HDFC ERGO General Insurance Company Limited

Customer Information Sheet

my:health Suraksha

Sr Policy Clause
TITLE DESCRIPTION
No Number
1 Product my:health Suraksha
Name
2 What am I Section A. Hospitalization Cover.
covered for: I. Expenses for below Covers up to the Sum Insured and limits as specified
under the schedule of coverage, subject to terms and conditions of the Policy
1. Medical Expenses for min 24 Hrs of hospitalization 1A. Mental Healthcare: Section B.I.1
Medical expenses for treatment of Mental Illnesses
Section B.I.2
2. Home Healthcare
3. Domiciliary Hospitalization Section B.I.3
4. Pre-HospitalizationMedical expenses for 90 days before hospitalization Section B.I.4
5. Post-HospitalizationMedical Expenses incurred in 180 days after the Section B.I.5
hospitalization
6. Day Care Procedures Section B.I.6
7. Road Ambulancecover Section B.I.7
8. Organ Donor Expenses Section B.I.8
9. Alternative TreatmentHospitalization Expenses Section B.I.9
Section B.II- Renewal Benefits
1. my:health Active Section B.II.1
2. Preventive Health Check up Section B.II.2
3. Cumulative Bonus
Section B.II.3
Section B.III: Optional Covers
Expenses under below optional covers up to the Sum Insured and limits as
specified under the schedule of coverage, subject to terms and conditions of
the Policy
1. Preventive Health Check Up- Booster Section B.III.1
2. Parent and child Care- Basic Section B.III.2
3. Parent and child Care- Booster Section B.III.3
4. Air Ambulance Cover Section B.III.4
5. Recovery Benefit Section B.III.5
6. Sum Insured Rebound Section B.III.6
7. Outpatient dental treatment Section B.III.7
8. External Medical Aids Section B.III.8
9. Major Illness Hospitalization Expenses Section B.III.9
10. Non-Medical Expenses cover Section B.III.10
11. Waiting Period modification Option Section B.III.11
12. Extended Cumulative Bonus Section B.III.12
13. Room rent restriction Option Section B.III.13
Section B.III.14
PWW/Ver - 9 AUG2021

14. Co payment
15. Major Illness – Benefit Section B.III.15
16. E-Opinion Section B.III.16
17. Hospital Cash Section B.III.17
18. Global Health Cover Section B.III.18
Add on Covers
1. my:health Critical Illness Add On
2. my:health Hospital Cash Add On

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. Trade Logo displayed above belongs to HDFC
1 Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
HDFC ERGO General Insurance Company Limited
Customer Information Sheet

my:health Suraksha

Sr Policy Clause
TITLE DESCRIPTION
No Number
3 What are i. Change-of-Gender treatments: Code – Excl07 – Expenses related to any Section C.1. II. iv
the major treatment, including surgical management, to change characteristics of the
exclusions body to those of the opposite sex.
in the policy: ii. Cosmetic or plastic surgery: Code – Excl08 – Expenses for cosmetic Section C.1.II. v
or plastic surgery or any treatment to change appearance unless for
reconstruction following an Accident, Burn(s) or Cancer or as part of
Medically Necessary Treatment to removea direct and immediate health
risk to the insured. For this to be considered a medical necessity, it must
be certified by the attending Medical Practitioner.
iii. Hazardous or Adventure sports: Code – Excl09 – Expenses related to any Section C.1.II. vi
treatment necessitated due to participation as a professional in hazardous or
adventure sports, including but not limited to, para-jumping, rock climbing,
mountaineering, rafting, motor racing, horse racing or scuba diving, hand
gliding, sky diving, deep sea diving.
iv. Breach of Law: Code – Excl10 - Expenses for treatment directly arising SectionC.1.II. vii
from or consequent upon any Insured Person committing or attempting to
commit a breach of law with criminal intent.
(Note: the above is a partial listing of the policy exclusions. Please refer to the
policy clauses for the full listing)

4 Waiting • 30 days for all illnesses (except accident) in the first year and is not applicable Section C.1.I.iii
Periods in subsequent renewals
• 24 months for specific illness and treatments in the first two years and is Section C.1.I.ii
not applicable in subsequent renewals
Section C.1.I.i
• Pre-existing Diseases will be covered after a waiting period of 48 months
• 48 months waiting period applicable for all the claims under Parent and Section C.1.I.iv
Child care Cover – Basic and Parent Child care Cover - Booster
• 90 days waiting period applicable on all claims under all the illnesses listed
under Critical Illness cover
• 7 Days survival period applicable for all the illnesses listed under Major Illness
cover

5 Payment Reimbursement Basis for all Claims under

Basis • Hospitalization cover,
• Parent &Child care Cover - Basic
• Parent & Child care Cover - Booster
• Outpatient Dental cover
• External Medical Aids
• Air Ambulance cover
Benefit Basis for all claims under
• Recovery Benefit
• Major Illness-Benefit
• Hospital Cash
• my:health Critical Illness Add on
• my:health Hospital Cash Benefit Add on

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. Trade Logo displayed above belongs to HDFC
2 Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
HDFC ERGO General Insurance Company Limited
Customer Information Sheet

my:health Suraksha

Sr Policy Clause
TITLE DESCRIPTION
No Number
6 Loss • Co-Payment as opted will be applicable on each and every admissible claim Section B.III
Sharing after deductible/ excess if any
• Deductible of USD 100 applies for treatments taken outside India
• If opted for,
i. Room Rent/ Boarding & Nursing 1% of Sum Insured per day subject
to a maximum of Rs.5,000/- per day
ii. ICU Rent/Boarding & Nursing max up to 2% of Sum Insured per day
subject to a maximum of Rs.10,000/- per day
7 Premium You have option to pay premium in total at the commencement of policy or in Section D
Payment instalments as below:
Option
Options Installment Premium Option
Option 1 Yearly
Option 2 Half Yearly
Option 3 Quarterly
Option 4 Monthly

8 Renewal • Policy is renewable for lifetime. Section D

Conditions • Grace Period for Renewal is 30 days from due date.
9 Renewal • my:Health Active Section B.II. 1, 2, 3
Benefits o Fitness discount @renewals
o Health Incentive
o Wellness services-Health Coach, Wellness services through
my: Health app
• Preventive Health Checkup
• Cumulative Bonus:
i. 5% of Sum insured for every claim free year, max up to 50% and same
will be reduced at the same rate as applied in the event of admissible
Claim.
ii. Cumulative Bonuswill be reduced at the same rate as applied in the
event of admissible Claim under Hospitalization Section of the Policy
however will not be lowered than zero.
10 Cancellation • The Company may cancel the policy at any time on grounds of Section D
misrepresentation non-disclosure of material facts, fraud by the insured
person by giving 15 days’ written notice. There would be no refund of
premium on cancellation on grounds of misrepresentation, non-disclosure
of material facts or fraud.
• You may cancel this policy by giving 15days’ written notice and in such an
event, the Company shall refund premium for the unexpired policy period
as per the grid specified in the Policy Wording.
• In case of any claim made during Policy Year, no premium will be refunded

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. Trade Logo displayed above belongs to HDFC
3 Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
HDFC ERGO General Insurance Company Limited
Customer Information Sheet

my:health Suraksha

Sr Policy Clause
TITLE DESCRIPTION
No Number
11 How to Kindly contact Us 48 hrs prior for planned hospitalisation or within 24 hours of Section E
Claim hospitalisation in case of emergency hospitalisation on

Toll Free (within India) :022-62346234 / 0120-62346234

Outside India

Toll Free No: 800 08250825

Global Toll Free No: +800 08250825 (accessible from locations outside India
only)

Landline no (Chargeable) : 0120-4507250

Email: travelclaims@hdfcergo.com

You must submit a duly filled claim form along with specified documents under
the policy within 30 days from date of discharge. Any additional information
requested must be submitted within 15 days of Our request
12 Policy In case of any grievance, We may be contacted through any of the following: Section D
Servicing /
Website: www.hdfcergo.com
Grievance /
Complaints Toll free: 022 6234 6234 / 0120 6234 6234
Contact Details for Senior Citizen: 022 022 – 6242 – 6226 | seniorcitizen@
hdfcergo.com
E-mail: grievance@hdfcergo.com
Insured person may also approach the grievance cell at any of the company’s
branches with the details of grievance.
If Insured person is not satisfied with the redressal of grievance through one of
the above methods, insured person may contact the grievance officer at cgo@
hdfcergo.com
For updated details of grievance officer, kindly refer the link:
https://www.hdfcergo.com/customer-voice/grievances
If Insured person is not satisfied with the redressal of grievance through
above methods, the insured person may also approach the office of Insurance
Ombudsman of the respective area/region for redressal of grievance as per
Insurance Ombudsman Rules 2017.
Grievance may also be lodged at IRDAI Integrated Grievance Management
System - https://igms.irda.gov.in/
13 Insured’s • Free Look for 15 days from the date of receipt of the Policy document Section D
Rights • Lifelong Renewal under the policy with 30 days Grace Period
• Sum Insured Enhancement The Sum Insured can be enhanced only at the
time of renewal subject to acceptance by the Company

14 Insured’s Disclosure of material facts sought to be declared on the proposal form. Section D
Obligations
Legal Disclaimer Note: The information must be read in conjunction with the productbrochure and policy document. In case
of any conflict between the Customer Information Sheet and the policy document, the terms and conditions mentioned in
the policy document shall prevail

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. Trade Logo displayed above belongs to HDFC
4 Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
Premium / Benefit Illustration
· Product Name – my:health Suraksha
· Plan Name – Silver Smart
· Sum Insured - 5 Lakhs
· Tenure – 1 Year
· Tier - 1a (Delhi/NCR)

Age Coverage opted Coverage opted on individual basis Coverage opted on family floater basis
of the on individual covering multiple members of the with overall Sum Insured (only one Sum
members basis covering family under a single policy (Sum Insured is available for the entire family)
insured each member Insured is available for each member of
(in Years) of the family the family)
separately (at a
single point in
time)
Premium Sum Premium Family Premium Sum Premium or Floater Premium Sum
(Rs.) Insured (Rs.) Discount after Insured onsolidated Discount after Insured
in Lakhs of 10% discount in premium if any discount in
(Rs.) (Rs.) Lakhs for all (Rs.) Lakhs
(Rs.) family (Rs.)
members
of the
family (Rs.)

7 7,165 5 7,165 717 6,449 5 21,623 NA 21,623 5

10 7,165 5 7,165 717 6,449 5 NA

35 9,138 5 9,138 914 8,224 5 NA

40 10,812 5 10,812 1081 9,731 5 NA

34,280 30,852 21,623

Total premium for Total premium for all members of the Total premium when policy is opted on floater
all members of family is Rs.30,852 when they are covered basis is Rs.21623
the family is Rs. under a single policy.
34,280 when each
member is covered
separately.
Sum Insured Sum Insured available for each individual Sum Insured of Rs. 5 Lakhs is available for
available for each is Rs. 5 Lakhs. the entire family.
individual is Rs. 5
Lakhs

Premium as mentioned above are exclusive of taxes.

Above premium examples are for Illustration purpose only, terms and 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.
Trade Logo displayed above belongs to HDFC Ltd and ERGO International AG and used by the Company under license. UIN:
my:health Suraksha - HDFHLIP21473V052021, my:Health Hospital Cash Benefit (Add-on) - HDFHLIA21271V022021 & my:
health Critical Illness - HDFHLIA21466V022021. 6
Policy Wordings
my:health Suraksha

Index
Preamble 4

Section A: Definitions 4

Standard Definitions 4

Specific Definitions 7

Section B Benefits 10

I. Hospitalization Cover 10

1. Medical Expenses 10

2. Home Healthcare 10

3. Domiciliary Hospitalization 10

4. Pre-Hospitalization cover 10

5. Post-Hospitalization cover 10

6. Day Care Procedures 11

7. Road Ambulance 11

8. Organ Donor Expenses 11

9. Alternative Treatments 11

II. Renewal Benefits 11

1. Preventive Health Check-Up 11

2. Cumulative Bonus 11

3. my: Health Active 12

III. Optional Covers 13

1. Preventive Health Check-Up - Booster 13

2. Parent and Child care Cover - Basic 14

3. Parent and Child care Cover – Booster 14

4. Air Ambulance Cover 15

5. Recovery Benefit 15

6. Sum Insured Rebound 15

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
1 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
7. Outpatient Dental Treatment 16

8. External Medical Aids 16

9. Major Illness Hospitalization Expenses 16

10 Non-Medical Expenses cover 16

11. Waiting period Modification Option 16

12. Extended Cumulative Bonus 16

13. Room Rent Modification Option 17

14. Co-Payment 17

15. Major Illness – Benefit 17

16. E-Opinion 17

17. Hospital Cash 17

18. Global Health Cover 18

Section C: Waiting Periods and Exclusions 18

1. Standard Exclusions and Waiting Period 18

I. Waiting Periods 18

II. Permanent Exclusions 19

2. Specific Exclusions and Waiting Period 20

I. Waiting Periods 20

II. Permanent Exclusions 20

Section D: General Conditions 21

Standard General Conditions 21

1. Free Look period 21

2. Condition Precedent to Admission of Liability 21

3. Multiple Policies 21

4. Disclosure of Information 21

5. Complete Discharge 21

6. Moratorium Period 21

7. Fraud 22

8. Renewal of Policy: 22

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
2 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
9. Portability 22

10. Migration 22

11. Cancellation 22

12. Premium Payment in Instalments 23

13. Possibility of Revision of terms of the Policy including the Premium Rates 23

14. Withdrawal of Policy 23

15. Claim Settlement (Provision for Penal Interest) 23

16. Nomination: 24

17. Grievance Redressal Procedure 25

Specific General Conditions 25

1. Non-Disclosure or Misrepresentation 25

2. Geography 26

3. Loadings 26

4. Grace Period 26

5. Endorsements 26

6. Premium Tier : 26

Section E: Other Terms & Conditions 27

Contact Us 42

Claim Procedure 27

Ombudsman Details 30

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
3 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
HDFC ERGO General Insurance Company Limited
Policy Wordings
my:health Suraksha

