HDFC Ergo Energy

Let's Get To Know The Product Better!

HDFC Ergo Energy is a health insurance policy designed by HDFC Ergo General Insurance Company Limited. This plan caters exclusively to individuals managing diabetes (including Type 1, Type 2, and related complications) and hypertension. Immediate coverage is available from day 1 for hospitalisations arising from these conditions. With this plan, you can enjoy peace of mind, knowing that essential medical care is accessible without the worry of unexpected financial burdens. The plan offers two variants - Silver and Gold.

Are You Eligible?

Individuals aged between 18 and 65, currently managing type I diabetes, type II diabetes, pre-diabetes (impaired fasting glucose/impaired glucose tolerance), and/or hypertension, are eligible to enrol in the policy.
 

A Comprehensive Overview Of The Product's Benefits And Limits

In addition to covering expenses for inpatient hospitalisation, which includes room and boarding charges, nursing fees, medical practitioner's expenses, prescribed medicines and drugs, ICU charges, and related costs incurred during hospital stays lasting more than 24 hours, here's an overview of a few other expenses covered by the HDFC Ergo Energy Plan -

• Pre- & Post-Hospitalisation Expenses
  You may have to undergo certain medical procedures before and after you are hospitalised, like doctor consultations, diagnostic tests, check-ups, physiotherapy, and more. The policy extends coverage up to the sum insured for a substantial period – 30 days prior to hospitalisation and 60 days following discharge. It's essential to keep in mind that these expenses are eligible for coverage only if they are associated with the medical condition that led to your hospitalisation and the claim is approved under the inpatient hospitalisation coverage.
   
• Daycare Treatment Coverage
  Daycare treatments are typically medical procedures or surgeries that traditionally required prolonged hospital stays but can now be completed within 24 hours, thanks to technological advancements in the healthcare field. The HDFC Ergo Energy Plan provides extensive coverage for all daycare procedures without any restrictions up to the chosen sum insured.
   
• Organ Donor Coverage
  The HDFC Ergo Energy Plan also provides coverage for organ donor expenses. It covers the costs associated with harvesting the organ from the donor for organ transplantation up to the sum insured you opt for under the policy.
   
• Modern Treatment Coverage
  As healthcare undergoes swift technological advancements, new treatment methods are being introduced too, the HDFC Ergo Energy Plan is tailored to stay abreast of these changes. The plan offers coverage for expenses related to modern treatments up to the chosen sum insured.
   
• Cumulative Bonus (No Claim Bonus)
  The insurer offers a reward called a No Claim Bonus for each claim-free year by elevating your sum insured by 10%, subject to a maximum limit of 100% of the base sum insured. It's important to note that the accumulated bonus will decrease at the same rate it was accrued if a claim is made in the future.
   
• Restoration Benefit
  The restoration benefit is like a safety net; it restores your sum insured after it's used up in a policy year. Under HDFC Ergo Energy Plan, it kicks in when you've used part of your base sum insured and cumulative bonus (if any). You can use this benefit once a year, and the restored sum insured can be used for both related and unrelated illnesses.
   
• Room Rent Limit
  It is the maximum amount your insurance company covers for your hospital room. If you opt for a room within this limit, you won't have any extra expenses. But, if you choose a room with a higher rent, you'll be subject to a proportionate deduction. This means you'll be responsible for a proportionate share of the entire bill, not just the difference in room rent. With the HDFC Ergo Energy Plan, you have the freedom to choose any room – shared, single, deluxe, or any available room. The policy doesn't fuss about your room choice, as there are no restrictions on room rent.
   

Check Out Some Highlighting Features of the Product!

• Wellness Program
  Get ready to supercharge your health journey with the active wellness program – the powerhouse of the HDFC Ergo Energy Plan. It's your personal health monitor, helping you track and conquer your fitness goals, covering both diet and exercise. What's even better? Earn wellness points along the way that can be used to pay your premium or cover specific expenses. The program includes -

• Wellness Tests
  The HDFC Ergo Energy Plan takes charge of monitoring your diabetes and hypertension through two comprehensive medical checks conducted throughout the policy year. Simply undergo the specified medical tests, submit the reports, and the insurer calculates incentive points based on the results, influencing the renewal premium. Keep in mind that the terms and conditions are contingent on the variant you select.
   
