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HDFC ERGO Health Insurance Claim Settlement

Since its foundation in 2002, HDFC Ergo Health Insurance has served around 1.5 crore customers. Over 12,000 crore claims have been settled to date, with a track of settling one claim per minute and boasting a claim settlement ratio of 99%. HDFC Ergo Health Insurance has a network of over 13,000. hospitals. They provide coverage for both modern and conventional medical treatments and drugs. Because they provide AYUSH treatment, their policyholders have complete financial stability and the freedom to choose the best course of action.[1]


This page contains information about HDFC Ergo Health Insurance's claim settlement ratio, how to check claim status, data in the claim form, and claim initiation. To check the progress of your claim, go to the website or call customer support. To avoid delays, fill out the claim form completely and accurately. Contact customer support to file a cashless or reimbursement claim.



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Claim Settlement Ratio of HDFC Ergo Health Insurance

The claim settlement ratio for HDFC Ergo Health Insurance is calculated by dividing the total claims paid within 30 days by the total number of claims paid. The following are the Claim Settlement Ratios for the preceding five years:

Fiscal Year

Claim Settlement Ratio

2023

95%

2022

100%

2021

97%

2020

86.52%

2019

83.66%

Why is Claim Settlement Ratio Important?

When choosing a health insurance company, it is critical to analyze the company's claim settlement ratio (CSR), which is a solid insurance indicator. CSR enables you to assess the company's ability to pay claims, which is critical for you and your loved ones. There are two primary reasons why CSR is important:


1. Assists in evaluating insurance companies: When purchasing an insurance policy, consider the insurer's Claim Settlement Ratio (CSR). CSR is a statistic that can help you decide if an insurer is right for you or not. Before making a purchase, examine the CSR of various firms to determine which one has the highest ratio. An insurer's claim settlement ratio increases the likelihood that you will get a claim if you need to file one.

2. Displays the percentage of claims that the insurer has paid out: A high claim settlement ratio is an important consideration when determining whether insurance is dedicated. A high settlement ratio shows that the insurer is more likely to pay out claims when policyholders require it. However, if the insured fails to supply the required evidence, the claim may be denied, lowering the insurer's claim settlement ratio.

HDFC Ergo Health Insurance Claim Initiation

If you need to file a claim from HDFC Ergo Health Insurance, please follow the process mentioned below:-

How To File a Claim


Step 1:- Initiation

When you schedule a medical appointment or have an emergency, contact InsuranceDekho or HDFC Ergo Health Insurance customer service right away.

  • You can contact HDFC Ergo Customer Support at care@hdfcergo.com or phone the HDFC Ergo Health Insurance customer support team at their toll-free number, 022 6234 6234.[2]

  • To contact an InsuranceDekho representative, please call 7551196989 or send an email to support@insurancedekho.com.[3]

Step 2:- Verification

When you submit your documents to HDFC Ergo Health Insurance, the claims team will review them thoroughly. If all of your information is correct, your claim will be processed.

Step 3:- Tracking

You can contact HDFC Ergo Health Insurance customer support to follow up on your claim. To receive frequent updates, you can also contact a customer service specialist at InsuranceDekho


Details to be Filled in the HDFC Ergo Health Insurance Claim Form

To submit a claim for HDFC Ergo Health Insurance, you must fill out two areas of information. The separated information is listed below:

PART A

PART B

Self Declaration

Hospital Details

Employee Details

Doctor Details

Policy Copy

Patient Details

Discharge Summary

Treatment Details

Hospital Bills

Hospital Declaration

ETF Details


Furthermore, the following information is also necessary:

  1. Duly filled claim form

  2. Discharge or daycare summary

  3. Final hospital bill

  4. Payment receipts

  5. Investigation report

  6. Pharmacy bills

  7. Implant invoice

  8. Doctor Prescriptions

  9. Consultation Papers

  10. Age Proof

  11. Indoor Case Paper

  12. Copy of canceled cheque

  13. KYC Form

Claim Process Of HDFC Ergo

HDFC Ergo Insurance has partnered with over 13,000 healthcare establishments and helps the insured get cashless services there. Notification of scheduled procedures at non-network hospitals must be sent to HDFC Ergo Insurance 48 hours in advance, or within 48 hours of the patient's admission to the hospital in the event of an emergency. Notably, authorization for cashless care at non-network hospitals is subject to completing the requirements mentioned in your HDFC Ergo Insurance policy and the hospital's agreements.

Furthermore, the steps to take in the event of cashless or reimbursement claims are mentioned below:

Cashless Claims

  • Contact the front desk to talk with the TPA, or third-party administrator.

  • TPA will fill up and submit your application to HDFC Ergo Insurance on your behalf.

  • If everything is permitted, the claim executive will review the reports and handle the claim.

  • You can start receiving therapy at the hospital as soon as you have approval.

  • Your insurer and the hospital will settle the bill immediately following treatment.

Reimbursement Claims

  • Notify HDFC Ergo Insurance of your hospital stay (within 48 hours of an emergency, or 48 hours in advance if planned).

  • Pay your hospital bills in full and submit all relevant documents.

  • Fill out and send in a claim form.

  • Await the insurer's approval and status report.


Keep in mind that you must:

  • Submit all documents, including your claim form, within 15 days following release.

  • Save all fully signed papers for submission to guarantee a smooth claim process.

How to Check the HDFC Ergo Health Insurance Claim Status?