PREAMBLE of a qualified registered AYUSH Medical Practitioner

and must comply with all the following criterion:
we will provide insurance cover to the insured person(s)
under this policy upto sum insured or limits mentioned on the i. Having at least 5 in-patient beds;
schedule of coverage in the policy schedule.
ii. Having qualified AYUSH Medical Practitioner in
this policy is subject to your statements in respect of all the charge round the clock;
insured persons in proposal form, declaration and/or medical
reports, payment of premium and the terms and conditions iii. Having dedicated AYUSH therapy sections as
of this policy. required and/or has equipped operation theatre
where surgical procedures are to be carried out;
DEFINITIONS
iv. Maintaining daily records of the patients and making
Certain words used in the Coverage description have specific them accessible to the insurance company’s
meanings which are mentioned in Definitions and which authorized representative.
impacts the Coverage. All such words, where ever mentioned
in this document are mentioned in Bold to enable you to Def. 4. AYUSH Day Care Centre means and includes
identify that particular word has a specific meaning for which Community Health Centre (CHC), Primary Health Centre
You need to refer Section – A Definitions. (PHC), Dispensary, Clinic, Polyclinic or any such health
centre which is registered with the local authorities, wherever
SECTION A: DEFINITIONS applicable and having facilities for carrying out treatment
procedures and medical or surgical/para-surgical interventions
or both under the supervision of registered AYUSH Medical
The terms defined below have the meanings asdescribed
Practitioner(s) on day care basis without in-patient services
to them wherever they appear in this Policy and, where
and must comply with all the following criterion:
appropriate, references to the singular include references
to the plural; references to the male include the female and i. Having qualified registered AYUSH Medical
references to any statutory enactment include subsequent Practitioner (s) in charge;
changes to the same
ii. Having dedicated AYUSH therapy sections as
Standard Definitions required and/or has equipped operation theatre
where surgical procedures are to be carried out;
Def. 1. Accident or Accidental means a sudden, unforeseen
and involuntary event caused by external, visible and violent iii. Maintaining daily records of the patients and making
means. them accessible to the insurance company’s
authorized representative.
Def. 2. Any one illness means continuous period of Illness
and includes relapse within 45 days from the date of last Def. 5. Cashless Facility means a facility extended by the
consultation with the Hospital/Nursing Home where treatment insurer to the insured where the payments, of the costs of
was taken treatment undergone by the insured in accordance with the
policy terms and conditions, are directly made to the Network
Def. 3. AYUSH HOSPITAL means an AYUSH Hospital is
Provider by the insurer to the extent pre-authorization is
a healthcare facility wherein medical/surgical/para-surgical
approved.
treatment procedures and interventions are carried out by
AYUSH Medical Practitioner(s) comprising of any of the Def. 6. Condition Precedent means a policy term or
following: condition upon which the Insurer’s liability under the policy
is conditional upon
a. Central or State Government AYUSH Hospital; or
Def. 7. Congenital Anomaly means a condition(s) which is
b. Teaching hospital attached to AYUSH College
present since birth, and which is abnormal with reference to
recognized by the Central Government /Central
form, structure or position.
Council of Indian Medicine/Central Council for
Homeopathy; or a) Internal Congenital Anomaly: Congenital Anomaly
which is not in the visible and accessible parts of the
c. AYUSH Hospital, standalone or co-located within-
body.
patient healthcare facility of any recognized system
of medicine, registered with the local authorities, b) External Congenital Anomaly: Congenital Anomaly
wherever applicable, and is under the supervision which is in the visible and accessible parts of the body

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
4 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
Def. 8. Co-Payment means a cost sharing requirement under II. the patient takes treatment at home on account of
a health insurance policy that provides that the policyholder/ non-availability of room in a Hospital
insured will bear a specified percentage of the admissible
claims amount. A Co-Payment does not reduce the Sum Def. 16. Emergency Care means management for an Illness
Insured or injury which results in symptoms which occur suddenly
and unexpectedly, and requires immediate care by a Medical
Def. 9. Cumulative Bonusmeans any increase or addition in Practitioner to prevent death or serious long term impairment
the Sum Insured granted by the Insurer without an associated of the insured person’s health.
increase in premium.
Def. 17. Grace Period means the specified period of time
Def. 10. Day care Centre means any institution established immediately following the premium due date during which a
for Day Care Treatment of Illness and / or injuries or a medical payment can be made to renew or continue a policy in force
set -up with a Hospital and which has been registered with without loss of continuity benefits such as waiting periods and
the local authorities, wherever applicable, and is under the coverage of pre –existing diseases. Coverage is not available
supervision of a registered and qualified medical practitioner for the period for which no premium is received.
AND must comply with all minimum criterion as under:-
Def. 18. Hospital means any institution established for
I. has qualified nursing staff under its employment; In-patient Care and Day Care Treatment ofIllness and/or
injuries and which has been registered as a Hospital with the
II. has qualified medical practitioner/s in charge; local authorities under the clinical Establishments (Registration
III. has fully equipped operation theatre of its own where and Regulation) Act, 2010 or under the enactments specified
surgical procedures are carried out; under the Schedule of Section 56(1) of the said Act OR
complies with all minimum criteria as under:
IV. maintains daily records of patients and will make
these accessible to the insurance company’s ■ has at least 10 in-patient beds, in towns having a
authorized personnel population of less than 10,00,000 and 15 in-patient
beds in all other places,
Def. 11. Day Care Treatment/ Proceduresmeans those
medical treatment, and/or surgical procedure which is ■ has qualified nursing staff under its employment
round the clock,
i) undertaken under General or Local Anaesthesia in
a Hospital/Day Care Centre in less than 24 hours ■ has qualified Medical Practitioner(s) in charge round
because of technological advancement, and the clock,

ii) which would have otherwise required Hospitalization ■ has a fully equipped operation theatre of its own
of more than 24 hours, where surgical procedures are carried out,

Treatment normally taken on an Out-patient basis is not ■ maintains daily records of patients and will make
included in the scope of this definition these accessible to the insurance company’s
authorized personnel.
Def. 12. Deductible means a cost sharing requirement under
a health insurance policy that provides that the Insurer will not Def. 19. Hospitalizationmeans admission in a Hospital for
be liable for a specified rupee amount in case of indemnity a minimum period of 24 consecutive ‘In-patient Care’ hours
policies and for a specified number of days/hours in case of except for specified procedures/ treatments, where such
Hospital cash policies, which will apply before any benefits admission could be for a period of less than 24 consecutive
are payable by the insurer. A Deductible does not reduce the hours.
sum insured. Def. 20. Illness/ Illnessesmeans a sickness or a disease or
Def. 13. Dental Treatment means a treatment related to pathological condition leading to the impairment of normal
teeth or structures supporting teeth including examinations, physiological function which manifests itself during the Policy
fillings (where appropriate), crowns, extractions and surgery Period and requires medical treatment

Def. 14. Disclosure of information norm means the policy (a) Acute condition - Acute condition is a disease, Illness or
shall be void and all premiums paid hereon shall be forfeited Injury that is likely to respond quickly to treatment which aims
to the Company, in the event of misrepresentation, mis- to return the person to his or her state of health immediately
description or non-disclosure of any material fact. before suffering the disease/ Illness/ Injury which leads to
full recovery
Def. 15. Domiciliary Hospitalization means medical
treatment for an Illness/disease/Injury which in the normal (b) Chronic condition - A chronic condition is defined as a
course would require care and treatment at a Hospital but disease, Illness, or Injury that has one or more of the following
is actually taken while confined at home under any of the characteristics:
following circumstances: 1. it needs ongoing or long-term monitoring through
I. the condition of the patient is such that he/she is not consultations, examinations, check-ups, and /or tests
in a condition to be removed to a Hospital, or 2. it needs ongoing or long-term control or relief of
symptoms

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
5 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 3. it requires rehabilitation for the patient or for the classified as having a Gleason score greater than
patient to be specially trained to cope with it 6 or having progressed to at least clinical TNM
classification T2N0M0
4. it continues indefinitely
v. All Thyroid cancers histologically classified as
5. 5. it recurs or is likely to recur T1N0M0 (TNM Classification) or below;
Def. 21. Injury means Accidental physical bodily harm vi. Chronic lymphocytic leukaemia less than RAI stage 3
excluding Illness or disease solely and directly caused by
external, violent and visible and evident means which is vii. Non-invasive papillary cancer of the bladder
verified and certified by a Medical Practitioner. histologically described as TaN0M0 or of a lesser
classification,
Def. 22. In-patient Care means treatment for which the
Insured Person has to stay in a Hospital for more than 24 viii. All Gastro-Intestinal Stromal Tumours histologically
hours for a covered event. classified as T1N0M0 (TNM Classification) or below
and with mitotic count of less than or equal to 5/50
Def. 23. Intensive Care Unit means an identified section, ward HPFs;
or wing of a Hospital which is under the constant supervision
of a dedicated Medical Practitioner(s), and which is specially ix. All tumours in the presence of HIV infection.
equipped for the continuous monitoring and treatment of
patients who are in a critical condition, or require life support 2. Open Chest CABG
facilities and where the level of care and supervision is I. The actual undergoing of heart surgery to correct blockage
considerably more sophisticated and intensive than in the or narrowing in one or more coronary artery(s), by coronary
ordinary and other wards. artery bypass grafting done via a sternotomy (cutting through
Def. 24. ICU (Intensive Care Unit)Charges means the the breast bone) or minimally invasive keyhole coronary artery
amount charged by a Hospital towards ICU expenses which bypass procedures. The diagnosis must be supported by a
shall include the expenses for ICU bed, general medical coronary angiography and the realization of surgery has to
support services provided to any ICU patient including be confirmed by a cardiologist.
monitoring devices, critical care nursing and intensive charges II. The following are excluded:
Def. 25. Maternity Expensesmeans a. Angioplasty and/or any other intra-arterial procedures
a. Medical treatment expenses traceable to childbirth 3. Myocardial Infarction (First Heart Attack of specified
(including complicated deliveries and caesarean severity)
section incurred during Hospitalization).
I. The first occurrence of heart attack or myocardial
b. Expenses towards lawful medical termination of infarction, which means the death of a portion of the
pregnancy during the policy Period. heart muscle as a result of inadequate blood supply
Def. 26. Major Illness means: to the relevant area. The diagnosis for Myocardial
Infarction should be evidenced by all of the following
Standard Definitions: criteria:

1. Cancer of specified severity a. A history of typical clinical symptoms consistent with

the diagnosis of acute myocardial infarction (For e.g.
A malignant tumour characterized by the uncontrolled growth typical chest pain)
and spread of malignant cells with invasion and destruction
of normal tissues. This diagnosis must be supported by b. New characteristic electrocardiogram changes
histological evidence of malignancy. The term cancer includes
leukaemia, lymphoma and sarcoma. c. Elevation of infarction specific enzymes, Troponins
or other specific biochemical markers.
The following are excluded:
II. The following are excluded:
i. All tumours which are histologically described as
carcinoma in situ, benign, pre-malignant, borderline a. Other acute Coronary Syndromes
malignant, low malignant potential, neoplasm of b. Any type of angina pectoris
unknown behavior, or non-invasive, including but
not limited to: Carcinoma in situ of breasts, Cervical c. A rise in cardiac biomarkers or Troponin T or I in
dysplasia CIN-1, CIN - 2 and CIN-3. absence of overt ischemic heart disease OR following
an intra-arterial cardiac procedure.
ii. Any non-melanoma skin carcinoma unless there is
evidence of metastases to lymph nodes or beyond; 4. Kidney failure requiring regular dialysis
iii. Malignant melanoma that has not caused invasion End stage renal disease presenting as chronic irreversible
beyond the epidermis; failure of both kidneys to function, as a result of which either
regular renal dialysis (hemodialysis or peritoneal dialysis) is
iv. All tumours of the prostate unless histologically instituted or renal transplantation is carried out. Diagnosis has

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
6 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
to be confirmed by a specialist medical practitioner. 9. Primary (Idiopathic) Pulmonary Hypertension

5. Major Organ/Bone Marrow Transplant I. An unequivocal diagnosis of Primary (Idiopathic)

Pulmonary Hypertension by a Cardiologist or
The actual undergoing of a transplant of: specialist in respiratory medicine with evidence of
a. One of the following human organs: lung, liver, kidney, right ventricular enlargement and the pulmonary
pancreas, that resulted from irreversible end-stage artery pressure above 30 mm of Hg on Cardiac
failure of the relevant organ, Cauterization. There must be permanent irreversible
physical impairment to the degree of at least Class
b. The undergoing of a transplant has to be confirmed IV of the New York Heart Association Classification
by a specialist medical practitioner. of cardiac impairment.

The following are excluded: II. The NYHA Classification of Cardiac Impairment are
as follows:
a. Other stem-cell transplants
i. Class III: Marked limitation of physical activity.
b. Where only islets of langerhans are transplanted Comfortable at rest, but less than ordinary activity
6. Multiple Sclerosis with persisting symptoms causes symptoms.

I. The unequivocal diagnosis of Definite Multiple ii. Class IV: Unable to engage in any physical activity
Sclerosis confirmed and evidenced by all of the without discomfort. Symptoms may be present even
following: at rest.

a. investigations including typical MRI findings which III. Pulmonary hypertension associated with lung
unequivocally confirm the diagnosis to be multiple disease, chronic hypoventilation, pulmonary
sclerosis and thromboembolic disease, drugs and toxins, diseases
of the left side of the heart, congenital heart disease
b. there must be current clinical impairment of motor and any secondary cause are specifically excluded.
or sensory function, which must have persisted for
a continuous period of at least 6 months. 10. Open Heart Replacement or Repair of Heart Valves

II. Other causes of neurological damage such as SLE The actual undergoing of open-heart valve surgery is to
and HIV are excluded. replace or repair one or more heart valves, as a consequence
of defects in, abnormalities of, or disease- affected cardiac
7. Permanent Paralysis of Limbs valve(s). The diagnosis of the valve abnormality must be
supported by an echocardiography and the realization
Total and irreversible loss of use of two or more limbs as of surgery has to be confirmed by a specialist medical
a result of injury or disease of the brain or spinal cord. A practitioner. Catheter based techniques including but not
specialist medical practitioner must be of the opinion that the limited to, balloon valvotomy/valvuloplasty are excluded.
paralysis will be permanent with no hope of recovery and must
be present for more than 3 months. Specific Definitions:

8. Stroke resulting in permanent symptoms 11. Surgery of Aorta

I. Any cerebrovascular incident producing permanent The actual undergoing of medically necessary surgery
neurological sequelae. for a disease of the aorta needing excision and surgical
replacement of the diseased aorta with a graft. For the
a. This includes infarction of brain tissue, thrombosis in purpose of this definition aorta shall mean the thoracic and
an intracranial vessel, haemorrhage and embolisation abdominal aorta but not its branches. Traumatic injury of the
from an extracranial source. aorta is excluded.
b. Diagnosis has to be confirmed by a specialist Def. 27. Medical Advice means any consultation or advice
medical practitioner and evidenced by typical from a Medical Practitioner including the issue of any
clinical symptoms as well as typical findings in CT prescription or follow up prescription.
Scan or MRI of the brain. Evidence of permanent
neurological deficit lasting for at least 3 months has Def. 28. Medical Expenses means those expenses that
to be produced. an Insured Person has necessarily and actually incurred for
medical treatment on account of Illness or Accident on the
II. The following are excluded: advice of a Medical Practitioner, as long as these are no more
a. Transient ischemic attacks (TIA) than would have been payable if the Insured Person had not
been insured and no more than other hospitals or Medical
b. Traumatic injury of the brain practitioners in the same locality would have charged for the
same medical treatment.
c. Vascular disease affecting only the eye or optic nerve
or vestibular functions. Def. 29. Medically Necessary treatment means any
treatment, test, medication, or stay in Hospital or part of stay

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
7 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
in Hospital which modes of communication

■ Is required for the medical management of the Illness Def. 36. OPD Treatment. OPD treatment means the one
or Injury suffered by the Insured Person; in which the Insured visits a clinic / Hospital or associated
facility like a consultation room for diagnosis and treatment
■ Must not exceed the level of care necessary to based on the advice of a Medical Practitioner. The Insured is
provide safe, adequate and appropriate medical care not admitted as a day care or in-patient.
in scope, duration or intensity.
Def. 37. Portability means, the right accorded to individual
■ Must have been prescribed by a Medical Practitioner. health insurance policyholders (including all members under
■ Must conform to the professional standards widely family cover), to transfer the credit gained for pre-existing
accepted in international medical practice or by the conditions and time bound exclusions, from one insurer to
medical community in India. another insurer.