• Wellness Support
  Dive into a world of personalised well-being with the HDFC Ergo Energy Plan. Gain entry to a dedicated wellness web portal for your health records, a personalised health coach to help you strategise and attain your diet and fitness goals, monthly newsletters delivering crucial healthcare insights, and a centralised helpline ready to address any queries you might have. It's not just a plan; it's your personalised guide to a healthier, happier you.
   
• Wellness Rewards
  Your renewal premiums can be discounted based on the results of your medical tests and key health parameters, including BMI, BP, etc.
   
• HbA1c Check-Up Benefit
  The HbA1c checkup holds significant importance for individuals managing diabetes. Regular monitoring of HbA1c levels not only helps assess the risk of complications related to heart diseases, kidney issues, nerve damages, etc., but also enables timely intervention. Under this plan, expenses incurred for HbA1c checkups are reimbursed up to Rs 750 per claim, contingent upon the submission of the original payment receipt. This provision facilitates regular checkups as a preventive measure without imposing financial strain. Certain terms and conditions may apply.
   
• No Financial Limits On Treatments/Diseases
  If your insurance company hasn't explicitly excluded coverage for a specific illness, you have the flexibility to claim the full amount up to the sum insured, irrespective of the particular disease. This policy eliminates the imposition of restrictive treatment or disease-wise sub-limits that are often a source of concern. For instance, there could be sub-limits on cataract surgery in other plans, but it is covered up to the sum insured under HDFC Ergo Energy.
   

Understanding Waiting Periods

When you get health insurance, there is a waiting period before coverage kicks in for certain illnesses or diseases. This is the time you need to wait before you can make a claim for these conditions. Here are the types of waiting periods–

• Initial Waiting Period: All medical conditions, except for accidents, have an initial 30-day waiting period. This means that you cannot claim for hospitalisation in the first 30 days, unless it is due to an accident.
   
• Pre-Existing Diseases Waiting Period: A pre-existing disease is any condition you had in the 48 months before getting a health insurance plan. During the specified timeframe, the insurance policy does not provide coverage for expenses related to pre-existing diseases. The HDFC Ergo Energy Plan imposes a waiting period of 24 months for pre-existing conditions, excluding diabetes and hypertension, for which there is no waiting period.
   
• Waiting Period For Specific Diseases: Insurance companies create a list of certain illnesses, separate from your pre-existing conditions, that will come with a waiting period, regardless of whether you’ve had these diseases before or not. This waiting period is set by the insurer and does not depend on your current health. HDFC Ergo Energy Plan has a waiting period of 24 months for specific diseases.
   

What The Plan Doesn’t Cover?

Exclusions are those situations that are not covered in your health insurance and are of many types –

• Standard Permanent Exclusions: Standard permanent exclusions are those limitations set by IRDAI, which all insurance companies must adhere to. Some of them include –
  • Investigation And Evaluation: Hospital admission just for observation or monitoring.
  • Rest Cure, Rehabilitation, And Respite Care: Admission for bed rest without active treatment.
  • Obesity/Weight Control: Treatment or surgery for weight control or obesity.
  • Change Of Gender Treatment: Treatments meant to alter the body's characteristics to the opposite sex.
  • Plastic/Cosmetic Surgery: Procedures to modify body characteristics or appearance.
  • Profession In Hazardous Or Adventure Sports: Treatment expenses for professional participation in adventurous activities like rafting, mountaineering, scuba diving, horse racing, etc.
  • Breach Of Law: Expenses for treating someone who has committed or attempted a criminal act.
  • Excluded Providers: Treatment from medical practitioners or hospitals not covered by the insurance company.
  • Narcotics: Treatment for addictive conditions like alcohol, drug addiction, etc.
  • Treatments In Establishments for Domestic Purposes: Expenses for treatment in health spas, nursing homes, or similar places arranged for domestic reasons.
  • Dietary Supplements, Unprescribed Substances: Vitamins, minerals, etc., not prescribed by a medical practitioner.
  • Refractive Error: Expenses for correcting refractive errors up to 7.5 diopters for better eyesight.
  • Unproven Treatments: Surgeries, medical procedures, or treatments not proven to be effective.
  • Expenses Related to Birth Control, Sterility, Infertility: Contraception, sterilisation, artificial insemination, and advanced reproductive technologies like IVF, ZIFT, GIFT, ICSI, gestational surrogacy, etc.
  • Maternity Expenses: Costs related to pre/post-natal care, childbirth-related hospitalisation, etc.

