Overview
The HDFC ERGO Easy Health Exclusive plan is a comprehensive health insurance policy offering extensive coverage for medical expenses. It features no room rent restrictions, full coverage for all diseases without sub-limits, and a cumulative bonus [10% up to 100% irrespective of claims]. It also offers maternity benefits [maximum Normal Delivery Rs. 30,000, Caesarean Delivery Rs. 50,000, depending on opted SI] with a waiting period of three to four years. Backed by the reliable HDFC brand, the plan is supported by over 13,000 network hospitals.
Experts Review
Written by Nikhil Nair
Senior Writer
The HDFC ERGO Easy Health Exclusive plan is a robust health insurance solution that offers comprehensive coverage without co-payment, room rent restrictions, or disease-wise sub-limits, making it appealing for those seeking hassle-free claims. It provides a higher daily cash benefit for shared accommodation compared to the Standard variant and includes maternity benefits, albeit with a three to four-year waiting period. Unlike the Standard variant, the Exclusive plan offers higher sum insured options (up to ₹50 lakh) and more comprehensive benefits, but it is 10-15% more expensive.
The basic cover under this plan includes a range of essential healthcare benefits such as pre-hospitalisation expenses for up to 60 days and post-hospitalisation expenses for up to 90 days. It also covers daycare treatments, domiciliary hospitalisation, AYUSH treatments, and organ donor expenses. Emergency ambulance charges are included up to ₹2,000 per hospitalisation. Additionally, the plan offers health check-ups up to 1% of the Sum Insured, capped at ₹5,000 per insured person/per policy, which can be availed once at the end of every block of three continuous policy years. HDFC ERGO's claim settlement ratio is high at 98% [as an avg. of 2021-24], supporting its operational efficiency.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
No Restoration Benefit, which is a notable gap.
Doctor consultations are not covered, which could be a drawback for some.
HDFC Ergo
Key Insights
Founded
2002
HDFC Ergo was established 23 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
98% claims settled in 30 Days
HDFC Ergo settles 98% of all claims it receives demonstrating strong credibility.
Network Hospitals
13,000+
HDFC Ergo has a strong network with over 13,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
7 complaints per 10,000 claims registered
HDFC Ergo maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 60 days before you are hospitalized and 90 days after discharge. This includes the cost of medication by the way.
Add-ons
Critical Illness
Get a lumpsum payment in the event you are diagnosed with critical illnesses outlined in the policy schedule.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Admission for administration of Intra-articular or Intra-lesional injections, supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc.) or IV immunoglobulin infusion.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Custodial care at home or in a facility for help with daily activities is excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Sinusitis
Rhinitis
Tonsillitis
Adenoidectomy
Mastoidectomy
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
Doctor consultations are not covered.
Customer Reviews
E
Esha
No room rent restrictions is a great feature.
G
Gautam
The exclusive benefits seem valuable.
J
Jaya
Feels like a premium health plan.
M
Manoj
Is the claim settlement really hassle-free?
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Frequently Asked Questions
Does Easy Health Exclusive have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does Easy Health Exclusive have room rent restrictions?
Does Easy Health Exclusive offer a restoration benefit?
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