Def. 30. Medical Practitioner means a person who holds Def. 38. Pre-existing disease means any condition, ailment,
a valid registration from the Medical Council of any State or injury or disease:
Medical Council of India or Council for Indian Medicine or for i. That is/are diagnosed by a physician within 48
Homeopathy set up by the Government of India or a State months prior to the effective date of the policy issued
Government and is thereby entitled to practice medicine by the insurer or its reinstatement or
within its jurisdiction; and is acting within the scope and
jurisdiction of license.Medical Practitioner who is sharing the ii. For which Medical advice or treatment was
same residence with the Insured person`s and is a member recommended by, or received from, a physician within
of Insured Person’s family are not considered as Medical 48 months prior to the effective date of the policy or
Practitioner under the scope of this Policy. its reinstatement.

Medical practitioner for mental illnesses means a Def. 39. Pre-hospitalization Medical Expenses
medical practitioner possessing a post-graduate degree or meansMedical Expenses incurred during pre-defined number
diploma in psychiatry awarded by an university recognised of dayspreceding the Hospitalization of the Insured Person,
by the University Grants Commission established under provided that:
the University Grants Commission Act, 1956, or awarded
or recognised by the National Board of Examinations and i. Such Medical Expenses are incurred for the
included in the First Schedule to the Indian Medical Council same condition for which the Insured Person’s
Act, 1956, or recognised by the Medical Council of India, Hospitalization was required, and
constituted under the Indian Medical Council Act, 1956, and ii. The In-patient Hospitalization claim for such
includes, in relation to any State, any medical officer who Hospitalization is admissible by the Insurance
having regard to his knowledge and experience in psychiatry, Company
has been declared by the Government of that State to be a
psychiatrist for the purposes of this Act; Def. 40. Post-hospitalization Medical Expenses means
Medical Expenses incurred during pre-defined number of days
Medical Practitioner (Definition applicable for the treatment immediately after the insured person is discharged from the
taken outside India) Hospital provided that:
Means a licensed medical practitioner acting within the i. Such Medical Expenses are for the same condition
scope of his license and who holds a degree of a recognized for which the insured person’s Hospitalization was
institution and is registered by the Authorized Medical Council required, and
of the respective country.
ii. The inpatient Hospitalization claim for such
Def. 31. Migration means, the right accorded to the health Hospitalization is admissible by the insurance
insurance policyholders (including all members under family company.
cover and members of group health insurance policy), to
transfer the credit gained for pre-existing conditions and time Def. 41. Qualified Nurse is a person who holds a valid
bound exclusions, with the same insurer. registration from the nursing council of India or the nursing
council of any state in India
Def. 32. Newborn Baby means baby born during the Policy
Period and is Aged up to 90 days Def. 42. Renewal means the terms on which the contract of
insurance can be renewed on mutual consent with a provision
Def. 33. Network Provider means Hospitals or health care of Grace Period for treating the Renewal continuous for the
providers enlisted by an insurer, TPA or jointly by an Insurer purpose of gaining credit for Pre-Existing Diseases, time-
and TPA to provide medical services to an insured by a bound exclusions and for all waiting periods
Cashless facility.
Def. 43. Room Rent means the amount charged by a Hospital
Def. 34. Non Network means any Hospital, Day Care Centre towards Room and Boarding expenses and shall include the
or other provider that is not part of the Network AssociatedMedical Expenses
Def. 35. Notification of Claim means the process of intimating Def. 44. Reasonable and Customary Chargesmeans the
a claim to the insurer or TPA through any of the recognized
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
8 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
charges for services or supplies, which are the standard Def. 10. Material Facts means all relevant information sought
charges for a specific provider and consistent with the by the Company in the Proposal Form and other connected
prevailing charges in the geographical area for identical or documents to enable it to take informed decision in the context
similar services ,taking into account the nature of Illness/ of underwriting the risk.
Injury involved.
Def. 11. Mental illness means a substantial disorder of
Def. 45. Surgery or Surgical Proceduremeans manual and / thinking, mood, perception, orientation or memory that grossly
or operative procedure (s) required for treatment of an Illness impairs judgment, behaviour, capacity to recognise reality or
or Injury, correction of deformities and defects, diagnosis and ability to meet the ordinary demands of life, mental conditions
cure of diseases, relief from suffering and prolongation of life, associated with the abuse of alcohol and drugs, but does not
performed in a Hospital or Day Care Centre by a medical include mental retardation which is a condition of arrested
practitioner. or incomplete development of mind of a person, specially
characterised by sub normality of intelligence;
Def. 46. Unproven/Experimental Treatment is a treatment
including drug experimental therapy, which is based Def. 12. Mental health establishment means any health
on established medical practice in India, is a treatment establishment, including Ayurveda, Yoga and Naturopathy,
experimental or unproven. Unani, Siddha and Homoeopathy establishment, by whatever
name called, either wholly or partly, meant for the care of
Specific Definitions
persons with mental Illness, established, owned, controlled
Def. 1. Adventurous/Hazardous Sports means any sport or maintained by the appropriate Government, local authority,
or activity involving physical exertion and skill in which an trust, whether private or public, corporation, co-operative
Insured Person participates or competes for entertainment society, organisation or any other entity or person, where
or as part of his Profession whether he / she is trained or not. persons with mental Illness are admitted and reside at, or kept
in, for care, treatment, convalescence and rehabilitation, either
Def. 2. Age or Aged means completed years as at the Policy temporarily or otherwise; and includes any general Hospital
Commencement Date. or general nursing home established or maintained by the
appropriate Government, local authority, trust, whether private
Def. 3. Alternative treatments means forms of treatments or public, corporation, co-operative society, organisation
other than treatment “Allopathic” or “modern medicine” and or any other entity or person; but does not include a family
includes Ayurveda, Unani, Sidha and Homeopathy in the residential place where a person with mental Illness resides
Indian context with his relatives or friends;
Def. 4. Associated Medical Expenses means Consultation Def. 13. Non-Medical Expenses – Are expenses other than
fees, charges on Operation theatre, surgical appliances & those defined as Medical Expenses and which are listed on
nursing, and expenses on Anesthesia, blood, oxygen incurred our website www.hdfcergo.com
during Hospitalization of the Insured Person
Def. 14. HDFC ERGO Mobile App isproprietary App of HDFC
Def. 5. Bank Rate means the rate fixed by the Reserve Bank ERGO General Insurance Company. With this App you can:
of India (RBI) at the beginning of the financial year in which
claim has fallen due. o Access Your Policy Details
Def. 6. Commencement Date means the commencement ■ Manage Your policy, download Your policy schedule
date of the Policy as specified in the Policy Schedule. and access to Your e-card will always be at Your
fingertips, 24 x 7.
Def. 7. Dependents means only the family members listed
below: o Policy Endorsement made easy
a) Your legally married spouse as long as she continues ■ By submitting a request to us through HDFC ERGO
to be married to You Mobile App, you can make any modifications in Your
policy, for e.g. change in spelling of the name, contact
b) Your children Aged between 91 days and 25 years number etc.
if they are unmarried, still financially dependent on
You and have not established their own independent o Effortless Claims Management
households;
■ Now you can SubmitYour claims from the app
c) Your natural parents or parents that have legally for faster processing and track the status at Your
adopted You, and Your parents in law fingertips. You can also intimate a claim using the
app. You can also view Network hospitals in Your
Def. 8. Family Floater means a Policy described as such in area with directions.
the Policy Schedule where under You and Your Dependents
(Spouse, dependent children, dependent parents/parents in o Stay Active – Short Walks, Big Benefits
laws) named in the Policy Schedule are insured under this
Policy as at the Commencement Date. . ■ The App tracks Your steps, fitness session and lets
you earn incentive on renewal discount on Your
Def. 9. Insured Person means the persons named in the policy.
Policy Schedule and insured under the Policy.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
9 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
Def. 15. Preventive Health Check-up - Preventive Health vii. The Cost of prosthetic and other Medical devices or
Check-up means a package of medical test(s) undertaken equipment if implanted internally during a Surgical
for general assessment of health status, it does not include Procedure.
any diagnostic or investigative medical tests for evaluation of
illness or a disease. Insured Person shall bear specified percentage of admissible
Claim amount under each and every Claim If Co-payment
Def. 16. Policy means Your statements in the proposal under Section D-14 is opted and specified in the Schedule of
form (which are the basis of this Policy), this policy wording Coverage in the Policy Schedule
(including endorsements, if any), and the Policy Schedule (as
a) Mental Healthcare
the same may be amended from time to time).
The Coverage for Mental illness is applicable if done in
Def. 17. Policy Period means the period between the Mental Health Establishment and is subject to the provisions
Commencement Date and the Expiry Date specified in the contained in the Mental Health Care Act, 2017, as amended
Policy Schedule from time to time and other applicable laws and Regulations
Def. 18. Policy Holder means Person who has proposed the 2.Home Healthcare
Policy and in whose name the Policy is issued
Insured Personcan avail Hospitalization at home under Home
Def. 19. Policy Schedule means Schedule attached to Healthcare for Medically Necessary Treatment of Illnesses,
and forming part of this Policy mentioning the details of the if prescribed by treating Medical Practitioner. We will pay
Insured Persons, the Sum Insured, the period and the limits Medical Expensesunder Section B1 incurred for treatment of
to which benefits under the Policy are subject to (Schedule such Illness where opted.
of coverage), including any Annexures and/or endorsements,
This Cover can be availed through Cashless Facilityonly as
made to or on it from time to time, and if more than one, then
procedure given under Claims Procedure - Section G.
the latest in time.
Insured Person shall bear specified percentage of admissible
Def. 20. Policy Year means a year following the Claim amount under each and every Claim If Co-payment
Commencement Date and its subsequent annual anniversary. under Section D-14 is opted and specified in the Schedule of
Def. 21. Sum Insuredmeans the sum shown in the Policy Coverage in the Policy Schedule
Schedule which represents Our maximum liability for each 3.Domiciliary Hospitalization
Insured Person for any and all benefits claimed for during the
Policy Year, and in relation to a Family Floater represents Our We will pay the Medical Expenses incurred on Domiciliary
maximum liability for any and all claims made by You and all Hospitalization of theInsured Person provided that:
of Your Dependents during the Policy Year i. It has been prescribed by the treating Medical
Practitioner and
Def. 22. We/Our/Us means the HDFC ERGO General
Insurance Company Limited ii. the condition of the Insured Personis such that he/
she could not be removed to a Hospital or
Def. 23. You/Your/Policyholder means the person named
in the Policy Schedule who is insured under the Policy or has iii. the Medical Necessary Treatment is taken at Home
proposed and concluded this Policywith Us. on account of non-availability of room in Hospital

SECTION B: BENEFITS Insured Person shall bear specified percentage of admissible

Claim amount under each and every Claim If Co-payment
We will pay under below listed Covers on Medically under Section D -14 is opted and specified in the Schedule
Necessary Hospitalization of an Insured Person due to of Coverage in the Policy Schedule
Illness or Injury sustained or contracted during the Policy 4.Pre-Hospitalization cover
Period. The payment is subject to Sum Insured and limits
including Cumulative Bonus if applicable as specified on the We will pay for the Pre-hospitalization Medical Expenses
Schedule of Coverage in the Policy Schedule. Subject to incurred during the 60 days immediately before Hospitalization
otherwise terms and conditions of the Policy. of an Insured Person provided thatClaim under Section B1 or
B6 is admissible under the Policy.
I. Hospitalization Cover
Where Insured Person has opted for Home Healthcare treatment
1. Medical Expenses under Section B2, Pre-HospitalizationMedicalExpenses are
i. Room rent, boarding and Nursing charges payable up to 60 days prior to start of the Medical treatment.
ii. Intensive Care Unitcharges Insured Person shall bear specified percentage of admissible
iii. Consultation fees Claim amount under each and every Claim If Co-payment
iv. Anesthesia, blood, oxygen, operation theatre under Section D -14 is opted and specified in the Schedule
charges, surgical appliances of Coverage in the Policy Schedule

v. Medicines, drugs and consumables 5. Post-Hospitalization cover

vi. Diagnostic procedures We will pay for the Post-HospitalizationMedical Expenses
incurred upto180 days from the date Insured Person is

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
10 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
discharged from Hospital provided that Claim under Section Insured Person shall bear specified percentage of admissible
B1 or B 6 is admissibleunder the Policy Claim amount under each and every Claim If Co-payment
under Section D -14 is opted and specified in the Schedule
Where Insured Person has opted for Home Healthcare treatment
of Coverage in the Policy Schedule
under Section B2, Post HospitalizationMedicalExpensesare
payable up to 180 days post completion of the medical 9. Alternative Treatments
treatment.
We will pay Medical Expensesas listed under Section B1 on
Insured Person shall bear specified percentage of admissible Hospitalization of Insured Personin Ayush Hospitalfor following
Claim amount under each and every Claim If Co-payment Alternative Treatments prescribed by Medical Practitioner
under Section D -14 is opted and specified in the Schedule
• Ayurvedic
of Coverage in the Policy Schedule
6. Day Care Procedures • Unani

We will pay for the Medical Expenses under Section B1 on • Siddha

Hospitalizationof Insured Person in Hospital or Day Care
• Homeopathy
CentreforDay Care Treatment.
Insured Person shall bear specified percentage of admissible provided that;
Claim amount under each and every Claim If Co-payment i. The procedure performed on the Insured Person
under Section D -14 is opted and specified in the Schedule cannot be carried out on Outpatient basis
of Coverage in the Policy Schedule
ii. In the event of admissible Claim under this Cover,
7. Road Ambulance no Claim shall be admissible under Section B 1 for
We will pay for expenses incurred on Road Ambulance Allopathic treatment of same Illness or Injury
Services if Insured Person is required;
Insured Person shall bear specified percentage of admissible
i. to be transferred to the nearest Hospital following an Claim amount under each and every Claim If Co-payment
emergency (namely a sudden, urgent, unexpected under Section D -14 is opted and specified in the Schedule
occurrence or event, bodily alteration or occasion of Coverage in the Policy Schedule
requiring immediate medical attention)
II. Renewal Benefits
ii. or from one Hospital to another Hospital 1. Preventive Health Check-Up
iii. of from Hospital to Home (within same City) following After every block ofeveryfour consecutive, continuous and
Hospitalization Claim free Policy Yearswith Us, We will pay towards cost
of Preventive Health Check-upto specified percentage (as
provided that Claim under Section B1 and B6 is admissible
mentioned on the Schedule of Coverage) of Sum Insuredfor
under the Policy.
those Insured Persons who were Insured under the previous
Insured Person shall bear specified percentage of admissible 4 Policy years with Us.
Claim amount under each and every Claim If Co-payment
Other terms and Conditions applicable to this Benefit
under Section D -14 is opted and specified in the Schedule
of Coverage in the Policy Schedule • This benefit will not be carried forward if not utilized.
8. Organ Donor Expenses • Eligibility to avail Health Check-up will be in
We will pay Medical Expenses as listed under Section B1 accordance to lower of expiring Policy Sum Insured
towards organ donor’sHospitalizationfor harvesting of the or Renewed Policy Sum Insured.
donated organ where an Insured Person is the recipient, • This cover is applicable only to Insured Person
provided that; covered under all four Policy Years and who continue
i. The organ donor is any person whose organ has been to remain insured in the subsequent Policy Year/
made available in accordance and in compliance with Renewal.
The Transplantation of Human Organ (amendment)
• Availing of Claim under this Cover will not impact the
Act, 2011,Transplantation of Human Organs and
Sum Insured or the eligibility for Cumulative Bonus
Tissues Rules, 2014and other applicable laws and
rules. 2. Cumulative Bonus
ii. Hospitalization Claim under Section B1 is admissible On each Renewal of the Policy with Us, We will apply 5% of
under the Policy Basic Sum Insured under expiring Policy as Cumulative Bonus
in the Policy provided that;
iii. The Organ Donor’s Pre-Hospitalization and Post-
Hospitalization expenses are excluded under the i. There has been no claim under the Policy in expiring
Policy year under Section B

iv. Any other Medical Expenses or Hospitalization ii. Cumulative Bonuswill be reduced at the same rate
consequent to the harvesting is excluded under the Policy as accrued in the event of admissible Claim under

