Overview
HDFC ERGO’s Health Wallet is an all-round health insurance policy offering coverage on both individual and family floater bases. The plan's unique Reserve Benefit covers OPD expenses such as diagnostic tests, vaccinations, and consultations with specialists. This feature carries forward unused amounts to the next policy year and earns a 6% bonus on the carried forward amount at renewal. It also offers a restore benefit that reinstates the sum insured if exhausted during the policy period.
Experts Review
Written by Nikhil Nair
Senior Writer
The HDFC ERGO Health Wallet plan is a robust health insurance solution with several standout features. Its Reserve Benefit is particularly noteworthy, providing coverage for OPD services like diagnostic tests and consultations with specialists, which helps manage out-of-pocket expenses. The plan's restore benefit ensures financial security by reinstating the sum insured if exhausted, although it requires complete utilization of the base sum insured and multiplier benefit. The plan covers in-patient hospitalization, pre- and post-hospitalization (60 and 90 days respectively), day care procedures, domiciliary treatment, AYUSH, and organ donor cover. It also offers a Multiplier Benefit of 50% of the basic sum insured after each policy year, up to a maximum of 100%, regardless of claims. The plan comes with no co-payment clause, no room rent restrictions, and no disease-specific sub-limits.
HDFC ERGO's high average claim settlement ratio of 98% (across 2021-24) and extensive network of over 13,000 hospitals enhance its appeal.
However, the plan has limitations. The restoration benefit is only triggered after complete exhaustion of the base sum insured and multiplier benefit, which may not be ideal for partial claims. Additionally, while the Reserve Benefit is valuable, its coverage cap varies based on the base sum insured, which might limit its utility for higher OPD expenses.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Offers Reserve Benefit, which makes this policy stand out.
Cons
Premiums are relatively high.
Maternity benefits not offered, which is a notable gap.
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
Reserve Benefit
STANDOUT
Coverage for OPD services like Diagnostic Tests, Vaccinations, Pharmacy, Dental expenses, Special health foods & supplements and Consultations with a Medical Practitioner, Physiotherapist, Dietician, Speech therapist, Psychologist up to defined limits. Additionally, get 6% bonus on the un-utilized Reserve cover. If the policy is renewed for 5 continuous years, the insurer allows to pay the renewal premiums up to 50% from the collected Reserve Benefit.
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.
Add-ons
Unlimited Restore
Recommended
Restores the cover unlimited times up to 100% of the sum insured for any illness.
Aggregate Deductible
Choose deductible between ₹2,00,000 and ₹10,00,000 and get a discount on premiums.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Any Convalescence, sanatorium treatment, private duty nursing or long-term nursing care.
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.
Cataract
Benign Prostatic Hypertrophy
Hysterectomy for Menorrhagia or Fibromyoma
Hernia (any type)
Hydrocele
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
Maternity benefits not offered.
Customer Reviews
G
Gaurav Rawat
The Reserve Benefit for OPD expenses is a game-changer! So practical for daily medical needs.
I
Indrajeet Negi
Restoration benefit ensures my sum insured is available even after a claim.
L
Lavina Mehta
The plan seems well-designed to offer both savings and protection.
O
Omkar Pande
Reserve Benefit coverage cap varies with base sum insured, might limit OPD utility for some.
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Frequently Asked Questions
Does Health Wallet 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 Health Wallet have room rent restrictions?
Does Health Wallet offer a restoration benefit?
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