How to File a Claim with HDFC ERGO Health Insurance?

How to File a Claim with HDFC ERGO Health Insurance?

HDFC ERGO General Insurance Company prides itself on an effective and streamlined health insurance claim process, tailored to meet customer needs. With a dedicated team to manage claims, HDFC ERGO promises a smooth experience for policyholders. They focus on minimizing paperwork and maximizing efficiency.

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Ways to File an HDFC ERGO Health Insurance Claim

This introduction will cover all you need to know about initiating a claim with HDFC ERGO health insurance, highlighting key steps and important considerations to ensure a smooth claim process.
HDFC ERGO General Insurance Company offers policyholders two convenient options to file health insurance claims: cashless and reimbursement.

1. Cashless Claims

   HDFC ERGO provides a hassle-free cashless claim process through its vast network of hospitals. This allows policyholders to receive medical treatments without the burden of upfront payment, which is especially advantageous during emergencies. The steps involved in this process are carefully crafted to ensure swift and efficient resolution of claims. At the network hospital, the insured individual simply needs to verify their identity and policy details to access this convenient facility.

2. Reimbursement Claims

   When a person receives medical treatment at a hospital that is not included in HDFC ERGO's network, they can still claim reimbursement for their expenses. This process is simplified by paying the bills upfront and then submitting reimbursement claims to the insurer. This option allows the patient to choose from a wider range of hospitals while ensuring a well-organized approach to processing and settling claims. To ensure a smooth reimbursement process, policyholders should retain all medical bills and documents safely for submission. Additionally, it is important to avoid any spelling, grammar, or punctuation errors while submitting the documents.

How to File an HDFC ERGO Health Insurance Claim Online with Policybazaar?

Step 1: Notify Policybazaar's claim support team about your hospitalization as soon as possible. Reach out at 1800-258-5881 or via email at care@policybazaar.com.

Step 2: You can also log in at Policybazaar.com and choose the 'File a New Claim' option under the 'Claims' tab.

Step 3: Select 'Health Insurance' and use your mobile number and OTP/password to log in.

Step 4: Follow the on-screen instructions and click on 'File a new claim.'

Policybazaar will then coordinate with HDFC ERGO General Insurance Company to process your claim.

How to File a Claim with HDFC ERGO Health Insurance?

Filing a claim with HDFC ERGO Health Insurance involves two distinct processes: Cashless Claims and Reimbursement Claims.

1. HDFC ERGO Health Insurance Cashless Claim Process:

   Understand the process to file a cashless claim with HDFC ERGO General Insurance Company for treatments at network hospitals.

   Locate a Network Hospital

   First, select a network hospital from the list provided in your policy documents. It is important to choose a network hospital to avail the benefits of cashless service.

   Notify the Insurer

   To obtain pre-approval for planned medical procedures, it is important to inform HDFC ERGO General Insurance Company at least three days in advance. In case of emergency hospitalisation, it is crucial to notify the company within 24 hours to initiate the claim process swiftly. This ensures a smooth and hassle-free claim process.

   Submit Pre-Authorisation Form

   Acquire and complete the pre-authorisation form available at the TPA desk in the hospital or from the insurer. Ensure to fill in the details accurately and submit the form along with a copy of your ID proof and health e-card at the hospital's TPA desk.

   Claim Verification and Settlement

   HDFC ERGO will undertake the verification of your claim details and, upon approval, will settle the bills directly with the hospital, thereby providing a seamless cashless experience.

2. HDFC ERGO Health Insurance Reimbursement Claim Process:

   Discover the steps to file a reimbursement claim with HDFC ERGO General Insurance Company for treatments at non-network hospitals.

   Notify the Insurer

   For both planned and emergency hospitalizations, timely notification to HDFC ERGO is critical. Notify the company at least three days in advance for planned admissions and within 24 hours for emergencies.

   Get the Claim Form

   Obtain the claim form either from HDFC ERGO or the TPA desk at the hospital. Make sure to understand the details required in the form to avoid any discrepancies.

   Pay Hospital Bill and Gather Required Documents

   After your discharge, it is necessary to settle all bills, and collect every relevant document, bill, and receipt related to your hospital stay. These documents are vital for the claim process.

   Submit Claim Form and Documents

   Compile and send the completed claim form along with all the essential documents to HDFC ERGO. This submission is the final step in initiating your reimbursement claim.

Documents Required to File an HDFC ERGO Health Insurance Claim

For a smooth claim process with HDFC ERGO Health Insurance, ensure to submit the following documents:

• Health e-card
• Valid photo ID proof
• Proof of address
• Original discharge summary
• Doctor's prescription recommending hospitalisation
• Doctor's consultation slip and prescriptions for diagnostic tests
• Certificate from the attending doctor
• Prescription for medicines and original pharmacy bills
• Diagnosis reports of X-rays, blood tests, etc.
• Other original receipts from the hospital
• Breakup of the hospital bill
• Ambulance receipt, if applicable
• FIR, in case of an accident

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