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
11 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 Section B of the Policy. Application of Fitness discount @ Renewal

iii. Cumulative Bonuscan be accumulated upto 50% of • Annual Policy: Discount amount accrued based on
Basic Sum Insured. Number of accumulated Healthy Weeks during the expiring
PolicyYearwill be applied on the Renewal Premium for expiring
iv. Cumulative Bonusapplied will be applicable only to Policy Sum Insured and for Insured Person covered under
Insured Person covered under expiring Policy and expiring Policy
who continue to remain insured on Renewal.
• Multi Year Policy:
v. In case of multiyear policies, Cumulative Bonusthat
o Fitness discount earned on yearly basis will be
has accrued for the second and third Policy Year will
accumulated till Policy End date.
be credited on Renewal. Accrued Cumulative Bonus
may be utilized in case of any Claim during Policy o On Renewal of the Policy, total discount amount
tenure accrued each Policy Year will be applied on Renewal
Premium of subsequent year and for Insured Person
3. my: Health Active
covered under expiring Policy
A. Fitness discount @ Renewal
• For Policiescovering more than one Insured
Insured Person can avail discount on Renewal Premium by Person,Healthy Weeks for each Insured Person
accumulating Healthy Weeks as per table given below. will be tracked andaccrued. Such discount will be
One Healthy Week can be accumulated by; applicable on individual RenewalPremium for both
Individual and Floater Sum Insured basis Policies.
• Recording minimum 50,000 steps in a week subject
to maximum 15,000 steps per day, tracked through • Premium will be discounted to the extent applicable
Your wearable device linked to OurHDFC ERGO to coverage corresponding to expiring Policy.
Mobile App and Your Policy number
• In case of Increase in Sum Insured at Renewal,
OR discount amount will be applied on the premium
corresponding to expiring PolicySum Insured.
• burning total of 900 calories upto maximum of 300
calories in one exercise session per day, tracked Your • Fitness discount @ Renewal will be applied only on
wearable device linked to OurHDFC ERGO Mobile Renewal of Policy with Us and only if accrued.
App and YourPolicy number
B. Health Incentive
• Fitness discount @ Renewal is applicable for Adult
This Program encourages Insured Persons to maintain good
Insured Persons only. Any Person covered as Child
health and avail incentives as listed below.
Dependent, irrespective of the Age is excluded.
Under this Program, Insured Person having Pre-Existing
Healthy Weeks Discounts Diseases or Obesity (BMI above 30) as listed under table A
below, will be eligible for reduction in Medical Underwriting
No. of Healthy Weeks Discount on Renewal Loading applied on first inception of the Policy with Us
Accumulated Premium provided that;
1-4 0.50% i. Insured Person shall undergo medical tests and/or
5-8 1.00% BMI check-up as listed below minimum 3 months
prior to expiry of Policy Year (For Multiyear Policies)
9-12 2.00% or before Renewal (For Annual Policies).
13-16 3.00% ii. Medical test shall be done at Your own cost through
17-26 6.00% our Network Provider on Our HDFC ERGO Mobile
App
27-36 7.50%
iii. If the test parameters are within normal limits, We
Above 36 10.00% will apply 50% discount on the Medical Underwriting
Steps to accumulate Healthy Weeks loading applied for corresponding Pre-Existing
Disease or Obesity as applicable on Renewal of the
Step 1 - The HDFC ERGO Mobile App must be downloaded Policy with Us.
on the mobile.
iv. If the test parameters at subsequent Renewal are
Step 2 - You can start accumulating Healthy Weeks by tracking not within normal limits or Medical test reports are
physical activity trough the Wearable device linked not submitted in accordance with i and ii above, the
ToOurHDFC ERGO Mobile App and YourPolicy number discount amount applied on Medical Underwriting
loading will be zero
We encourage and recognize all types of exercise/fitness
activities by making use of wearable devices to track and
record the activities Insured Person engages in.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
12 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
Table A Mobile App as a chat service or as a call back facility.
Pre-existing Diseases Test ii. Wellness services
Diabetes HbA1c • Discounts: on OPD, Pharmaceuticals, pharmacy,
diagnostic centres.
Hypertension Blood Pressure reading
• Customer Engagement: Monthly newsletters, Diet
Hyperlipidemia Total Cholesterol
consultation, health tips
Cardiovascular Diseases ECG
• Specialized programs: stress management,
Hypothyroidism Thyroid function tests Pregnancy Care, Work life balance management.
Obesity BMI These services will be available through OurHDFC ERGO
Mobile App
Application of Health Incentive
Disclaimer applicable toHDFC ERGO Mobile App and
• Annual Policy: Discount amount accrued during associated services
the expiring Policy year will be applied on the
Renewal Premium corresponding to expiring Policy It is agreed and understood that Our HDFC ERGO Mobile
Sum Insuredand for Insured Person covered under App and Wellness services intention is not to provide specific
expiring Policy medical advice but rather to provide users with information to
better understand their health and their diagnosed disorders.
• Multi Year Policy: The information is not a substitute for professional medical
care by a qualified doctor or other health care professional.
o Discount amount earned on yearly basis will be
accumulated till Policy End date. The information provided is general in nature and is not specific
to you. You must never rely on any information obtained using
• On Renewal of the Policy, total discount amount this app for any medical diagnosis or recommendation for
accrued each year will be applied on Renewal medical treatment or as an alternative to medical advice from
Premium of subsequent year and for Insured Person your physician or other professional healthcare provider. If you
covered under expiring Policy think you may be suffering from any medical condition you
• For Policiescovering more than one Insure should seek immediate medical attention.
Person,testsshall be done for each Insured Person Reliance on any information on this App is solely at your own
basis which such reduction in loading where ever risk. HDFC EGRO General Insurance Company Limited do
applicable will be applied on individual Renewal not assume any liability towards any loss or damage arising
Premium for both Individual and Floater Sum Insured out of or in relation to any opinion, actual or alleged errors,
basis Policies. omissions and representations, any decision made or action
taken or not taken in reliance upon the information.
• Medical Underwriting loading will be discounted only
on Renewal of Policy with Usand only for Insured III. Optional Covers
Person covered under such expiring Policy
Preamble
• Discount on Medical Underwriting loading under this In consideration of payment of additional Premium or reduction
cover is applicable only on next Renewal and cannot in the Premium as applicable, it is hereby declared and agreed
be utilized if Policy not renewed with us. that We will pay/restrict the expenses under below listed
C. Wellness services: Covers subject to all other terms, conditions, exclusions and
waiting periods applicable to the Policy.
The services listed below are available to all Insured Person
through Our Network Provider on OurHDFC ERGO Mobile App These Covers are optional and applicable only if opted for and
only. Availing of services under this Section will not impact the upto the Sum Insured or limits mentioned on the Schedule of
Sum Insured or the eligibility for Cumulative Bonus. Coverage in the Policy Schedule.

i. Health Coach: 1. Preventive Health Check-Up - Booster

An Insured Person will have access to Health Coaching On opting this Cover, Insured Person will be entitled for Health
services in aregiven below: Check-up after each Policy Year with Us irrespective of Claims
made under the Policy in accordance with options given below.
• Disease management
• Activity and fitness i. We will reimburse the cost of Preventive Health
Check-up to limits mentioned on the Schedule of
• Nutrition Coverage.
• Weight management
Or
• Psychological Counselling
• Depression Counselling ii. Insured Person shall have the option to undergo
Health Check-Up at our Network Service Provider
These services will be available through Our HDFC ERGO in accordance to criteria given below.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
13 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 infertility, surrogate or vicarious pregnancy, voluntary
Sum Insured Tests
termination of pregnancy, procedures to assist birth
Upto 2 Lacs Medical Examination Report, Complete control, contraceptive supplies.
Blood Count Urine R, Fasting Blood
Sugar, Serum Creatinine, Lipid Profile, 3. Parent and Child care Cover – Booster
Electro Cardio Gram We will pay to the Insured Person subject to waiting period
and limits as mentioned in the Schedule of Coverage on the
3 Lac and Chest X Ray , 2D echo/ Stress test,
Policy Schedule under Covers as given below.
above PSA for Males, PAP smear for Females,
Medical Examination Report, Complete I. Parent Care
Blood Count Urine R, Fasting Blood
i. Maternity Expenses - Medical Expenses for a delivery
Sugar, Serum Creatinine, Lipid Profile,
(including caesarean section) on Hospitalization or
Electro Cardio Gram
the lawful medical termination of pregnancy during
Other Terms and Conditions applicable to this Cover the Policy Period.
• This benefit will not be carried forward if not utilized ii. OPD Treatment in Pre-natal and post-natal period
within 60 days of Policy Anniversary/Renewal date. up to the limit of this cover, provided Claim under i.
Maternity Expenses is admissible under the Policy
• On opting this Cover, Renewal Benefit 1, Preventive
Health Check-up under Section C stands deleted. iii. Infertility Treatment: Medical Expenses listed under
Section B1 incurred for infertility treatment, assisted
2. Parent and Child care Cover - Basic reproductive treatments undertaken on advice of a
We will pay to the Insured Personsubject to waiting period Medical Practitioner, up to 50% of Normal Delivery
as mentioned in the Schedule of Coverage on the Policy Sum Insured under this Cover. This cover is
Schedule under Covers as given below. applicable for both Male and Female Insured Person
I. Parent Care II. Child Care
i. Medical Expenses under Section B1 for Maternity We will pay following expenses towards Child Care for New
Expenseslimitedup to 2 deliveries or 1 delivery and Born Baby under this cover if Claim for Maternity Expenses
1 termination or 2 terminations during the lifetime of is admissible under the Policy.
the Insured Person
i) New Born baby cover:
ii. OPD Treatment in Pre-natal and Post-natal period We will pay Medical xpenses listed under Section B1 towards
provided Claim under Maternity Expenses is treatment of a New Born Baby within the limit of Sum Insured
admissible under the Policy. under this Cover as mentioned in Schedule of Coverage on
II. Child Care the Policy Schedule

We will pay/cover following expenses towards Child Care ii) Vaccination Charges:
for New Born Baby under this cover if Claim for Maternity We will pay expenses incurred on vaccination for New Born
Expenses is admissible under the Policy. Baby as per National Immunization Schedule until New Born
i. We will pay Medical Expenses listed under Section Baby completes 1 year of age subject to maximum of sub limit
B1 withinSum Insured for Parent Caretowards of Sum Insured under this Cover.
treatment of a New Born Baby as per limit mentioned If opted, this cover, General exclusion E.1.II. xiv),xv) and
on Schedule of Coverage. E.2.II. xi) under General Exclusions, Section E and Optional
Cover 2 “Parent and Child Cover – Basic” under Section D
ii. New Born Baby Cover–We will cover New Born Baby
stands deleted.
immediately after the birth as per original terms of
the Policy on receipt of completed proposal form and III. Waiting Period modification Option
Premium received within 90 days of birth of Baby and
On availing this option, Waiting Period listed under Section
subject to acceptance by Us.
E.2.I (iv), will stand modified as mentioned in the Schedule
If this Cover is opted, General exclusion xv) under General of Coverage on the Policy Schedule.
Exclusions, Section E, stands deleted. All other terms and conditions of the Parent & Child Care
Exclusions applicable to this Cover. Cover - Booster shall remain unaltered.
i. Pre-Hospitalization and post-Hospitalization Exclusions applicable to this Cover.
expenses are not payable under this cover i. Pre-Hospitalization and post-Hospitalization
ii. We will not pay any expenses related to ectopic expenses are not payable under this cover
pregnancy under this cover. Ectopic pregnancy will ii. We will not pay any expenses related to ectopic
be covered as a part of expenses under Section B1 pregnancy under this cover. Ectopic pregnancy will
only. be covered as a part of expenses under Section B1
iii. Treatment for impotency, treatment to effect only.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
14 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 iii. Treatment for impotency, treatment to effect 6. Sum Insured Rebound
infertility, surrogate or vicarious pregnancy, voluntary
We will add to the Sum Insured, an amount equivalent to
termination of pregnancy, procedures to assist birth
the Claim amount paid under Basic Sum Insured,subject to
control, contraceptive supplies.
maximum of Basic Sum Insured on subsequent Hospitalization
4. Air Ambulance Cover of the Insured Person during Policy Year subject to

We will pay for Air Ambulance transportation in an airplane or i. The Total Sum Insured added under this cover will
helicopter for Emergency Care which requires immediate and not exceed the Basic Sum Insured in a Policy Year
rapid ambulance transportation as prescribed by a Medical
ii. Total of Basic Sum Inured under Hospitalization
Practitioner, from the site of first occurrence of the Illness/
Cover, Cumulative/Extended Cumulative Bonus (if
Accident to the nearest Hospital, that ground transportation
applicable) earned and Sum Insured Rebound will
cannot provide. Claim would be reimbursed up to the actual
be available to all Insured Persons for all claims
expenses subject to a maximum of Sum Insured as specified
under Section B during the current Policy Year and
on the Schedule of Coverage in the Policy Schedule.
subject to the condition that a single claim in a Policy
Exclusion: Year cannot exceed the sum of Basic Sum Insured
and the Cumulative/Extended Cumulative Bonus (if
We will not pay for return transportation to the Insured Person’s
opted) earned
home by air ambulance
5. Recovery Benefit iii. In case of treatment for Chemotherapy and Dialysis,
Sum Insured Rebound will be applicable only once
We will pay Sum Insured as specified on the Schedule of in lifetime of Policy
Coverage in the Policy Schedule upon Medically Necessary
Hospitalization of an Insured Person exceeding 10 consecutive i. This cover will be applicable annually for policies with
and continuous days and for which Claim is admissible under term more than one year.
Section B– Hospitalization Cover.
ii. Any unutilized amount of Sum Insured Rebound
This benefit is not applicable if Medical treatment is taken cannot be carried over to next Policy Year or Renewal
under Section B2 – Home Health care and B3 – Domiciliary Policy
Hospitalization
iii. The Sum Insured Rebound can be utilized for Claims
under Section B only.
Illustration 1
Sum Cumulative Admissible Total SI
Claim SI Rebound Payable
Time Insured Bonus Claim Rebound till
no. Available amount
available available amount date
3 months 3,00,000 30,000 2,50,000 0 0 2,50,000
1
5 months 50,000 30,000 1,40,000 0 0 80,000
9 months 2 0 0 2,50,000 3,00,000 3,00,000 2,50,000
11 months 4 0 0 70,000 50,000 3,00,000 50,000

Illustration 2
Sum Admissible Total SI
Claim Cumulative Payable
Time Insured Claim SI Rebound Rebound till
no. Bonus amount
available amount date
3 months 1 3,00,000 30,000 2,50,000 0 0 2,50,000
6 months 2 50,000 30,000 1,40,000 2,50,000 2,50,000 1,40,000

=250,000-
9 months 3 0 0 2,50,000 60,000+50,000 3,00,000 2,40,000
=240,000
11 months 4 0 0 70,000 0 3,00,000 0