Follow the steps outlined below to check the status of your HDFC Ergo Health claim both online and offline:

Online

  • Visit HDFC Ergo Insurance’s official website.


  • Select the “Claim” option.


  • In the dropdown menu select the “track claim” option.


  • You will be redirected to a new page.


  • Fill in the following details to track your claim status.[1]


Offline

  • When you visit the nearest HDFC Ergo Health Insurance branch, please bring a copy of your insurance document.

  • Speak with a branch office executive who will assist you in understanding your coverage and the status of your claim.

You can also get an update by sharing your claim reference number with a customer service representative over the phone at 022 6234 6234, which is a toll-free number, or by calling any of the numbers listed on the HDFC Ergo Health Insurance website.[2]



HDFC Ergo Health Insurance Claim Settlement Time

According to the Insurance Regulatory and Development Authority of India (IRDAI), an insurer normally settles a claim 30 days after receiving money or filing claim documentation.

Tips to Get Your Claim Settlement Faster

To speed up the settlement of your claims, keep the following in mind:

  • Develop a deeper grasp of your policy.

  • Send only full documents.

  • Keep a note of any correspondence with your insurance provider.

  • Maintain an active policy.

  • Examine each document carefully.

  • Consult an attorney if necessary.

HDFC Ergo Health Insurance Claim Assistance and Support

To seek claim assistance and support from HDFC Ergo Health Insurance:[2]

  • Call toll-free at 022 6234 6234


  • Email at care@hdfcergo.com.


  • Whatsapp HDFC Ergo Health Insurance by saying 'Hi' at 8169 500 500.


To obtain claim assistance and support from InsuranceDekho, you may:[3]


Email: support@insurancedekho.com

Contact us: 7551196989

References

[1]https://www.hdfcergo.com/

[2]https://www.hdfcergo.com/customer-care-new

[3]https://www.insurancedekho.com/contact-us

Health Insurance News

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. 

  • How to process cashless claims under health insurance plans by HDFC Ergo?

    As per HDFC Ergo General Insurance, it usually approves cashless health insurance claims within 20 minutes. To process cashless claim under health insurance plans by HDFC Ergo, you will be required to follow the steps given below: 

    • Fill the pre-authorisation form at the network hospital for cashless approval
    • Once the hospital updates HDFC Ergo General Insurance, then the insurance company will send you the status update
    • Hospitalisation will be done on the basis of pre-authorisation approval
    • At the time of discharge, the insurance company will directly settle the medical bill at the network hospital.
  • How to make reimbursement claims under health insurance plans offered by HDFC Ergo General Insurance?

    As per HDFC Ergo General Insurance, it usually settles reimbursement health insurance claims within 6 hours. To make reimbursement claims under health insurance plans by HDFC Ergo General Insurance, you will be required to follow the steps given below:

    • Get hospitalised at a non-network hospital, pay the bills, and preserve the original invoices
    • Register a claim by sending all the invoices and treatment documents to the insurer 
    • Your documents will be verified by the insurer. i.e., HDFC Ergo General Insurance 
    • You will receive the approved claim amount in your bank account within the stipulated time.
  • What is the time frame within which the hospitalisation must be reported to HDFC Ergo General Insurance?

    In case of planned hospitalisation, you must inform HDFC Ergo General Insurance at least 48 hours prior to hospitalisation. Whereas in case of emergency hospitalisation, the insurer must be informed within 24 hours of hospitalisation. 

  • What is the Claim Settlement Ratio of health insurance by HDFC Ergo?

    As per the IBAI’s General Insurance Claim Insights Handbook For Policyholders-4th and 5th Edition, the Claim Settlement Ratio (CSR) of HDFC Ergo general Insurance for the financial years 2018-19 and 2019-20 is 83.66% and 86.52% respectively. 

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    I liked that I could customise my health insurance plan to fit my specific needs. InsuranceDekho offers a lot of flexibility in terms of coverage and add-ons. Purchasing HDFC Ergo Health Insurance was quick.

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    HDFC ERGO
    By Anita Singh
    On: Jul 04, 2024
  • The affordable plan

    The health insurance plans offered by HDFC ERGO combine affordability and thorough coverage. Their policies are open and honest, devoid of any surprises or obscure language. InsuranceDekho’s easy process of choosing HDFC ERGO's health insurance made my future secure. Their commitment to client satisfaction is what makes them stand out; their support staff is always on hand to quickly resolve any questions or issues.

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    HDFC ERGO
    By Mukesh Yadav
    On: Jun 25, 2024
  • Comparison between plans was v...

    Using InsuranceDekho to obtain HDFC ERGO Health Insurance was a great decision. The website facilitated plan comparison, and the transaction was seamless. The customer service is excellent and the coverage is comprehensive. Extremely happy!

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    HDFC ERGO
    By Varsha Agarwal
    On: Jun 24, 2024
  • Fast and easy process

    Needed health insurance pronto. InsuranceDekho's comparison tool saved me loads of time. Found a plan that fit my needs and budget perfectly. HDFC Ergo helped during the most crucial times.

    S
    HDFC ERGO
    By Satakshi Soni
    On: May 29, 2024
  • Customer care assistance while...

    In all honesty, my choice of HDFC Optima Secure Health Insurance proved to be a lifesaver. It provided me with immediate assistance by paying for my unforeseen hospital bills. The procedure went smoothly, and InsuranceDekho's assistance was first-rate. I urge everyone to purchase it!

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    By Kanishka Gupta
    On: May 21, 2024

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