HDFC ERGO Health Insurance 2026 – Optima Plans & Premiums

Explore the Range of Coverage Plans Available

Listed here are the health insurance policies offered by HDFC ERGO.

1. Medisure Classic
2. Health Suraksha Silver
3. Health Suraksha Silver with Regain & ECB
4. Health Suraksha Gold
5. Health Suraksha Gold with Regain & ECB
6. HDFC ERGO Critical Illness Silver
7. HDFC ERGO Critical Illness Platinum

Optima Secure – Features, Benefits & Coverage Details

Medisure Classic – An Affordable Entry-Level Coverage Option

• Basic sum insured per policy year: Individual Policies: Rs.1 lakh to Rs.5 lakh Floater Policies: Rs.2 lakh to Rs.5 lakh
• Cashless hospitalization: In authorized hospitals in the 6000+ network across India

• Basis: Individual and family floater
• Policy term: 1 or 2 years
• Cumulative bonus: Cumulative bonus of 5% for each year that is claim-free subject to a maximum cumulative bonus of 50%
• Tax benefit: Under Section 80D of the Income Tax Act, 1961
• Medical test: Mandatory above 51 years of age

 Health Suraksha Silver – Who Is It Best Suited For?

• Key Features: Sum insured Rs. 3–7.5 lakh/year | Individual & family floater | 1 or 2-year policy term

• Coverage: In-patient, day care, domiciliary, pre & post-hospitalisation, ambulance, organ donor & AYUSH treatments

• Network & Cashless: 6,000+ authorized hospitals across India

• Bonuses & Benefits: 5% cumulative bonus per claim-free year (max 50%) | Tax benefit under Section 80D

• Other Details: No maximum entry age | Medical test mandatory after 45

Gold Plan with Maternity & Newborn Benefits at a Glance

• Key Features: Sum insured Rs. 3–10 lakh/year | Individual & family floater | 1 or 2-year policy term

• Coverage: In-patient, day care, domiciliary, pre & post-hospitalisation, ambulance, organ donor & AYUSH treatments

• Network & Cashless: 6,000+ authorized hospitals across India

• Bonuses & Benefits: 10% enhanced cumulative bonus per claim-free year (max 100%) | Tax benefit under Section 80D

• Other Details: No entry age limit | Medical test mandatory after 45

Maternity, Newborn & Beyond – What the Gold Plan Offers

• Sum Insured: Rs. 3–10 lakh/year | Basis: Individual & Family Floater | Term: 1–2 years

• Key Benefits: Cashless hospitalization (6000+ network hospitals), In-patient & domiciliary treatment, Pre & post-hospitalization, Maternity & newborn cover, Day care, Ambulance, Organ donor, AYUSH & e-opinion for critical illnesses, Convalescence benefit (10+ continuous days)

• Extras: 5% cumulative bonus/claim-free year (max 50%) | Tax benefit u/s 80D | No entry age limit | Medical test mandatory after 45

Silver Plan with Regain & Enhanced Cumulative Bonus Explained

• Sum Insured: Rs. 3L – 10L per policy year
• Cashless Hospitalization: 6,000+ network hospitals across India
• Basis: Individual & Family Floater | Term: 1 or 2 years
• Cumulative Bonus: 10% per claim-free year (up to 100%)
• Tax Benefit: Section 80D | Medical Test: Required above 45 years | Entry Age: No limit

• Coverage Includes: Newborn & Maternity, Day Care, Ambulance, Domiciliary, In-patient, Pre/Post-Hospitalization, Organ Donor, AYUSH & Critical Illness E-opinion

Critical Illness Silver – Coverage for 8 Serious Conditions

• Sum Insured: Rs. 5L – 10L per policy year
• Cashless Hospitalization: 6,000+ network hospitals across India
• Basis: Individual | Term: 1 or 2 years
• Tax Benefit: Applicable | Medical Test: Required above 45 years | Entry Age: 5 – 65 years

• Coverage: 8 specific illnesses

Critical Illness Platinum – Wider Protection Across 15 Illnesses

Find a Cashless Treatment Hospital Near You

HDFC ERGO offers cashless facility at over 6,000 network hospitals across the country. Insured members can get admitted in a network hospital of the insurer to avail cashless treatment. The insurance company will settle the hospitalisation expenses incurred by the insured member directly with the network hospital. To locate a network hospital nearest you, select your state and city from the drop-down box on the online Network Hospital Locator tool. You will get a list of network hospitals in your area with contact details.

Documents Required for HDFC ERGO Health Insurance Claim 

The list of documents needed to submit an HDFC ERGO health insurance claim is as follows: 

• Completed and signed HDFC ERGO health insurance claim form 

• A copy of the HDFC ERGO health insurance policy or a health card 

• Test results, doctor prescriptions, hospital discharge cards, etc. 

• All medical bills, including those from hospitals and pharmacies, as well as receipts for payments 

• KYC documents must be given for claims over Rs.1 lakh. 

Step-by-Step Guide to Raising a Claim

HDFC ERGO is one of the top health insurance providers with a dedicated in-house claim service team to provide smooth claim servicing to the customer

• Cashless Claim: (Network Hospitals) Present your cashless/policy card, fill the pre-authorisation form with your doctor, and submit it to the TPA for approval. For unplanned hospitalisation, complete this within 24 hours.

• Reimbursement Claim: (Non-Network Hospitals) Pay bills upfront, submit the claim form with medical documents within 7 days of discharge. Approval confirmed within 30 days of document receipt.

Benefits of HDFC ERGO Health Insurance 

Here are the benefits of HDFC ERGO health insurance as follows: 

• Hospitalization, home healthcare, and domiciliary hospitalization are all covered costs 

• Accidental death, permanent disablement, and temporary total disability are available 

• Alternative treatments, pre-posthospitalization, and road ambulance services are discussed 

• Broken bones, chauffeur benefit, and hospital pay for accidents are all accessible 

• Preventive health check-ups, cumulative bonuses, and exercise discounts are offered upon renewal 

• Non-medical charges, emergency international coverage, room rent waiver, and waiting period modification choices are also available 

• Optional coverages include renewal premium benefits, parental care benefits, medical evacuation, and dependent children's education benefits.