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
15 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
7. Outpatient Dental Treatment Period as mentioned on Schedule of Coverage on
the Policy Schedule
After three consecutive and continuous Policy Year with Us,
We will pay 50% of Medical Expenses incurred by Insured ii. Claim for each Major Illnessis payable only once
Person towards Dental Treatment prescribed by Medical during the lifetime of Policy with Us. However, Insured
Practitionerup to the amount as mentioned in the Schedule Person will continue to be covered under this Section
of Coverage on the Policy Schedule. Claim under this Section for other Major Illnesses.
can be availed only through our Network Provider. The Cover
is applicable only to Insured Person covered under three iii. Claim under this Cover is admissible only when total
consecutive and continuous Policy Years and who continue of Basic Sum Insuredis completely utilized.
to remain insured in the subsequent Policy Year/Renewal
iv. The additional Sum Insured under this Cover is
The Coverage is applicable only towards cost of X-rays, exclusive and specific for the treatment of the first
extractions, amalgam or composite fillings, root canal occurrence of the above Critical Illness undertaken
treatments and prescribed drugs for the same. in a Hospital/Nursing Home as an in-patient and will
not be available for other illnesses/hospitalization.
Claim under this Section will not affect Cumulative Bonus
under Section C2, condition ii.
Major Illness Covered
Exclusions specific to Outpatient Dental Treatment
1 Cancer of specified severity
i. Cosmetic surgery, dentures, dental prosthesis, dental
implants, orthodontics, orthognathic surgery, jaw alignment 2 Open Chest CABG
or treatment for the temporomandibular (jaw) joint, or upper
3 Myocardial Infarction((First Heart Attack of
and lower jaw bone surgery and surgery related to the
specific severity)
temporomandibular (jaw) unless necessitated by an acute
traumatic injury due to an accident or cancer 4 Kidney Failure requiring regular dialysis
8. External Medical Aids 5 Multiple Sclerosis with Persisting
Symptoms
After every two consecutive and continuous Policy YearwithUs,
We will pay up to 50% of cost incurred towards following 6 Major Organ/Bone Marrow Transplant
Medical Expenses subject to maximum of Sum Insuredas
mentioned in the Schedule of Coverage, on the Policy 7 Stroke resulting in permanent symptoms
Schedule; 8 Surgery of Aorta
i. One pair of spectacles or one pair of contact lenses, 9 Primary (Idiopathic) Pulmonary
ii. A hearing aid Hypertension

Other terms 10. Non-Medical Expenses cover

• The Cover is applicable only to Insured Person We will pay for Non-Medical Expenses upto the limit mentioned
covered under two consecutive and continuous in Schedule of Coverage in the Policy Schedule on Medically
Policy Years and who continue to remain insured in necessary Hospitalization of Insured Person for claims
the subsequent Policy Year/Renewal admissible under Section B1, 2 and 3.
In view of this Cover, Exclusion E.2.II. xii) of Section E, shall
• Under a Family Floater Policy, Our liability shall be
stand covered upto the extent mentioned above.
limited to either one pair of spectacles or contact
lenses or hearing aid per family. 11. Waiting period Modification Option

• Medical Expenses incurred under this Cover shall be On availing this option, Waiting Periods listed underSection E
prescribed by our Network Provider and is payable 1.I – i, ii and iii will stand modified as mentioned in Schedule
only once after block of every two consecutive and of Coverage on the Policy Schedule for following Sections;
continuous Policy Year with Us. Section B – Hospitalization Cover
• Claim under this Section will not affect Cumulative Section D4 – Air Ambulance
Bonus under Section C2, condition ii
Section D5 – Recovery Benefit
9. Major Illness Hospitalization Expenses
Section D9 – Major Illness Hospitalization Expenses
We will pay for Medical Expenses incurred and admissible
Section D17 –Hospital Cash
under Section B1,up to additional Sum Insured equivalent
to Basic Sum Insured,onMedically necessary Hospitalization Section D18 – Global Health Cover
of Insured Person for Major illnesseslisted below whose
All other terms and Conditions of the respective Section and
diagnosis first commence/occursafter the applicable waiting
Policy shall remain unaltered.
period from commencement of the first Policy with Us, subject
to the following; 12. Extended Cumulative Bonus
i. Waiting Period – The coverage is subject to Waiting On availing this cover, Cumulative Bonus percentage

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
16 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
mentioned under Section C2 – Cumulative Bonus will stand
7 Permanent Paralysis of Limbs
modified as mentioned in Schedule of Coverage on the Policy
Schedule subject to; 8 Stroke resulting in Permanent Symptoms
i. Once the Extended Cumulative Bonus benefit is 9 Surgery of Aorta
availed by the Insured Person, it cannot be opted
out at subsequent Renewal. 10 Primary (Idiopathic) Pulmonary Hypertension
11 Open Heart Replacement or Repair of Heart Valves
ii. All other terms and Conditions of Renewal Benefits
Section C, ii shall remain unaltered. Survival Period
13. Room Rent Modification Option Claim under this Cover is payable only if Insured Person
survives 30 days from the diagnosis, fulfillment of the definition
On availing this option, limits specified under Section B1 i and
of the Major illness covered and with confirmatory diagnosis
B 1 ii will stand modified as below.
of the conditions covered while the Insured Person is alive
i. Room Rent, boarding and Nursing – limit of 1% of (A claim would not be admitted if the diagnosis is made post
the Basic Sum Insured subject to maximum of Rs. mortem)
5,000 per day
16. E-Opinion
ii. Intensive care unit – limit of 2% of the Basic Sum We will pay expenses incurred towards second Medical
Insured subject to maximum of Rs. 10,000 per day Opinion availed from Medical Practitioner in respect of Major
Illness covered and listed below under the Policy through our
Proportionate deduction:
Network Provider.
In In case Room Rent during Hospitalization of Insured
The Coverage under this benefit shall cease to exist upon
Personexceeds the aforesaid limits, the reimbursement/
availing Second Opinion for any one Major Illness as listed
payment of Room Rent charges including all Associated
below.
Medical Expenses incurred at Hospital shall be effected in
the same proportion as the admissible rate per day bears to
the actual rate per day of Room Rent charges. This condition Major Illness Covered
is not applicable in respect of Hospitals where differential 1 Cancer of specified severity
billing for Associated Medical Expenses is not followed based
on RoomRent. 2 Open Chest CABG

14. Co-Payment 3 Myocardial Infarction(First Heart Attack of specific

severity)
On availing this option, Co-Payment as mentioned on the
Schedule of Coverage in the Policy Schedule will be applied 4 Kidney Failure requiring regular dialysis
on each and every admissible claim after Deductible/Excess
5 Major Organ/Bone Marrow Transplant
wherever applicableunder the Policy. Once the Co-Payment
option is availed by the Insured Person, it cannot be opted 6 Multiple Sclerosis with Persisting Symptoms
out of at subsequent Renewal.
7 Permanent Paralysis of Limbs
15. Major Illness – Benefit
8 Stroke resulting in Permanent Symptoms
If the eldest Insured Person covered under the Policy suffers
from Major Illnessas listed below, whose diagnosis first 9 Surgery of Aorta
commence/occurs after the applicable Waiting Period from 10 Primary (Idiopathic) Pulmonary Hypertension
commencement of first Policy with Us, We will pay Sum
Insured as mentioned on the Schedule of Coverage. 11 Open Heart Replacement or Repair of Heart Valves

The Coverage under this benefit shall cease to exist upon Disclaimer - E- Opinion Services are being offered by Network
occurrence of any one Major Illness covered for which Claim providers through its portal/mail/App or what so ever electronic
is admitted by the Company. form to Policyholders/Insured of HDFC ERGO GENERAL
INSURANCE COMPANY LIMITED. In no event shall HDFC
Major Illness Covered ERGO be liable for any direct, indirect, punitive, incidental,
special consequential damages or any other damages
1 Cancer of specified severity whatsoever caused to the Policyholders/Insured of HDFC
2 Open Chest CABG ERGO while receiving the services from Network providers.
17. Hospital Cash
3 Myocardial Infarction(First Heart Attack of specific
severity) We will pay per day Sum Insured up to maximum Number of
days and in manner as specified in Schedule of Coverage
4 Kidney Failure requiring regular dialysis
on the Policy Schedule,for each continuous and completed
5 Major Organ/Bone Marrow Transplant period of 24 hours of Medically Necessary Hospitalization of
an eldest Insured Person in the Policy and for which Claim is
6 Multiple Sclerosis with Persisting Symptoms admissible under Section B – Hospitalization Cover.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
17 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
18. Global Health Cover
SECTION C: WAITING PERIODS AND
On availing this Cover, We will paytheMedicalExpenses EXCLUSIONS
incurred outside India under below given Sections and
Covers wherever optedand as mentioned on the Schedule 1. Standard Exclusions and Waiting Period
of Coverage in the Policy Schedule.
I. Waiting Periods
Section B: Hospitalization Cover Claims under the Policy are covered subject to waiting Period
as specified below:
B1 Medical Expenses
i) Pre-existing Diseases – Code – Excl01
B4 Pre-Hospitalization cover
a) Expenses related to the treatment of a pre-existing
B5 Post-Hospitalization cover disease (PED) and its direct complications shall be
B6 Day Care Procedures excluded until the expiry of 48 months of continuous
coverage after the date of inception of the first policy
B7 Road Ambulance with insurer.
B8 Organ Donor Expenses b) In case of enhancement of Sum Insured the exclusion
B9 Alternative Treatments shall apply afresh to the extent of sum of Sum Insured
increase.

Section D: Optional Covers c) If the Insured Person is continuously covered without

any break as defined under the portability norms of
D1 Preventive Health Check-Up - Booster the extant IRDAI (Health Insurance) Regulations,
D2 Parent and Child care Cover - Basic then waiting period for the same would be reduced
to the extent of prior coverage.
D3 Parent and Child care Cover – Booster
d) Coverage under the Policy after the expiry of 48
D4 Air Ambulance Cover months for any pre-existing disease is subject to the
D5 Recovery Benefit same being declared at the time of application and
accepted by Insurer.
D6 Sum Insured Rebound
ii) Specified Disease/Procedure waiting period- Code
D7 Outpatient Dental Treatment – Excl02
D8 External Medical Aids a) Expenses related to the treatment of the listed
D9 Major Illness Hospitalization Expenses Conditions, surgeries/treatmentsshall be excluded
until the expiry of 24 months of continuous coverage
D10 Non-Medical Expenses cover after the date of inception of the first Policy with us.
D15 Major Illness – Benefit This exclusion shall not be applicable for claims
arising due to an Accident.
D16 E-Opinion
b) In case of enhancement of sum insured the exclusion
D17 Hospital Cash shall apply afresh to the extent of Sum Insured
Global Cover is applicable subject to following terms and increase.
conditions c) If any of the specified disease/procedure falls under
i. Global coverage for expenses towards all the listed the waiting period specified for Pre-existing diseases,
covers is applicable and effective only if mentioned then the longer of the two waiting periods shall apply.
on the Schedule of Coverage in the Policy Schedule.
d) The waiting period for listed conditions shall apply
ii. A Deductible of USD 100 will apply for expenses even if contracted after the Policy or declared and
under all the respective covers separately for each accepted without a specific exclusion.
and every claim.
e) If the Insured Person is continuously covered without
iii. Claims on Reimbursement basis will be payable in any break as defined under the applicable norms on
INR only. portability stipulated by IRDAI, then waiting period
for the same would be reduced to the extent of prior
iv. All other terms and conditions of the respective coverage.
Section and Covers under the policy shall remain
unaltered

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
18 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
a. Illnesses c) The within referred waiting period is made applicable
to the enhanced Sum Insured in the event of granting
Internal Congenital Non infective Arthritis higher Sum Insured subsequently.
diseases
II. Permanent Exclusions
Diseases of gall bladder calculus diseases of
We will not make any payment for any claim in respect
including cholecystitis Urogenital system e.g.Kid-
of any Insured Person caused by, arising from or
neystone,Urinary Bladder
attributable to any of the following unless expressly
Stone
stated to the contrary in this Policy:
Pancreatitis Ulcer and erosion of stom-
i. Investigation & Evaluation: Code – Excl04
ach and duodenum
a. Expenses related to any admission primarily
All forms of Cirrhosis Gastro Esophageal Reflux
for diagnostic and evaluation purposes only are
Disorder (GERD)
excluded.
Perineal Abscesses Perianal Abscesses
b. Any diagnostic expenses which are not related or not
Cataract Fissure/fistula in anus, incidental to the current diagnosis and treatment are
Haemorrhoids including- excluded.
Gout and rheumatism
ii. Rest Cure, rehabilitation and respite care: Code –
Pilonidal sinus Excl05 – Expenses related to any admission primarily
for enforced bed rest and not for receiving treatment.
Benign tumors, cysts, Osteoarthritis and osteo-
This also includes:
nodules, polyps including porosis
breast lumps a. Custodial care either at home or in a nursing facility
for personal care such as help with activities of daily
Polycystic ovarian dis- Fibroids ( fibromyoma)
living such as bathing, dressing, moving around either
eases
by skilled nurses or assistant or non-skilled persons.
Sinusitis, Rhinitis Tonsillitis
b. Any services for people who are terminally ill to
Skin tumors Benign Hyperplasia of address physical, social, emotional and spiritual
Prostate needs.
b. Surgical Procedures iii. Obesity/Weight control: Code – Excl06 – Expenses
related to the surgical treatment of obesity that does
Adenoidectomy, tonsillec- Tympanoplasty, Mastoid- not fulfil all the below conditions:
tomy ectomy
a. Surgery to be conducted is upon the advice of the
Dilatation and curettage Nasal concha resection doctor
(D&C)
b. The surgery/procedure conducted should be
Myomectomy for fibroids Surgery of Genito urinary supported by clinical protocols
system
c. The member has to be 18 years of age or older and
Surgery on prostate Cholecystectomy
d. Body Mass Index (BMI)
Hernia Hydrocele/Rectocele
i. Greater than or equal to 40 or,
Surgery for prolapsed inter Joint replacement sur-
vertebral disc geries ii. Greater than or equal to 35 in conjunction with any of
the following severe co-morbidities following failure of
Surgery for varicose veins Surgery for Nasal septum
less invasive methods of weight loss:
and varicose ulcers deviation
1. Obesity related cardiomyopathy
Surgery for Perianal Fissurectomy, Haemor-
Abscesses rhoidectomy, Fistulectomy, 2. coronary heart disease
ENT surgeries
3. severe sleep apnoea
iii) 30-day waiting period – Code – Excl03
4. uncontrolled type2 diabetes
a) Expenses related to the treatment of any illness
within 30 days from the first Policy commencement iv. Change-of-Gender treatments: Code – Excl07 –
date shall be excluded except claims arising due to Expenses related to any treatment, including surgical
an Accident, provided the same are covered. management, to change characteristics of the body to
those of the opposite sex.
b) This exclusion shall not, however, apply if the Insured
Person has continuous coverage for more than v. Cosmetic or plastic surgery: Code – Excl08
twelve months. – Expenses for cosmetic or plastic surgery or

