Overview
The HDFC ERGO EquiCover plan is a specialized health insurance policy designed for individuals with disabilities (40% or more) and those diagnosed with HIV/AIDS. It offers coverage for alternative medicine [up to Base SI], which is crucial for the plan’s target consumers. Above all, the EquiCover plan is backed by the reliable HDFC brand and supported by over 13,000 network hospitals.
Experts Review
Written by Nikhil Nair
Senior Writer
HDFC ERGO’s EquiCover plan is a commendable initiative targeting individuals with disabilities and HIV/AIDS, offering them access to health insurance. However, it comes with significant caveats, including a 20% mandatory co-payment clause, room rent restrictions [1% of SI % 2% of SI for ICU], and sub-limits on certain treatments like cataract surgery and modern treatments. The plan lacks domiciliary cover, restoration benefits, and bonuses, and its waiting periods are extensive, with two years for pre-existing disabilities and three years for other pre-existing conditions.
While the EquiCover plan is unique in its inclusivity, its limitations make it less appealing unless it is used as a last resort. HDFC ERGO's claim settlement ratio is competitive at 98% [as an avg. of 2021-24], but buyers should carefully evaluate the plan's restrictions before purchasing. The premium for this plan is generally 10-15% lower than comparable plans due to its basic coverage structure.
Pros
Insurer has a solid track record with great claim and service metrics.
Offers HIV/AIDS & Disability Support, which makes this policy stand out.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, which is a key feature.
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
Bad
HIV/AIDS & Disability Support
STANDOUT
This is a specially designed policy for individuals diagnosed HIV/AIDS or having disabilities (40% or more).
Co-payment
The policy will only cover 80% of the final bill. The rest is on you. They call this a co-payment.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Cataracts, Modern treatments and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you are already dealing with Pre-Existing Disability, you will be covered after 2 years. However, if you are dealing with other pre-existing diseases including thyroid and cardiovascular problems, then you’ll have to wait 3 years before they start covering these complications.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Venereal or Sexually Transmitted disease.
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.
Benign ENT disorders
Tonsillectomy
Adenoidectomy
Mastoidectomy
Tympanoplasty
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.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
No coverage if you are forced to hospitalize at home.
Doctor consultations are not covered.
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Frequently Asked Questions
Does EquiCover 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.
- Pre-Existing Disability: There’s a 2-year waiting period before you can make claims related to Pre-Existing Disability.
Does EquiCover have room rent restrictions?
Does EquiCover offer a restoration benefit?
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