: Ayurvedic, Unani, Siddha and Homeopathy are covered up to Sum Insured limit 
  • Organ donor expenses: Covered up to the Sum Insured
  • Road ambulance cover: Covered up to ₹2,000 per hospitalisation
  • Hospital cash: Daily charges of ₹500, for 30 days maximum, for every consecutive and completed 24-hour period of hospitalisation
  • Preventive health check-up1% of Base Sum Insured maximum up to ₹ 2,000 at the end of each block of continuous 3 policy years
  • A cumulative bonus of 10% of the Base Sum Insured under the expiring Policy will be applied to each claim-free year subject to a maximum of 50% of the Base Sum Insured

  • In-patient hospitalisation: Covers hospitalisation expenses without any disease sub limit and no room rent restriction
  • Pre-hospitalisation medical expenses cover: 60 days
  • Post-hospitalisation medical expenses cover: up to 180 days
  • Day care procedures: All day care procedures covered
  • Domiciliary hospitalisation: Covered up to the Sum Insured
  • Alternative Treatments: Ayurvedic, Unani, Siddha and Homeopathy are covered up to Sum Insured limit 
  • Organ donor expenses: Covered up to the Sum Insured
  • Road ambulance cover: Covered up to ₹2,000 per hospitalisation
  • Hospital cash: Daily charges of ₹1,000, for 30 days maximum, for every consecutive and completed 24-hour period of hospitalisation
  • Preventive health check-up: 1% of the base sum insured up to ₹7,500 for each year without a claim
  • A cumulative bonus of 10% of the base sum insured under the expiring Policy will be applied to each claim-free year up to 50% of the Base Sum Insured
  • Restore benefit:100% Restoration on partial or complete utilisation of sum insured.

The Base Sum Insured, Cumulative Bonus and Restore Sum Insured are available to all Insured Persons for all claims under the Coverage during the current Policy Year, subject to condition that a single claim in a Policy Year cannot exceed the Base Sum Insured and Cumulative Bonus (if applicable).

In the event of complete or partial utilisation of the Base Sum Insured due to any claim admitted during the Policy Year, irrespective of the utilisation of the Cumulative Bonus, the Company shall restore the Sum Insured up to the Base Sum Insured (as applicable under the current Policy Year) for any subsequent claims admissible subject to the following conditions:

  • This Benefit shall be applied only once during each Policy Year and any unutilised amount, in whole or in part, will not be carried forward to the subsequent Policy Year.
  • The Base Sum Insured restoration under the Restore Benefit would be triggered only upon complete or partial utilisation of the Base Sum Insured by the way of first claim admitted under the Policy and be available for subsequent claims thereafter in the Policy Year, for the Insured Person.
  • In case of a family floater policy, the Restore Benefit will be available on floater basis for all Insured Persons covered under the Policy and will operate in accordance with the above conditions.

Number of Claim

Claim Amount

Available Benefit Limit

Admissible claim amount

Utilisation of Sum Insured

Base Sum Insured

Cumulative Bonus*(on first renewal)

Restore Benefit

First claim

₹3,00,000

₹5,00,000

₹50,000

0

₹3,00,000

Base (partial)

Second claim

₹7,00,000

₹2,00,000

₹50,000

₹3,00,000

₹5,50,000

Base (balance) + Cumulative Bonus + Restore Benefit (partial)

Third claim

₹3,00,000

-

-

₹2,00,000

₹2,00,000

Restore Benefit (partial)

*If opted

Single claim in a Policy Year cannot exceed the Base Sum Insured and Cumulative Bonus (if applicable).

  • 30 days initial waiting period for hospitalisation, other than accidental injuries.
  • 24 months waiting period on specific illnesses and surgical procedures.
  • 36 months waiting period on pre-existing diseases.

a)    Illnesses:

Internal Congenital Diseases

Non-infective Arthritis

Diseases of the gall bladder, including cholecystitis

Calculus diseases of Urogenital system, for e.g., kidney stone or urinary bladder stone

Pancreatitis

Ulcer and erosion of stomach and duodenum

All forms of cirrhosis

Gastroesophageal Reflux Disorder (GERD)

Perineal abscesses

Perianal Abscesses

Cataract

Fissure/fistula in anus, haemorrhoids including gout and rheumatism

Pilonidal sinus

 

Benign tumours, cysts, nodules, polyps, including breast lumps

Osteoarthritis and osteoporosis

Polycystic ovarian diseases

Fibroids (fibromyoma)

Sinusitis, rhinitis

Tonsillitis

Skin tumours

Benign hyperplasia of prostate

b)    Surgical Procedures:

Adenoidectomy, tonsillectomy

Tympanoplasty, Mastoidectomy

Hernia

Dilatation and curettage (D&C)

Nasal concha resection

Surgery for prolapsed inter vertebral disc

Myomectomy for fibroids

Surgery of Genito urinary system

Surgery for varicose veins and varicose ulcers

Surgery on prostate

Cholecystectomy

Surgery for Perianal Abscesses

Hydrocele/Rectocele

Joint replacement surgeries

Surgery for Nasal septum deviation

Ligament, Tendon and Meniscal tear

Hysterectomy

Fissurectomy, Haemorrhoidectomy, Fistulectomy, ENT surgeries

Endometriosis

Prolapsed Uterus

Rectal Prolapse

Varicocele

Retinal detachment

Glaucoma

Nasal polypectomy

 

 

 

  • War or any act of war, invasion, the act of a foreign enemy.
  • Participation or involvement in naval, military or air force operation.
  • Congenital external diseases, defects, or anomalies.
  • Treatment for alcoholism, drug or substance abuse or any addictive condition.
  • Committing or attempting to commit intentional self-injury or attempted suicide or suicide.
  • Committing or attempting to commit a breach of law with criminal intent.