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
19 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 any treatment to change appearance unless for d. Reversal of sterilization
reconstruction following an Accident, Burn(s) or Cancer
or as part of Medically Necessary Treatment to removea xv. Maternity: Code – Excl18
direct and immediate health risk to the insured. For this a. Medical treatment expenses traceable to childbirth
to be considered a medical necessity, it must be certified (including complicated deliveries and caesarean sections
by the attending Medical Practitioner. incurred during hospitalization) except ectopic pregnancy;
vi. Hazardous or Adventure sports: Code – Excl09 – b. Expenses towards miscarriage (unless due to an
Expenses related to any treatment necessitated due accident) and lawful medical termination of pregnancy during
to participation as a professional in Hazardous or the Policy period.
Adventure sports, including but not limited to, para-
jumping, rock climbing, mountaineering, rafting, motor 2. Specific Exclusions and Waiting Period
racing, horse racing or scuba diving, hand gliding, sky I. Waiting Periods
diving, deep sea diving.
Claims under the Policy are covered subject to waiting Period
vii. Breach of Law: Code – Excl10 - Expenses for as specified below:
treatment directly arising from or consequent upon any
Insured Person committing or attempting to commit a i) A waiting period of 48 months shall apply for all Claims
breach of law with criminal intent. under Parent and Child Care Cover – Basic/Parent and Child
Cover – Booster (Section D, 2 and 3)
viii. Excluded Providers: Code11 - Expenses incurred
towards treatment in any hospital or by any Medical II. Permanent Exclusions
Practitioner or any other provider specifically excluded We will not make any payment for any claim in respect of
by the Insurer and disclosed in its website/notified to any Insured Person caused by, arising from or attributable to
the policyholders are not admissible. However, in case any of the following unless expressly stated to the contrary
of life threatening situations or following an Accident, in this Policy:
expenses up to the stage of stabilization are payable
but not the complete claim. i. War or any act of war(whether war be declared or not
or caused during service in the armed forces of any
ix. Treatment for Alcoholism, drug or substance abuse country), invasion, act of foreign enemy, civil war, public
or any addictive condition and consequences thereof. defence, rebellion, revolution, insurrection,military or
Code – Excl12 usurped acts, nuclear weapons/materials, chemical
x. Treatments received in health hydros, nature cure and biological weapons, radiation of any kind.
clinics, spas or similar establishments or private ii. Any Insured Person committing or attempting to commit
beds registered as a nursing home attached to such intentional self-injury or attempted suicide or suicide
establishments or where admission is arranged wholly while mentally sound or unsound.
or partly for domestic reasons. Code – Excl13
iii. Any Insured Person’s participation or involvement in
xi. Dietary supplements and substances that can be naval, military or air force operation.
purchased without prescription, including but not
limited to Vitamins, minerals and organic substances iv. Investigative treatment for Sleep-apnoea,general
unless prescribed by a Medical Practitioner as part of debility or exhaustion (“run-down condition”).
Hospitalization claim or day care procedure. Code – v. Congenital external diseases, defects or anomalies,
Excl14
vi. Stem cell harvesting.
xii. Refractive Error: Code - Excl15 – Expenses related to
the treatment for correction of eye sight due to refractive vii. Investigative treatment for analysis and adjustments
error less than 7.5 dioptres. of spinal subluxation, diagnosis and treatment by
manipulation of the skeletal structure or for muscle
xiii. Unproven Treatments: Code – Excl16 – Expenses stimulation by any means except treatment of fractures
related to any unproven treatment, services and (excluding hairline fractures) and dislocations of the
supplies for or in connection with any treatment. mandible and extremities).
Unproven treatments are treatments, procedures or
supplies that lack significant medical documentation viii. Circumcisions (unless necessitated by Illness or Injury
to support their effectiveness. and forming part of treatment).

xiv. Sterility and Infertility: Code- Excl17 – Expenses related ix. Any Convalescence, sanatorium treatment, private duty
to sterility and infertility. This includes: nursing or long-term nursing care.

a. Any type of contraception, sterilization x. Preventive care, and other nutritional and electrolyte
supplements, unless certified to be required by the
b. A s s ist e d R e p r o d u c t i o n se r vice s in clu d in g attending Medical Practitioner as a direct consequence
artificial insemination and advanced reproductive of an otherwise covered claim.
technologies such as IVF, ZIFT, GIFT, ICSI
xi. Vaccination including inoculation and immunisations
c. Gestational Surrogacy (Except post bite treatment),
xii. Non-Medical expenses such as Food charges (other
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
20 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 than patient’s diet provided by hospital), laundry has commenced, such proportionate premium
charges, attendant charges, ambulance collar, commensurate with the insurance coverage during
ambulance equipment, baby food, baby utility charges such period.
etc. Full list of Non-Medical expenses is attached and
also available at www.hdfcergo.com. 2. Condition Precedent to Admission of Liability

xiii. Treatment rendered by a Medical Practitioner which is The terms and conditions of the Policy must be fulfilled by the
outside his discipline or the discipline for which he is Insured Person for the Company to make any payment for
licensed; treatments rendered by a Medical Practitioner claim(s) arising under the Policy.
who is a member of an Insured Person’s family, or stays 3. Multiple Policies
with him,
i. In case of multiple policies taken by an Insured
xiv. Treatment taken on Outpatient basis Person during a period from one or more insurers to
xv. The provision or fitting of hearing aids, spectacles or indemnify treatment costs, the Insured Person shall
contact lenses. have the right to require a settlement of his/her claim
in terms of any of his/her policies. In all such cases
xvi. Any treatment and associated expenses for alopecia, the Insurer chosen by the Insured Person shall be
baldness including corticosteroids and topical obliged to settle the claim as long as the claim is
immunotherapy wigs, toupees, hair pieces, any non- within the limits of and according to the terms of the
surgical hair replacement method. Optometric therapy. chosen Policy.
xvii. Any treatment or part of a treatment that is not of a ii. Insured Person having multiple policies shall also
Reasonable and Customary charge, not Medically have the right to prefer claims under this Policy for the
Necessary; treatments or drugs not supported by a amounts disallowed under any other policy / policies
prescription. even if the Sum Insured is not exhausted. Then the
xviii. Expenses for Artificial limbs and/or device used insurer shall independently settle the claim subject
for diagnosis or treatment (except when used to the terms and conditions of thisPolicy.
intra-operatively).prosthesis, corrective devices
iii. If the amount to be claimed exceeds the Sum Insured
external durable medical equipment of any
under a single Policy, the Insured Person shall have
kind,wheelchairscrutchesand oxygen concentrator for
the right to choose Insurer from whom he/she wants
bronchial asthma/ COPD conditions, cost of cochlear
to claim the balance amount.
implant(s) unless necessitated by an Accident.
Exhaustive list of Non-Medical Expenses is attached iv. Where an Insured Person has policies from more
and also available on www.hdfcergo.com. than one Insurer to cover the same risk on indemnity
xix. Any Claim arising due to Non-disclosure of Pre-existing basis, the Insured Person shall only be indemnified
Illness or Material fact as sought to be declared on the the treatment costs in accordance with the terms and
Proposal form. conditions of the chosen Policy.

4. Disclosure of Information
SECTION D: GENERAL CONDITIONS
The policy shall be void and all premium paid thereon shall be
Standard General Conditions forfeited to the Company in the event of misrepresentation,
mis description or non-disclosure of any material fact by the
1. Free Look period
policyholder.
The Free Look Period shall be applicable on new individual
5. Complete Discharge
health insurance policies and not on renewals or at the time
of porting/migrating the Policy. Any payment to the Policyholder, Insured Person or his/ her
nominees or his/ her legal representative or assignee or to the
The Insured Person shall be allowed free look period of fifteen
Hospital, as the case may be, for any benefit under the Policy
days from date of receipt of the policy document to review the
shall be a valid discharge towards payment of claim by the
terms and conditions of the policy, and to return the same if
Company to the extent of that amount for the particular claim.
not acceptable.
6. Moratorium Period
If the Insured has not made any claim during the Free Look
Period, the insured shall be entitled to After completion of eight continuous years under the policy,
no look back to be applied. This period of eight years is called
i. a refund of the premium paid less any expenses
as Moratorium Period. The moratorium would be applicable
incurred by the Company on medical examination
for the sums insured of the first policy and subsequently
of the Insured Person and the stamp duty charges or
completion of 8 continuous years would be applicable from
ii. where the risk has already commenced and date of enhancement of sums insured only on the enhanced
the option of return of the Policy is exercised limits. After the expiry of Moratorium Period no health
by the Insured Person, a deduction towards the insurance claim shall be contestable except for proven fraud
proportionate risk premium for period of cover or and permanent exclusions specified in the policy contract.
The policies would however be subject to all limits, sub limits,
iii. Where only a part of the insurance coverage co-payments, deductibles as per the policy contract.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
21 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
7. Fraud policy along with all the members of the family, if any, at least
45 days before, but not earlier than 60 days from the policy
If any claim made by the Insured Person, is in any respect
renewal date as per IRDAI guidelines related to Portability. If
fraudulent, or if any false statement, or declaration is made or
such person is presently covered and has been continuously
used in support thereof, or if any fraudulent means or devices
covered without any lapses under any health insurance policy
are used by the Insured Person or anyone acting on his/her
with an Indian General/Health insurer, the proposed Insured
behalf to obtain any benefit under this Policy, all benefits under
Person will get the accrued continuity benefits in waiting
this policy and the premium paid shall be forfeited.
periods as per IRDAI guidelines on portability.
Any amount already paid against claims made under this
For Detailed Guidelines on Portability, kindly refer the link
Policy but which are found fraudulent later shall be repaid by
all recipient(s)/policyholder(s), who have made that particular https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_
claim, who shall be jointly and severally liable for such Layout.aspx?page=PageNo3987
repayment to the Insurer.
10. Migration
For the purpose of this clause, the expression “fraud” means
The Insured Person will have the option to migrate the Policy to
any of the following acts committed by the Insured Person or
other health insurance products/plans offered by the Company
by his agent or the hospital/doctor/any other party acting on
by applying for Migration of the policyatleast30 days before the
behalf of the Insured Person, with intent to deceive the insurer
policy renewal date as per IRDAI guidelines on Migration. If
or to induce the insurer to issue an insurance policy:
such person is presently covered and has been continuously
a) the suggestion, as a fact of that which is not true and covered without any lapses under any health insurance
which the Insured Person does not believe to be true; product/plan offered by the Company, the Insured Person will
get the accrued continuity benefits in waiting periods as per
b) the active concealment of a fact by the Insured IRDAI guidelines on Migration.
Person having knowledge or belief of the fact;
For Detailed Guidelines on Migration, kindly refer the link
c) any other act fitted to deceive; and
https://www.irdai.gov.in/ADMINCMS/cms/frmGuidelines_
d) any such act or omission as the law specially declares Layout.aspx?page=PageNo3987
to be fraudulent
11. Cancellation
The Company shall not repudiate the claim and / or forfeit the i. The Policyholder may cancel this policy by giving
Policy benefits on the ground of Fraud, if the Insured Person 15days’ written notice and in such an event, the
/ beneficiary can prove that the misstatement was true to the Company shall refund premium for the unexpired policy
best of his knowledge and there was no deliberate intention to period as detailed below.
suppress the fact or that such misstatement of or suppression
of material fact are within the knowledge of the Insurer. For Policies where instalment option is not availed and
no claim has been made under the Policy, We will refund
8. Renewal of Policy: premium in accordance with the table below:
The policy shall ordinarily be renewable except on grounds of
fraud, misrepresentation by the insured person. Month Policy Policy Policy
Tenure 1 Tenure 2 Tenure 3
i. The Company shall endeavour to give notice for Year Year Year
Renewal. However, the Company is not under
obligation to give any notice for Renewal. Up to 1 85.0% 92.5% 95.0%
Month
ii. Renewal shall not be denied on the ground that the
Insured Person had made a claim or claims in the Up to 3 70.0% 85.0% 90.0%
preceding policy years. Month

iii. Request for Renewal along with requisite premium Up to 6 45.0% 70.0% 80.0%
shall be received by the Company before the end of Month
the policy period. Up to 12 0.0% 45.0% 60.0%
iv. At the end of the policy period, the Policy shall Month
terminate and can be renewed within the GracePeriod Up to 15 NA 30.0% 50.0%
of 30 days to maintain continuity of benefits without Month
Break in Policy. Coverage is not available during the
Grace Period. Up to 18 NA 20.0% 45.0%
Month
v. No loading shall apply on renewals based on
individual claims experience. Up to 24 NA 0.0% 30.0%
Month
9. Portability
Up to 27 NA NA 20.0%
The Insured Person will have the option to port the Policy to Month
other insurers by applying to such Insurer to port the entire

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
22 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 Waiting Periods” in the event of payment of premium
Month Policy Policy Policy
within the stipulated Grace Period.
Tenure 1 Tenure 2 Tenure 3
Year Year Year iv. No interest will be charged If the installment premium
Up to 30 NA NA 12.5% is not paid on due date.
Month v. In case of installment premium due not received
Up to 36 NA NA 0.0% within the Grace Period, the Policy will get cancelled.
Month vi. In the event of a claim, all subsequent premium
For Policies where Premium is paid by instalment, additional installments shall immediately become due and
conditions as given below will be applicable. payable.
• When yearly payment option is chosen, cancellation vii. The Company has the right to recover and deduct
grid as per 1-Year Tenure policies will be applicable all the pending installments from the claim amount
due under the policy.
• For all other options, 50% of current instalment
premium will be refunded when the current period Instalment Premium payment through Auto Debit/ECS
is less than 6 months in to the policy year. For Facility
instalment after 6 months, no refund will be payable.
i. If Option of Premium payment by Installment is
• In case of admissible claim under the Policy, future opted through auto Debit/ECS facility, a separate
instalments for the current policy year will be adjusted authorization form shall be submitted by Insured
in the claim amount and no refund of any premium Person where Premium to be debited at a chosen
will be applicable during policy year frequency will be mentioned upfront

Notwithstanding anything contained herein or otherwise, no ii. Where there is a change either in the terms and
refunds of premium shall be made in respect of Cancellation conditions of the Coverage or Policy or in the
where, any claim has been admitted or has been lodged or premium rate, the ECS authorization shall be
any benefit has been availed by the Insured Person under obtained afresh
the Policy.
iii. The Insured Person has the option to withdraw from
ii. The Company may cancel the policy at any time on the ECS mode at least fifteen days prior to the due
grounds of misrepresentation non-disclosure of material date of instalment premium payable
facts, fraud by the insured person by giving 15 days’
written notice. There would be no refund of premium iv. No additional charges will be levied or recovered
on cancellation on grounds of misrepresentation, non- in any manner from the benefits payable towards
disclosure of material facts or fraud. cancellation of the ECS mode

12. Premium Payment in Instalments 13. Possibility of Revision of terms of the Policy including
the Premium Rates
If the Insured Person has opted for Payment of Premium
on an installment basis i.e. Yearly, Half Yearly, Quarterly or The Company, with prior approval of IRDAI, may revise or
Monthly, as mentioned in the Policy Schedule, the following modify the terms of the Policy including the premium rates.
Conditions shall apply (notwithstanding any terms contrary The Insured Person shall be notified three months before the
elsewhere in the Policy) changes are effected.
i. Grace Period as mentioned in the table below would 14. Withdrawal of Policy
be given to pay the installment premium due for the i. In the likelihood of this product being withdrawn in
Policy. future, the Company will intimate the Insured Person
about the same 90 days prior to expiry of the policy.
Options Installment Grace Period
Premium applicable ii. Insured Person will have the option to migrate to
Option similar health insurance product available with the
Company at the time of renewal with all the accrued
Option 1 Yearly 30 days continuity benefits such as Cumulative Bonus, waiver
Option 2 Half Yearly 30 days of waiting period as per IRDAI guidelines, provided
the policy has been maintained without a break.
Option 3 Quarterly 30 days
15. Claim Settlement (Provision for Penal Interest)
Option 4 Monthly 15 days
i. If there are any deficiencies in the necessary claim
ii. During such Grace Period, coverage will not be documents which are not met or are partially met,
available from the due date of installment premium We will send a maximum of 3 (three) reminders
till the date of receipt of premium by Company. following which We will send a closure letter or make
a part-payment if We have not received the deficiency
iii. The Insured Person will get the accrued continuity documents after 45 days from the date of the initial
benefit in respect of the “Waiting Periods”, “Specific

