HDFC Ergo Energy Gold
Overview
Millions of people in India are estimated to be living with diabetes. These people require continuous healthcare monitoring along with immediate medical attention in case a complication arises, making a robust health insurance coverage essential for them.
HDFC Ergo Energy Gold does exactly the same. It is a special health insurance plan designed for people living with diabetes or hypertension that provides health cover to those diagnosed with Type 1 or Type 2 diabetes, Pre-Diabetes or Hypertension. It covers all complications arising out of diabetes or hypertension from day 1. So, if you are living with diabetes or hypertension, this is a go-to plan for you. Otherwise, check out other health insurance options.
Pros and Cons
- Special Plan āĀ Provides coverage to those living with Type 1 or Type 2 diabetes, pre-diabetes or hypertension
- No waiting period ā Provides day 1 cover for all complications arising out of diabetes or hypertension.
- Wellness program ā Two complete medical tests (including HbA1C) administered during a policy year to manage your health
- No room restriction ā Choose any room you like. Your insurer covers the bill.
- The plan covers all daycare procedures providing comprehensive coverage.
- This health insurance plan is exclusively available to individuals living with diabetes or hypertension and is not available to others.
- Does not cover cost of consumables or non-medical items. Pay it out-of-pocket.Ā
- No coverage if you are forced to be hospitalised at home.
- The coverage under this plan is fairly expensive.
Plan Benefits
No waiting period for diabetes or hypertension
This plan covers diabetes, and hypertension, and all complications arising out of them from day 1, providing essential support to those living with these health conditions
Choose any room you like
The plan has no restriction on room type or room rent. So, choose any room you like in the hospital and your insurer covers you fully.
Day care procedures covered
In case you need to undergo surgeries or treatments that require less than 24 hour hospitalisation, you get full coverage from your insurer.
Pre and Post Hospitalisation care covered
Covers treatment related medical expenses 30 days before and 60 days after hospitalisation making the coverage more comprehensive.
Organ donor expenses covered
The insurer covers the medical cost of surgery for harvesting the organ from a donor, in case you are the organ recipient.
Ambulance cover available in emergency situations
Covers ambulance charges in emergency situations up to a maximum of Rs. 2000 per hospitalisation
Cumulative bonus available
Your insurer provides a cumulative bonus of 10% of base sum insured on each renewal up to a maximum of 100% of sum insured. The bonus, once added, does not reduce in case you make a claim.
Restore Benefit
Your insurer provides a one-time restoration benefit equal to 100% of base sum insured in case you utilise your base sum insured partially or fully during a policy year.
Copayment option available
If you find this plan expensive, you can opt for a 20% copay. This copay clause reduces your premium burden. This is an optional feature. Choose it carefully as it requires you to pay 20% of all admissible claim costs.
Wellness program for continuous monitoring
The insurer conducts medical check-ups (as per the list) twice every policy year for continuous monitoring of your health. Cashless facility is available if you undergo these tests at network centres.Ā
Get rewards for saying healthy
Stay healthy and get up to a 25% discount on your renewal premium. The insurer will assess your health based on the results of medical tests administered under the wellness program.
Policy Conditions
| Sum Insured Range | Rs. 2 Lakh to Rs. 50 Lakh |
| Entry Age | 18 ā 65 Years |
| Policy Tenure Options | 1, 2 or 3 Years |
| Coverage Types | IIndividual, available for only those living with diabetes or hypertension |
| Family Coverage | Not available |
| Premium Payment | Ā Annual |
Exclusions
Waiting Periods
- Initial Waiting Period: Zero initial waiting period, cover starts from day 1
- Specific Illness Waiting Period: 24 months
- Waiting Period on Pre-Existing Diseases: 36 months (except diabetes and hypertension)
Medical ExclusionsĀ
- Congenital external diseases
- Maternity / Sterility or Infertility treatments
- Obesity control
- Cosmetic surgeries (unless due to accident, cancer, etc.)
- Unproven treatment
- Dental treatment
- Refractive error correction for less than 7.5 diopters
Non-Medical Exclusions
- Non-medical items or consumables
- Self-injury or attempt to suicide
- Alcoholism, drug or substance abuse
- Hospitalisation due to war or an act of warĀ
- Treatment necessitated due to use of a nuclear, chemical or biological weapon and radiation of any kind
- Experimental, investigative and unproven treatments
About the Insurer
HDFC Ergo General Insurance is a joint venture between HDFC Ltd., one of Indiaās leading housing finance institutions, and ERGO International AG, the primary insurance entity of the Munich Re Group in Germany. Established in 2002, the company offers a broad range of insurance products including health, motor, travel, home, and cyber insurance, along with tailored solutions for businesses and enterprises.Ā
HDFC Ergo is known for its strong digital presence and efficient claims service and remains a trusted name in the Indian insurance space.
Performance Highlights (FY24)
Turnover ā Rs. 18,802 Crore
Claim Settlement Ratio ā 97.94%
Incurred Claim Ratio ā 87.70%
Volume of Claim Complaints ā 6.89 / 10,000 claims
Network Hospitals ā 13,000+
Get In Touch
Looking for some insurance related advice? You can book a call with us. Itās absolutely FREE.
Frequently Asked Questions
Who is eligible to purchase HDFC Ergo Energy Gold plan?
Individuals aged between 18 to 65 years, diagnosed with Type 1 or Type 2 Diabetes, Pre-Diabetes, or Hypertension are eligible to purchase HDFC Ergo Energy Gold plan.
Can I buy HDFC Ergo Energy Gold plan if I don't have diabetes or hypertension?
No, this plan is exclusively designed only for individuals with diabetes or hypertension. It is not available to others.
Is there a waiting period for coverage of diabetes or hypertension or related conditions under HDFC Ergo Energy Gold?
No. HDFC Ergo Energy Gold offers day 1 coverage for all complications and hospitalisations arising out of diabetes or hypertension.
What sum insured options are available under HDFC Ergo Energy Gold?
You can choose from a wide range of options from Rs. 2 Lakh to Rs. 50 Lakh.
Does HDFC Ergo Energy Gold cover pre and post-hospitalisation expenses?
Yes. The plan covers 30 days of pre-hospitalisation and 60 days of post-hospitalisation medical expenses.
Are day care procedures covered under HDFC Ergo Energy Gold?
Yes, the plan covers all day care treatments that require less than 24 hour hospitalisation.
Is there any waiting period for pre-existing diseases under HDFC Ergo Energy Gold?
Yes. While diabetes and hypertension are covered from day 1, other pre-existing diseases have a waiting period of 24 months before they are coveredā.
Does HDFC Ergo Energy Gold offer a wellness program?
Yes, HDFC Ergo Energy Gold variant offers a wellness program with periodic medical tests. It rewards for staying healthy by offering up to 25% discount on renewal premiums based on test results.
What is the restore benefit under HDFC Ergo Energy Gold?
If you utilise your base sum insured partially or fully, the insurer restores 100% of it once during the policy year, available for future claims.
Is there a copayment clause in HDFC Ergo Energy Gold?
Yes. You can choose a 20% copayment option that reduces your annual premium but requires you to pay 20% of admissible claim amounts.
Does HDFC Ergo Energy Gold cover non-medical items?
No. Non-medical expenses or consumables are not covered under HDFC Ergo Energy Gold and must be borne out-of-pocket.ā
Does HDFC Ergo Energy Gold cover organ donor expenses?
Yes, the policy covers the surgical cost of harvesting organs from a donor if you are undergoing an organ transplantā.
Can I cover my family under HDFC Ergo Energy Gold?
No, this plan is available only on an individual basis; family floater coverage is not offered.
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