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HDFC ERGO Health Insurance Claim Settlement

506 reviews Rate This
Cashless Approval TAT45 mins Cashless Claim Processing
Claim Settlement Ratio100%
Network Hospitals12,000+
PED Coverage Starting From3 year
Special Benefits2X Cover from Day 1
Starting Premium Rs. 1090/month

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Claim Settlement of HDFC ERGO Health Insurance

If you hold a health insurance plan offered by HDFC Ergo, you can easily register a claim and get it settled at your convenience. With a dedicated claim settlement team in place, HDFC Ergo is committed to hassle-free and quick claim settlement processes. Being an ultimate favorite of hundreds and thousands of policyholders, the insurance company makes sure you or any insured member can avail easy access during an emergency. What’s more, is the claims procedure that comes across as extremely customer-friendly. HDFC Ergo allows the policyholders to settle their claims by opting for either the cashless facility or reimbursement.

  • Claim Process for Cashless Treatment

    A cashless claim is available in case treatment is done at network hospitals. HDFC Ergo has more than 10,000 hospitals in the network. The steps for cashless claim process are as follow:

    • First of all, find an HDFC Ergo network hospital in a city where you want to get cashless treatment
    • Intimate HDFC Ergo within 24 hours in emergency hospitalisation and 48 hours before admission in case of planned hospitalisation.
    • While visiting the hospital, carry your Health Insurance cashless card issued by HDFC Ergo and one photo ID.
    • Pre-authorization is done by the chosen network hospital. (Transfer of cashless request from network hospital to HDFC Ergo and coordination for authorization).
    • HDFC Ergo/TPA scrutinizes all the documents and gives the final outlook on the claim.
    • You will receive an update via SMS/e-mail on every phase of the claim on your registered email id or mobile number.
    • The hospital sends the final bill to HDFC Ergo for authorization purpose.
    • After scrutinizing the same, the insurer gives the final authorization (if the transactions are approved) to the hospital.
    • The expense of any inadmissible expenses, co-payment, and deductions is to be borne by you.

    How to Check HDFC ergo general insurance Health Insurance Policy Claim Status

    You can check the status of your claim either online or offline.

    Online Procedure

    You can follow the below How to Check your claim status:

    • Visit the official website of HDFC ergo general insurance and select the claim section.
    • Afterwards, at the claim status portal of the insurance company, enter details such as policy number/ mobile number/ email id. Thereafter, you would receive OTP on your registered mobile number or email Id. Once you enter that, click on ‘Go’.You can track the status of your claim from the displayed web page.

    Offline Procedure

    If you are not able to check your claim status online, then simply call their customer care executive at +91 120 6234 6234. Alternatively, you can also visit the nearest branch of HDFC ergo general insurance company.

  • Reimbursement Treatment

    The reimbursement process is for those who get treatment at a non-network hospital. HDFC Ergo reimburses the amount within a short time. The process for this facility is as follow:

    • Contact the nearest hospital and intimate within 24 hours (emergency hospitalisation) or 48 hours (planned hospitalisation).
    • Register a claim, fill the reimbursement claim form and send the same with the required documents to the HDFC Ergo Claim Office.
    • After scrutinizing the documents, HDFC Ergo will approve the claim.
    • If additional documents or information are needed, HDFC Ergo will contact you.
    • After adequate receipt of required documents, the claims will be settled by the insurer.
    • You will receive the status update through email/SMS on every phase of the claim. 
    • On receipt of complete documents, the claim would be processed by HDFC Ergo and paid through NEFT.
  • Documents Needed

    Here is a list of documents required for filing a reimbursement claim.

    • Original investigation reports
    • Final hospital discharge summary
    • FIR or post-mortem report if happened
    • Pharmacy bills along with the prescription
    • Original bills, receipts, and discharge report
    • Indoor case papers and duly-filled claim form
    • Original hospital bills and a valid photo ID proof
    • Treating doctor's report, and original consultation notes
    • Nature of operation performed and surgeon's bill and receipt
    • Test reports along with attending doctor’s or surgeon’s report

    All claims with amount Rs. 1 Lakh and above require KYC form along with a photocopy of anyone KYC document (Aadhaar card, voter ID, passport, driving license, etc).

    In case of any query, contact the customer care executives at InsuranceDekho.


  • Incurred Claim Ratio (ICR) of HDFC ERGO Health Insurance

    The Incurred Claim Ratio (ICR) indicates the overall performance of insurance companies and gives people an overview of what they can expect from their insurer. The Incurred Claim Ratio for HDFC Ergo for FY 2018-19 is 62%. It clearly indicates that HDFC Ergo is in a position to clear claims without having to overburden their finances.

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*Tax benefits are subject to changes in Income Tax Act.

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HDFC ERGO Health Insurance Contact Details

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Claim Process at HDFC ERGO Health Insurance

  • Network Hospital
  • Non-Network Hospital
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Fill in the pre-authorisation form and hand it over to hospital's insurance/TPA desk to initiate claim request.
  • 4

    Claim Settlement

    Once your request is approved, claim is settled. If not approved, claim for reimbursement after discharge.
  • 1

    Claim Assistance

    For any assistance or query, call InsuranceDekho at the toll-free number 755 1196 989.
  • 2

    Claim Intimation

    Emergency hospitalisation needs intimation within 24 hours and for planned hospitalisation intimate within 48 hours prior to admission.
  • 3

    Claim Processing

    Submit claim form with original documents such as doctor’s reports, hospital bills, diagnostic tests, etc.
  • 4

    Claim Settlement

    Once your request for reimbursement of expenses is approved, the claim will be settled.

3624 HDFC ERGO Cashless Network Hospitals in India

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HDFC ERGO Health Insurance Claim Settlement FAQs

  • What are the health insurance claim settlement options offered by HDFC Ergo?

    HDFC Ergo offers both, cashless treatment or reimbursement facility options to its customers for claim settlement purpose.

  • What is the process of health insurance claim intimation at HDFC Ergo?

    In order to initiate a claim, the policyholder is required to initiate contact at HDFC Ergo at 022-6234-6234. You can also initiate contact with the experts at InsuranceDekho at 7551-196-989.


  • When should I intimate HDFC Ergo about the hospitalisation?

    Irrespective of whether you opt for cashless treatment or reimbursement mode, make sure you inform HDFC Ergo within 24 hours (emergency hospitalisation) and within 48 hours prior to admission (planned hospitalisation), be it at a network hospital or a non-network hospital. 

  • What are the documents required for claim settlement process at HDFC Ergo?

    At HDFC Ergo, the list of documents needed for registering claim includes:

    • Duly filled and signed claim form with HDFC Ergo policy number.
    • Original discharge summary.
    • Original Investigation reports.
    • Past treatment documents, if any.
    • Medico Legal Certificate (MLC) or FIR in case of an accident.
    • Original final bill comprising detailed breakup.
    • Original payment receipt.
    • Original pharmacy invoices supported by prescriptions, etc. 
  • How to calculate the Claim Settlement Ratio (CSR) of HDFC Ergo General Insurance?

    You can calculate the Claim Settlement Ratio of HDFC Ergo General Insurance by dividing the total number of claims received by the total number of claims settled in that year. 

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