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
23 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 request for such documents vii. If requested by Us and at Ourcost, the Insured Person
must submit to medical examination by Our Medical
ii. The Company shall settle or reject a claim, as the Practitioner as often as We consider reasonable
case may be, within 30 days from the date of receipt and necessary and We/Our representatives must be
of last necessary document. permitted to inspect the medical and Hospitalization
iii. In the case of delay in the payment of a claim, records pertaining to the Insured Person’s treatment
the Company shall be liable to pay interest to the and to investigate the circumstances pertaining to the
Policyholder from the date of receipt of last necessary claim.
document to the date of payment of claim at a rate viii. We and Our representatives must be given all
2% above the Bank Rate. reasonable co-operation in investigating the claim in
iv. However, where the circumstances of a claim warrant order to assess Our liability and quantum in respect
an investigation in the opinion of the Company, it of the claim
shall initiate and complete such investigation at the 16. Nomination:
earliest, in any case not later than 30 days from
the date of receipt of last necessary document. In The Policyholder is required at the inception of the Policy
such cases, the Company shall settle or reject the to make a nomination for the purpose of payment of claims
claim within 45 days from the date of receipt of last under the Policy in the event of death of the Policyholder. Any
necessary document. change of nomination shall be communicated to the Company
in writing and such change shall be effective only when an
v. In case of delay beyond stipulated 45 days, the endorsement on the Policy is made. In the event of death
Company shall be liable to pay interest to the of the Policyholder, the Company will pay the nominee {as
Policyholder at a rate 2% above the Bank Rate from named in the Policy Schedule/Policy Certificate/Endorsement
the date of receipt of last necessary document to the (if any)} and in case there is no subsisting nominee, to the
date of payment of claim. legal heirs or legal representatives of the Policyholder whose
discharge shall be treated as full and final discharge of its
vi. If We, for any reason decide to reject the claim
liability under the Policy.
the reasons regarding the rejection shall be
communicated to You in writing within 30 days of
the receipt of documents.

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
24 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
17. Grievance Redressal Procedure

In case of any grievance the insured person may contact the company through:

• Website: www.hdfcergo.com

• Toll free: 022 6234 6234 / 0120 6234 6234

• Contact Details for Senior Citizen: 022 – 6242 – 6226 | seniorcitizen@hdfcergo.com

• E-mail: grievance@hdfcergo.com

Insured person may also approach the grievance cell at any of the company’s branches with the details of grievance.

If Insured person is not satisfied with the redressal of grievance through one of the above methods, Insured Person may
contact the grievance officer at cgo@hdfcergo.com
For updated details of grievance officer, kindly refer the link: https://www.hdfcergo.com/customer-voice/grievances
Contact Points First Contact Point Escalation level 1 Escalation level 2
Contacts us at https://www.hdfcergo.com/ https://www.hdfcergo.com/ https://www.hdfcergo.com/
customer-care/grievances customer-care/grievances/ customer-care/grievances/
Call - : 022 6234 6234 / escalation level 1 escalation level 2
0120 6234 6234 Call - : 022 6234 6234 / Call - : 022 6234 6234 /
0120 6234 6234 0120 6234 6234
Contact Point for Senior https://www.hdfcergo.com/ https://www.hdfcergo.com/ https://www.hdfcergo.com/
Citizen customer-care/grievances customer-care/grievances customer-care/grievances
Call - : 022 – 6242 – 6226 Call - : 022 – 6242 – 6226 Call - : 022 – 6242 – 6226
Email - seniorcitizen@ Email - seniorcitizen@ Email - seniorcitizen@
hdfcergo.com hdfcergo.com hdfcergo.com
care@hdfcergo.com grievance@hdfcergo.com cgo@hdfcergo.com
Grievance cell of any of our The Grievance Cell, HDFC The Compliance Officer,
Branch office ERGO General Insurance Registered & Corporate
Write to us at Company Ltd., Office: HDFC House, 1st
6ht Floor, Leela Business Floor, 165-166 Backbay
Park, AndheriKurla Road, Reclamation, H. T. Parekh
Andheri , Mumbai – 400059 Marg, Churchgate, Mumbai
– 400020

i. If Insured person is not satisfied with the redressal of grievance through above methods, the insured person may also
approach the office of Insurance Ombudsman of the respective area/region for redressal of grievance as per Insurance
Ombudsman Rules 2017.
ii. Grievance may also be lodged at IRDAI Integrated Grievance Management System - https://igms.irda.gov.in/

Specific General Conditions purpose of continuing the health insurance coverage in case
of Non-Disclosure/Misrepresentation of Pre-existing diseases
1. Non-Disclosure or Misrepresentation
subject to your prior consent;
i. If at the time of issuance of Policy or during continuation
of the Policy, the information provided to Us in the proposal a) Permanently exclude the disease/condition and
form or otherwise, by You or the Insured Person or anyone continue with the Policy
acting on behalf of You or an Insured Person, is found to be
incorrect, incomplete, suppressed or not disclosed, wilfully or b) Incorporate additional waiting period of not exceeding
otherwise, the Policy shall be: 4 years for the said undisclosed disease or condition
from the date the non-disclosed condition was
a) cancelled ab initio from the inception date or the detected and continue with the Policy.
Renewal date (as the case may be), or the Policy
may be modified by Us at Our sole discretion, upon c) Levy underwriting loading from the first year of
15 days’ notice by sending an endorsement to Your issuance of policy or renewal, whichever is later.
address shown in the Schedule and
The above options will not prejudice the rights of the Company
b) the claim under such Policy if any, shall be prejudiced. to invoke cancellation under clause 1 i above.

ii. We may also exercise any of the below listed options for the
HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
25 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
2. Geography ii. Rectification in gender of the Insured Person (if this
does not impact the premium)*
This Policy only covers Medical Treatment taken within India,
except under the policies with Global Health Cover as may iii. Rectification in relationship of the Insured Person with
be specified in the on the Schedule of Coverage in the policy the Proposer
Schedule.
iv. Rectification of date of birth of the Insured Person (if
3. Loadings this does not impact the premium)*
i. We may apply Medical Underwriting loading on the v. Change in the correspondence address of the Proposer
premium, based on the declarations made in the (if this does not impact the premium)*
proposal form and the health status, habits and lifestyle,
past medical records, and the results of the Pre-Policy vi. Change in Nominee Details
medical examination of the persons proposed for vii. Change in Height, weight, marital status (if this does
insurance. not impact the premium) *
ii. The maximum Medical Underwriting loading shall not viii. Change in bank details
exceed 35% for each diagnosis / medical condition and
a total of 100% for each Insured Person ix. Any other non-financial endorsement
iii. Medical Underwriting loadings will be applied from 2. Financial Endorsements – which result in alteration
Commencement date of the Policy including subsequent in premium
Renewal(s) with Us or on increased Sum Insured. We i. Change in Age/date of birth
will not apply any additional loading on Your policy
premium at Renewal based on claim experience in ii. Change in Height, weight
Your Policy. However increase or decrease of discount iii. Addition of Insured Person (New Born Baby or newly
in Medical Underwriting loading is subject to terms wedded spouse)
mentioned underSection C3 – Health Incentives
iv. Deletion of Insured Person on death or Marital
iv. We will inform You about the applicable Medical separation
underwriting loading with time bound exclusion (if any)
v. Any other financial endorsement
through a counter offer letter and will issue the Policy
only on Your acceptance within 15 days of the receipt The Policyholder shallapply in a proposal form along with
of such counter offer letter. In case, you neither accept birthCertificate / marriage certificate as the case may be for
the counter offer nor revert to Us within 15 days, We addition of Insured person.
shall cancel Your application and refund the premium 6. Premium Tier :
paid within next 7 days.
For the purpose of policy issuance, the premium will be
4. Grace Period
computed basis the city of residence provided by theInsured
i. A Grace Period of 30 days is available for Renewal of Person in the proposal form. Classification of cities would
the Policy. Any Illness, disease or condition contracted be as under:
during Grace Periodwill not be covered and will be
• Tier 1a: Delhi and NCR region
treated as Pre-existing diseases.
ii. Policies for which Premium is received aftertheGrace • Tier 1b: Mumbai, Mumbai Suburban and Navi Mumbai,
Period shall be considered as a fresh policy. Pune, Surat, Ahmedabad, Varodara

iii. For Policies on instalment basis, Grace Period is • Tier 2: Rest of India
available as given below. Conditions:
i. On payment of Tier 1a premiums, anInsured Person can
Installment Premium Grace Period applicable
avail treatment all over India without any co-payment.
Option
ii. On payment of Tier 1b premium, an Insured Person can
Yearly 30 days avail treatment at Tier1b cities and Tier 2 cities without
Half Yearly 30 days any Co-Payment. However if an Insured Person avails
a treatment in Tier 1a cities , 20% Co-Payment shall
Quarterly 30 days be applicable on admissible claim amount.
Monthly 15 days iii. On payment of Tier 2 premium, an Insured Person can
avail treatment at Tier 2 cities without any Co-Payment.
5. Endorsements
However if an Insured Person avails a treatment in Tier
The following endorsements are permissible during the 1a or Tier1b cities, 20% Co-Paymentshall be applicable
Policy Period: on admissible claim amount.
1. Non-Financial Endorsements – which do not affect the iv. Co-Paymentunderii and iii above will not be applied If an
premium Insured Personopts for Hospitalization with Room Rent
up to Rs 2,500 per day or on HospitalizationforMedically
i. Minor rectification/correction in name of the Proposer /
Necessary treatment following an Accident
Insured Person (and not the complete name change)

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
26 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 SECTION E: OTHER TERMS & CONDITIONS

Contact Us

Within India Outside India

Toll Free :022 6234 6234 / 0120 6234 6234 Toll Free No: 800 08250825
Global Toll Free No: +800 08250825
Email: healthclaims@hdfcergo.com
(accessible from locations outside India only)
Landline no (Chargeable) : 0120-4507250
Email: travelclaims@hdfcergo.com
Claim document HDFC ERGO General Insurance Co. Ltd. HDFC ERGO General Insurance Co Ltd
submission at address Stellar IT Park, Tower-1 6th Floor, Leela Business Park,
5th Floor, C - 25, Sector 62 Andheri Kurla Road, Andheri East,
Noida – 0120 398 8360 Mumbai-400059,
Ph-022 66383600

Claim Procedure

Procedure Cashless Hospitalization Cashless Reimbursement Home

claims for Claims Healthcare
Emergencies Planned
Hospitalizations Claims
outside India
Claim Intimation You shall intimate the Claims to us through any available mode of communication as specified in the
Policy, Health Card or our Website
Claim Intimation Within 24 hours At least 72 Within 24 hours Within 48 hours Immediately
Timelines of the Emergency hours prior to of the Emergency of admission or on diagnosis of
Hospitalization theplanned Hospitalization before discharge Illness
Hospitalization from the Hospital,
At least 72 whichever is
hours prior to earlier
the planned
Hospitalization
Particulars to be i.   The health card issued by Us Following
provided to Us for ii.   KYC documents particulars in
Claim notification addition to those
iii.   The Policy Number listed under
iv.   Name of the Policyholder Hospitalization
v.   Name and address of Insured Person in respect of whom the request is Claim:
being made i. Treatment
details
vi.   Nature of the Illness/Injury and the treatment/Surgery required
ii. Preferred
vii.   Name and address of the attending Medical Practitioner
date and
viii.   Hospital where treatment/Surgery is proposed to be taken or /Hospital where time for initial
the Insured person is admitted assessment

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
27 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 Process for i. If the particulars are not provided in i. We shall send On receipt of
obtaining Pre- full or are insufficient for Us to consider Release of duly filled pre
Authorization the request, We will request additional Information form authorization
information or documentation to the Insured form with other
Person for sufficient details
ii. On receipt of duly filled pre signature and to assess the
authorization form from the Network consent. request, We
Provider along with other sufficient will inform our
details to assess the request, We may; ii. After receiving Home Healthcare
the signed service provider
• Issue the authorization letter Release Of who will follow the
specifying the sanctioned amount any Information form, following process:
specific limitation on the claim and Wewill retrieve
non-payable items, if applicable hospitalization i. Meet the
or documents along treating medical
• Reject the request for pre- with invoices practitioner
authorization specifying reasons for and verify the
the rejection iii. If these details requirement
are not provided along with the
in full or are prescription/
insufficient for Us discharge
to consider the summary (if
request, We will applicable) and
request additional the condition of
information or the patient
documentation
ii. Verify the past
iv. On receipt medical history of
of the complete the patient
documents We
may iii. Complete
physical
• issue the examination of
guarantee the patient
of payment
specifying the iv. Check if the
sanctioned patient requires
amount, any any equipment,
specific limitation devices etc
on the claim
and non- v. Share the
payable items, if care plan and
applicable or treatment cost
or estimation with
• reject the Us.
request for pre-
authorization
specifying
reasons for the
rejection

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
28 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 • issue the v. On receipt of
guarantee the complete
of payment documents We
specifying the may;
sanctioned
amount, any • issue the
specific limitation authorization
on the claim letter specifying
and non- the sanctioned
payable items, if amount, any
applicable or specific limitation
or on the claim
• reject the and non-
request for pre- payable items, if
authorization applicable
specifying or
reasons for the • reject the
rejection request for pre-
authorization
under Home
Healthcare
specifying
reasons for
the rejection.
On rejection of
Pre-Authorization
under Home
Healthcare,
Claim procedure
under Cashless
treatment or
Reimbursement
may be followed.
List of Claim Not Applicable As enlisted below Not Applicable
documents

List of Documents for Reimbursement Claims: ix. All original diagnostic reports (including imaging
and laboratory) along with prescription by Medical
i. Duly signed, stamped and completed Claim Form Practitioner and invoice / bill with receipt from diagnostic
centre
ii. Photo ID & Age Proof
x. All original medicine / pharmacy bills along with
iii. Copy of claim intimation letter / reference of Claim prescription by Medical Practitioner
Intimation Number in the absence of main claim
documents xi. MLC / FIR Copy – in Accidental cases only

iv. Copy of the Network Provider’s Registration Certificate xii. Copy of Death Summary and copy of Death Certificate
/ Hospital registration no in case of Hospitalization (in death claims only)

v. Original Discharge Card / Day Care Summary / Transfer xiii. Pre and Post-Operative Imaging reports
Summary
xiv. Copy of indoor case papers with nursing sheet detailing
vi. Original final Hospital Bill with all original deposit and medical history of the patient, treatment details, and
final payment receipt patient’s progress

vii. Original invoice with payment receipt and implant xv. Original invoice for Vaccination and payment receipt
stickers for all implants used during surgeries e.g. lens
sticker and invoice in cataract Surgery, stent invoice xvi. KYC documents
and sticker in Angioplasty Surgery.
Conditions for obtaining Cashless facility:
viii. All previous consultation papers indicating history and
treatment details for current Illness i. Cashless facility can be availed only at Our Network

