HDFC ERGO Critical Illness Platinum

Plan details

Every field, in one place

Honesty note: Critical illness plans are fixed-benefit, NOT a replacement for indemnity health cover. Confirm the listed illnesses against current brochure.

Indicative premium

Order-of-magnitude only — NOT a quote

Indicative figures vary by city, family member count, medical loading and policy term. Always confirm on the insurer's premium calculator.

Known exclusions

What this plan typically does NOT cover

• ✕Conditions not in the listed illnesses (typically 15-25 listed)
• ✕Death within 30-day survival period after diagnosis (lumpsum forfeited)
• ✕Self-inflicted injury, substance abuse
• ✕Congenital diseases
• ✕AIDS / HIV related conditions on some variants

Known traps

The fine print that decides claim outcomes

• ▸Fixed-benefit lumpsum — paid ONCE per listed illness. Policy terminates after payout on most variants.
• ▸30-day survival period — die within 30 days of diagnosis, claim is forfeited.
• ▸Listed illnesses are insurer-specific — re-read the list, not all '25 critical illnesses' are the same.
• ▸PED waiting period is 48 months (longer than indemnity standard).
• ▸Premium re-rates aggressively at renewal post-50.

How to claim

Cashless vs reimbursement — the steps

1. 1Notify insurer. Within 24 hours of emergency admission or 48-72 hours for planned hospitalisation. Use HDFC ERGO's helpline or app — keep the reference number.
2. 2Cashless: Pre-authorisation form filled by hospital, sent to HDFC ERGOvia the hospital's TPA desk. Approval typically 4-6 hours during business; longer overnight. If your hospital is OUT of network (or PPN-only), you'll be on reimbursement.
3. 3Reimbursement:Pay hospital out-of-pocket, then submit claim form + original bills + discharge summary + investigation reports + KYC. Insurer's IRDAI-mandated turnaround is 30 working days from receipt of complete documents.
4. 4Watch for deductions. Room rent above your eligible category triggers proportionate deduction across the WHOLE bill, not just room rent. Sub-limits on cataract / modern treatment apply even when total SI is far higher.
5. 5If denied: Ask for a written denial citing the exact clause. Internal grievance redressal first, then IRDAI Bima Bharosa or the Insurance Ombudsman.