HDFC ERGO Health Insurance Claim Process

The HDFC Ergo Claim Process involves the interaction between the insured and the insurer, where the policyholder seeks compensation for medical expenses incurred during treatment. The company has established a quick and efficient claims process, enabling customers to access medical treatment without delays. They have designed a user-friendly website where policyholders can easily register claims and upload documents, providing a seamless experience even during medical emergencies. Let's explore how the HDFC Ergo Online Claim Process works.

Claim Process Offered by HDFC Ergo Health Insurance

Based on the type of hospitalization and the timing of payment of medical bills, the HDFC Ergo Claim Process is divided into two categories. Let's examine each type:

Cashless Claims: A type of health insurance claim where the policyholder can avail of treatment without paying the bills upfront. The insurance company later settles the bill with the hospital.

Reimbursement Claims: These claims involve the policyholder seeking compensation for medical expenses incurred during treatment at a non-network hospital. The policyholder pays the bill at discharge, and later the insurance company settles the claim by transferring the amount into the customer’s bank account.

HDFC Ergo Reimbursement Process

For planned hospitalization, the policyholder needs to inform the company 48 hours before admission, and for emergency hospitalization, within 24 hours. The HDFC Ergo Reimbursement process can be completed in four simple steps:

Step 1: Claim Registration

• Visit the HDFC Ergo website. Locate the 'Claims' option on the top menu. Select 'Health Insurance' from the drop-down menu and click on the 'Reimbursement' tab. Download the 'Claim Form'.
• Upload documents related to medical treatment by scanning and uploading them on the provided link.

Note:

• Claims must be registered within 15 days of discharge from the hospital.
• The link to download the claim form and upload documents is available on the page.

Step 2: Processing of Claims

HDFC Ergo’s team of doctors will verify all documents. Upon successful verification, a 'Post Satisfactory Receipt' will be sent to the customer within 7 days.

Note:

• HDFC Ergo Health Insurance Claims updates will be sent to customers on their registered mobile numbers.
• They can check the policy status from the same page.

Step 3: Uploading any Pending Document

The company may request additional documents, which should be scanned and uploaded.

Step 4: Settlement of the Claim

After successful verification, HDFC Ergo Health Insurance Company will settle all claims by transferring the amount to the customer’s bank account via NEFT.

Note: The amount will be transferred within 7 days of receiving the last document.

Cashless Claims:

HDFC Ergo cashless claims are efficient, as the company settles the bill within 2 hours of receiving the last document. For cashless claims, policyholders need to inform the company within 24 hours of emergency hospitalization and 48 hours for planned hospitalization. The process for cashless claims is as follows:

Step 1: Hospitalization

• Use the network hospital locator on the official website. Click on 'Claims', select 'Health Insurance', and go to the 'Cashless Claims' tab.
• Upload documents and load the 'Pre-Authorization Form' from the same page.

Step 2: Submit the Documents

After treatment, collect all documents, scan, and submit them to the company.

Step 3: Pre-Authorization

• The network hospital administration will coordinate with the company, complete the form, and submit it to HDFC Ergo Health Insurance Company.
• The hospital may assign a TPA to act as a mediator between the hospital and the insurance company.
• The policyholder can hand over all documents along with policy details to the TPA, who will complete all paperwork and verify details on behalf of the hospital.

Step 4: Verification

The company will verify all submitted documents and details. HDFC Ergo has an in-house team of doctors for verification.

Step 5: Claim Settlement

Once the claims and documents are verified, the company will transfer the amount to the hospital.

Step 6: Status Update

HDFC Ergo Health Insurance Company keeps the policyholder informed via text messages at every stage of the claim. Messages are sent to the registered mobile number of the customer.

Point To Be Noted:

If policyholders face any issues at any stage of claim processing, they can call customer care. HDFC Ergo Health Insurance Customer Support Number is: 022 6234 6234 / 0120 6234 6234

Documents Required To Submit HDFC Ergo Health Insurance Claim

The required documents are as follows:

• Duly filled and signed Claim Form
• Discharge Summary
• Original Final Bill
• Payment Receipts
• Medicine invoices
• Investigation Reports
• Implants Sticker Invoice

Conclusion

HDFC Ergo Health Insurance offers a hassle-free claim process. Policyholders can easily submit their documents online or opt for offline options through the TPA. This smooth claim process makes HDFC Ergo one of the top choices for buying health insurance.