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
29 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 Provider. The complete list of Network Providers and treatment, including dates, Hospital and locations match
empanelled Service Providers is available on Our with the details as per Cashless authorized.
website and can be obtained by contacting Us.
iv. We will make payment for the Cashless authorized
ii. We reserve the right to modify, add or restrict any amount directly to the Network Provider.
Network Provider for Cashless Facilities at Our sole
discretion. The same shall be duly updated on Our v. If the claim is not notified to Us within the specified time
website. You shall check the updated list of Network limits, then We shall be provided the reasons for the
Providers before applying for Cashless Claim. delay in writing. We will condone such delay on merits
where the delay has been proved to be for reasons
iii. Pre-authorization is valid for 15 days from date of beyond the claimant’s control
issuance and if all the details of the Hospitalization/

List of Ombudsman

NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

OFFICE DETAILS JURISDICTION OF OFFICE (UNION TERRITORY, DISTRICT)

AHMEDABAD - Shri Kuldip Singh

Office of the Insurance Ombudsman,
Jeevan Prakash Building, 6th floor, Gujarat,
Tilak Marg, Relief Road, Dadra & Nagar Haveli,
Ahmedabad – 380 001. Daman and Diu.
Tel.: 079 - 25501201/02/05/06
Email: bimalokpal.ahmedabad@cioins.co.in

BENGALURU -
Office of the Insurance Ombudsman,
Jeevan Soudha Building,PID No. 57-27-N-19
Ground Floor, 19/19, 24th Main Road, Karnataka.
JP Nagar, Ist Phase,
Bengaluru – 560 078.
Tel.: 080 - 26652048 / 26652049
Email: bimalokpal.bengaluru@cioins.co.in

BHOPAL
Office of the Insurance Ombudsman,
Janak Vihar Complex, 2nd Floor,
6, Malviya Nagar, Opp. Airtel Office, Madhya Pradesh
Near New Market, Chattisgarh.
Bhopal – 462 003.
Tel.: 0755 - 2769201 / 2769202
Fax: 0755 - 2769203
Email: bimalokpal.bhopal@cioins.co.in

BHUBANESHWAR - Shri Suresh Chandra Panda

Office of the Insurance Ombudsman,
62, Forest park,
Bhubneshwar – 751 009. Orissa.
Tel.: 0674 - 2596461 /2596455
Fax: 0674 - 2596429
Email: bimalokpal.bhubaneswar@cioins.co.in

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
30 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

OFFICE DETAILS JURISDICTION OF OFFICE (UNION TERRITORY, DISTRICT)

CHANDIGARH
Office of the Insurance Ombudsman,
S.C.O. No. 101, 102 & 103, 2nd Floor, States of Punjab, Haryana (excluding 4 districts viz Gurugram,
Batra Building, Sector 17 – D, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh,
Chandigarh – 160 017. Union Territories of Jammu & Kashmir, Ladakh and Chandigarh.
Tel.: 0172 - 2706196 / 2706468
Fax: 0172 - 2708274
Email: bimalokpal.chandigarh@cioins.co.in

CHENNAI
Office of the Insurance Ombudsman,
Fatima Akhtar Court, 4th Floor, 453,
Anna Salai, Teynampet, Tamil Nadu, Puducherry Town and Karaikal (which are part of
CHENNAI – 600 018. Puducherry).
Tel.: 044 - 24333668 / 24335284
Fax: 044 - 24333664
Email: bimalokpal.chennai@cioins.co.in

DELHI - Shri Sudhir Krishna

Office of the Insurance Ombudsman,
2/2 A, Universal Insurance Building, Delhi, 4 Districts of Haryana viz. Gurugram, Faridabad, Sonepat
Asaf Ali Road, and Bahudurgarh
New Delhi – 110 002.
Tel.: 011 - 23232481/23213504
Email: bimalokpal.delhi@cioins.co.in

GUWAHATI
Assam,
Office of the Insurance Ombudsman, Meghalaya,
Jeevan Nivesh, 5th Floor, Manipur,
Nr. Panbazar over bridge, S.S. Road, Mizoram,
Guwahati – 781001(ASSAM).
Arunachal Pradesh,
Tel.: 0361 - 2632204 / 2602205
Nagaland and Tripura.
Email: bimalokpal.guwahati@cioins.co.in

HYDERABAD
Office of the Insurance Ombudsman,
6-2-46, 1st floor, "Moin Court",
Lane Opp. Saleem Function Palace, State of Andhra Pradesh, Telangana and Yanam - a part of Union
A. C. Guards, Lakdi-Ka-Pool, Territory of Puducherry.
Hyderabad - 500 004.
Tel.: 040 - 23312122
Fax: 040 - 23376599
Email: bimalokpal.hyderabad@cioins.co.in

JAIPUR
Office of the Insurance Ombudsman,
Jeevan Nidhi – II Bldg., Gr. Floor,
Bhawani Singh Marg, Rajasthan.
Jaipur - 302 005.
Tel.: 0141 - 2740363
Email: bimalokpal.jaipur@cioins.co.in

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
31 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

OFFICE DETAILS JURISDICTION OF OFFICE (UNION TERRITORY, DISTRICT)

ERNAKULAM - Ms. Poonam Bodra

Office of the Insurance Ombudsman,
2nd Floor, Pulinat Bldg.,
Opp. Cochin Shipyard, M. G. Road, Kerala, Lakshadweep, Mahe-a part of Union Territory of
Ernakulam - 682 015. Puducherry
Tel.: 0484 - 2358759 / 2359338
Fax: 0484 - 2359336
Email: bimalokpal.ernakulam@cioins.co.in

KOLKATA - Shri P. K. Rath

Office of the Insurance Ombudsman,
Hindustan Bldg. Annexe, 4th Floor,4, C.R. Avenue, States of West Bengal, Sikkim and Union Territories of Andaman
KOLKATA - 700 072. & Nicobar Islands.
Tel.: 033 - 22124339 / 22124340
Fax : 033 - 22124341
Email: bimalokpal.kolkata@cioins.co.in
Districts of Uttar Pradesh :
LUCKNOW -Shri Justice Anil Kumar Srivastava
Laitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad,
Office of the Insurance Ombudsman, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi,
6th Floor, Jeevan Bhawan, Phase-II,Nawal Kishore Road, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur,
Hazratganj, Lucknow - 226 001. Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad,
Tel.: 0522 - 2231330 / 2231331
Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur,
Fax: 0522 - 2231310
Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur,
Email: bimalokpal.lucknow@cioins.co.in
Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar.
MUMBAI
Office of the Insurance Ombudsman,
3rd Floor, Jeevan Seva Annexe, Goa,
S. V. Road, Santacruz (W), Mumbai - 400 054. Mumbai Metropolitan Region
Tel.: 69038821/23/24/25/26/27/28/28/29/30/31 excluding Navi Mumbai & Thane.
Fax: 022 - 26106052
Email: bimalokpal.mumbai@cioins.co.in

NOIDA - Shri Chandra Shekhar Prasad

Office of the Insurance Ombudsman, State of Uttaranchal and the following Districts of Uttar Pradesh:
Bhagwan Sahai Palace Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar,
4th Floor, Main Road, Etah, Kanooj, Mainpuri, Mathura, Meerut, Moradabad,
Naya Bans, Sector 15, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad,
Distt: Gautam Buddh Nagar, Gautambodhanagar, Ghaziabad, Hardoi, Shahjahanpur,
U.P-201301. Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras,
Tel.: 0120 - 2514252 / 2514253 Kanshiramnagar, Saharanpur.
Email: bimalokpal.noida@cioins.co.in

PATNA - Shri N. K. Singh

Office of the Insurance Ombudsman,
1st Floor,Kalpana Arcade Building,,
Bazar Samiti Road, Bihar,
Bahadurpur, Jharkhand.
Patna 800 006.
Tel.: 0612-2680952
Email: bimalokpal.patna@cioins.co.in

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
32 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
 NAMES OF OMBUDSMAN AND ADDRESSES OF OMBUDSMAN CENTRES

OFFICE DETAILS JURISDICTION OF OFFICE (UNION TERRITORY, DISTRICT)

PUNE - Shri Vinay Sah

Office of the Insurance Ombudsman,
Jeevan Darshan Bldg., 3rd Floor, Maharashtra,
C.T.S. No.s. 195 to 198, Area of Navi Mumbai and Thane
N.C. Kelkar Road, Narayan Peth, excluding Mumbai Metropolitan Region.
Pune – 411 030.
Tel.: 020-41312555
Email: bimalokpal.pune@cioins.co.in

Annexure I - List of Non-Medical Expenses

S.
Item S.
No. Item
No.
1 BABY FOOD
27 CERTIFICATE CHARGES
2 BABY UTILITIES CHARGES
28 COURIER CHARGES
3 BEAUTY SERVICES
29 CONVEYANCE CHARGES
4 BELTS/ BRACES
30 MEDICAL CERTIFICATE
5 BUDS
31 MEDICAL RECORDS
6 COLD PACK/HOT PACK
32 PHOTOCOPIES CHARGES
7 CARRY BAGS
33 MORTUARY CHARGES
8 EMAIL / INTERNET CHARGES
34 WALKING AIDS CHARGES
FOOD CHARGES (OTHER THAN PATIENT'S DIET
9 OXYGEN CYLINDER (FOR USAGE OUTSIDE THE
PROVIDED BY HOSPITAL) 35
HOSPITAL)
10 LEGGINGS
36 SPACER
11 LAUNDRY CHARGES
37 SPIROMETRE
12 MINERAL WATER
38 NEBULIZER KIT
13 SANITARY PAD
39 STEAM INHALER
14 TELEPHONE CHARGES
40 ARMSLING
15 GUEST SERVICES
41 THERMOMETER
16 CREPE BANDAGE
42 CERVICAL COLLAR
17 DIAPER OF ANY TYPE
43 SPLINT
18 EYELET COLLAR
44 DIABETIC FOOT WEAR
19 SLINGS
45 KNEE BRACES (LONG/ SHORT/ HINGED)
BLOOD GROUPING AND CROSS MATCHING OF
20 46 KNEE IMMOBILIZER/SHOULDER IMMOBILIZER
DONORS SAMPLES
47 LUMBO SACRAL BELT
SERVICE CHARGES WHERE NURSING CHARGE
21
ALSO CHARGED 48 NIMBUS BED OR WATER OR AIR BED CHARGES
22 TELEVISION CHARGES 49 AMBULANCE COLLAR
23 SURCHARGES 50 AMBULANCE EQUIPMENT
24 ATTENDANT CHARGES 51 ABDOMINAL BINDER
EXTRA DIET OF PATIENT (OTHER THAN THAT PRIVATE NURSES CHARGES- SPECIAL NURSING
25 52
WHICH FORMS PART OF BED CHARGE) CHARGES
26 BIRTH CERTIFICATE 53 SUGAR FREE TABLETS

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
33 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
S. S.
Item Item
No. No.
CREAMS POWDERS LOTIONS (TOILETRIES ARE 18 SPUTUM CUP
54 NOT PAYABLE, ONLY PRESCRIBED MEDICAL
19 DISINFECTANT LOTIONS
PHARMACEUTICALS PAYABLE)
20 LUXURY TAX
55 ECG ELECTRODES
21 HVAC
56 GLOVES
22 HOUSE KEEPING CHARGES
57 NEBULISATION KIT
23 AIR CONDITIONER CHARGES
ANY KIT WITH NO DETAILS MENTIONED [DELIVERY
58
KIT, ORTHOKIT, RECOVERY KIT, ETC] 24 IM IV INJECTION CHARGES
59 KIDNEY TRAY 25 CLEAN SHEET
60 MASK 26 BLANKET/WARMER BLANKET
61 OUNCE GLASS 27 ADMISSION KIT
62 OXYGEN MASK 28 DIABETIC CHART CHARGES
63 PELVIC TRACTION BELT DOCUMENTATION CHARGES / ADMINISTRATIVE
29
EXPENSES
64 PAN CAN
30 DISCHARGE PROCEDURE CHARGES
65 TROLLY COVER
31 DAILY CHART CHARGES
66 UROMETER, URINE JUG
32 ENTRANCE PASS / VISITORS PASS CHARGES
67 AMBULANCE
EXPENSES RELATED TO PRESCRIPTION ON
68 VASOFIX SAFETY 33
DISCHARGE
34 FILE OPENING CHARGES
List II–Items that are to be subsumed into Room Charges
INCIDENTAL EXPENSES / MISC. CHARGES (NOT
35
S. EXPLAINED)
Item
No. 36 PATIENT IDENTIFICATION BAND / NAME TAG
1 BABY CHARGES (UNLESS SPECIFIED/INDICATED) 37 PULSEOXYMETER CHARGES
2 HAND WASH
3 SHOE COVER
4 CAPS
5 CRADLE CHARGES
6 COMB
7 EAU-DE-COLOGNE / ROOM FRESHNERS
8 FOOT COVER
9 GOWN
10 SLIPPERS
11 TISSUE PAPER
12 TOOTH PASTE
13 TOOTH BRUSH
14 BED PAN
15 FACE MASK
16 FLEXI MASK
17 HAND HOLDER

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
34 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.
List III–Items that are to be subsumed into Procedure Charges List IV–Items that are to be subsumed into costs of treatment

S. S.
Item Item
No. No.
1 HAIR REMOVAL CREAM 1 ADMISSION/REGISTRATION CHARGES
DISPOSABLES RAZORS CHARGES (for site HOSPITALISATION FOR EVALUATION/
2 2
preparations) DIAGNOSTIC PURPOSE
3 EYE PAD 3 URINE CONTAINER
4 EYE SHEILD BLOOD RESERVATION CHARGES AND ANTE
4
NATAL BOOKING CHARGES
5 CAMERA COVER
5 BIPAP MACHINE
6 DVD, CD CHARGES
6 CPAP/ CAPD EQUIPMENTS
7 GAUSE SOFT
7 INFUSION PUMP– COST
8 GAUZE
HYDROGEN PEROXIDE\SPIRIT\ DISINFECTANTS
9 WARD AND THEATRE BOOKING CHARGES 8
ETC
ARTHROSCOPY AND ENDOSCOPY
10 NUTRITION PLANNING CHARGES - DIETICIAN
INSTRUMENTS 9
CHARGES- DIET CHARGES
11 MICROSCOPE COVER
10 HIV KIT
SURGICAL BLADES,
12 11 ANTISEPTIC MOUTHWASH
HARMONICSCALPEL,SHAVER
12 LOZENGES
13 SURGICAL DRILL
13 MOUTH PAINT
14 EYE KIT
14 VACCINATION CHARGES
15 EYE DRAPE
15 ALCOHOL SWABES
16 X-RAY FILM
16 SCRUB SOLUTION/STERILLIUM
17 BOYLES APPARATUS CHARGES
17 Glucometer& Strips
18 COTTON
18 URINE BAG
19 COTTON BANDAGE
20 SURGICAL TAPE
21 APRON
22 TORNIQUET
23 ORTHOBUNDLE, GYNAEC BUNDLE

HDFC ERGO General Insurance Company Limited. IRDAI Reg. No.146 CIN: U66030MH2007PLC177117. Registered & Corporate Office: 1st
35 Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. Trade Logo displayed above belongs to
HDFC Ltd and ERGO International AG and used by the Company under license. UIN: my:health Suraksha - HDFHLIP21473V052021.