(Kindly refer to the policy wording for a complete detailed list)

Available on our website.

FREQUENTLY ASKED QUESTIONS

If you are between 18 and 55 years old, join the GIGA by HDFC Bank program, and you are in.

  • Get a health policy curated, keeping the needs of gig workers/freelancers like you in mind

  • Get up to ₹15 lakhs in coverage at an affordable premium

  • Annual coverage starts at ₹5 lakhs as the base sum assured

  • Better benefits, seamless online processes, instant policy issuance - it is in tune with your fast life 

Buy with an online purchase process that is streamlined and customer-friendly.

No need if you are not 55 years old yet. A simple ‘Good Health Declaration’ is good enough.  

Yes, get your spouse and up to 4 dependent children covered along with you.  

A year from the date you purchased it. 

The certificate promptly reaches your registered email address.

Yes, there are 13,000+ network hospitals all around the country to choose from. To know more, click here. 

HDFC ERGO's in-house team will process claims. For further details on the claims process, visit the HDFC ERGO website, www.hdfcergo.com.  

Having a hospitalisation? Just file a claim on our website, www.hdfcergo.com or the app, or by sending claims paperwork to HDFC ERGO General Insurance Co. Ltd., Stellar IT Park, Tower-1, Fifth Floor, C - 25, Sector 62, Noida - 0120 398 8360.

Platinum Plan FAQs

Under the Platinum Plan, you can avail Sum Insured options of ₹5 lakh, ₹10 lakh, and ₹15 lakh. 

The Platinum plan does not have any ICU or Room Rent restraints.

Under the Platinum Plan, pre-hospitalisation medical expenses are covered for 60 days before admission to the hospital, and post-hospitalisation medical expenses are covered for up to 180 days after discharge.

If prescribed by a medical practitioner, in-patient hospitalisation under Alternative Treatment for Ayurvedic, Unani, Siddha, and Homeopathy is covered up to Sum Insured.

Under Platinum plan hospital cash benefit of ₹1000/- per day for a maximum period of 30 days in a policy year is covered for each continuous and completed 24 hours of hospitalisation.

On complete or partial utilisation of the base Sum Insured by way of the first claim admitted under the Policy, 100% of the base Sum Insured will be restored to the Insured Person and will be accessible for subsequent claims in the Policy Year. Subject to the condition that single claim in a policy year cannot exceed the sum of Base Sum Insured and the cumulative bonus (if applicable).

For each claim-free year, you can get a preventive health check-up benefit of up to 1% of the sum covered (up to ₹7,500) under the Platinum Plan.

Each claim-free year results in a 10% increase in the Sum Insured Amount, up to a maximum of 50% in any policy year.

Medical Expenses for organ donor’s hospitalisation for harvesting a donated organ, where an Insured Person is a recipient in accordance and in compliance with

·     The Transplantation of Human Organ (amendment) Act, 2011

·     Transplantation of Human Organs and Tissues Rules, 2014

·     And other applicable laws and/or regulations

Organ donor expenses are covered up to the Sum Insured limit.

You can avail a maximum of ₹2,000 per hospitalisation in ambulance expenses to transport an insured individual to the nearest hospital in the event of an emergency.

Gold Plan FAQs

Under the Gold Plan, you can avail Sum Insured options of ₹5 lakh, ₹10 lakh, and ₹15 lakh.

The Gold Plan's Room Rent Limit is up to 1% of the Base Sum Insured, up to a maximum of ₹3,000 daily, and Intensive Care Unit (ICU) expenditures are covered up to 2% of the Sum Insured per day.

Under the Gold plan, pre-hospitalisation medical expenses are covered for 60 days before admission to the hospital, and post-hospitalisation medical expenses are covered for up to 90 days after discharge.

If prescribed by a medical practitioner, you can up to Sum Insured for in-patient hospitalisation for Ayurvedic, Unani, Siddha, and Homeopathy therapy.

Under Gold plan hospital cash benefit of ₹ 500/- per day for a maximum period of 30 days in a policy year is covered for each continuous and completed 24 hours of hospitalisation.

The Gold Plan does not offer Restore Benefit.

Under Gold plan, you can avail preventive health check-up benefit up to 1% of Base Sum Insured, maximum up to ₹ 2,000 at the end of each block of continuous 3 policy years.

 

Each claim-free year results in a 10% increase in the Sum Insured amount, up to a maximum of 50% in any policy year.

Medical Expenses for organ donor hospitalisation, for harvesting of a donated organ, where an Insured Person is a recipient in accordance and in compliance with

  • The Transplantation of Human Organ (amendment) Act, 2011
  • Transplantation of Human Organs and Tissues Rules, 2014 
  • And other applicable laws and/or regulations
  • Organ donor expenses are covered up to the Sum Insured limit.

You can avail a maximum of ₹2,000 per hospitalisation in ambulance expenses to transport an insured individual to the nearest hospital in the event of an emergency. 

Disclaimers 

# Available under Platinum Plan 

*Figure as on 30th June 2024.

**Data as on 31st March, 2024 (includes members of the group)

*** Data for FY24

^ Data till FY24

^^ Subject to no medical history

Terms & Conditions apply. HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146. CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. 

For more details on the risk factors, terms and conditions, please read the sales brochure/ prospectus before concluding the sale. The above-mentioned product is underwritten by HDFC ERGO General Insurance Company Limited. HDFC Bank Limited (Senapati Bapat Marg, Lower Parel, Mumbai - 400 013) is an authorized corporate agent of HDFC ERGO General Insurance Company Limited. IRDAI License No. CA0010. UIN: HDFC Group Health Insurance -HDFHLGP21116V012021.