• Additional Permanent Exclusions: Apart from the list of standard permanent exclusions mentioned above, insurance companies might add more exclusions for specific situations or medical conditions.If you are dealing with certain diseases or severe medical conditions that insurers find too risky, they might permanently exclude them from your coverage. It is important to note that insurers can only apply permanent exclusions for illnesses specified by the Insurance Regulatory and Development Authority of India (IRDAI).
   
• Non-Standard Exclusions (Specific Exclusions): Specific exclusions in the HDFC Ergo Energy Plan go beyond the standard permanent exclusions set by the IRDAI. These exclusions differ among insurance companies and depend on the policy's terms and conditions. Here are some notable specific exclusions that the HDFC Ergo Energy Plan excludes from coverage –
• • Expenses related to intentional self-injury or attempted suicide in a sane or insane state.
  • Participation or involvement in naval, military, air force operations, etc.
  • Expenses related to investigative treatment for sleep-apnoea, general debility or exhaustion (“run-down condition”).
  • Expenses related to congenital external diseases, defects or anomalies
  • Expenses associated with stem cell harvesting.
  • Circumcision, unless required due to Illness or Injury and forming part of treatment.
  • Expenses related to convalescence, sanatorium treatment, private duty nursing or long-term nursing care.
  • Vaccination including inoculation and immunisations except in case of post animal bite treatment.
  • Provision or fitting of hearing aids, spectacles or contact lenses.
  • Expenses related to non-allopathic treatment.
  • Expenses related to dental treatment and surgery of any type, unless requiring hospitalisation.
  • Expenses related to pancreatic islet transplantation.
     

A Quick Recap

Brochure and Policy Wording links

• Brochure: https://www.hdfcergo.com/docs/default-source/downloads/brochures/energy-brochure-online.pdf
   
• Policy Wording: https://www.hdfcergo.com/docs/default-source/downloads/policy-wordings/health/energy-combined-pw-cis.pdf
   

FAQs

1. Does the HDFC Ergo Energy Plan provide coverage for domiciliary treatments?
   No. The plan does not cover expenses related to domiciliary treatment, i.e, treatment taken at home.
    
2. Does the HDFC Ergo Energy Plan cover illnesses other than diabetes and hypertension as well? 
   Yes, HDFC Ergo Energy Plan not only provides coverage for diabetes and hypertension but also takes care of expenses related to other diseases and illnesses, just like regular health insurance plans.  
3. Does HDFC Ergo Energy Plan require pre-medical tests?
   Certainly! A pre-medical test is a compulsory requirement for purchasing this plan. This health evaluation is essential as it reveals your current health status and any existing illnesses, allowing the insurer to offer you the most appropriate coverage based on your health conditions.
    
4. Does the HDFC Ergo Energy Plan come with room rent restrictions?
   No. HDFC Ergo Energy Plan gives you the flexibility to choose any room available in the hospital – be it a single private room, shared room, deluxe room, etc.
    
5. What is the maximum cover you can opt for under the HDFC Ergo Energy Plan?
   HDFC Ergo Energy Plan provides you with maximum health coverage of up to Rs 50 Lakhs.