Eligibility Criteria of Energy Plan

The eligibility criteria for the HDFC Ergo Energy Health Insurance Plan are primarily centred on individuals diagnosed with diabetes and or hypertension. Applicants are usually required to undergo a medical assessment or share recent health reports to help the insurer evaluate current health status. The policy is available to adults within a defined entry age range, and coverage is offered based on underwriting guidelines. Let see the eligibility criteria of this plan as mentioned below:

Features offered By HDFC Ergo Energy Plan

The HDFC Ergo Energy Health Insurance Plan offers day one coverage for hospitalisation related to diabetes and hypertension, which means there is no waiting period for treatment arising from these conditions. This is a major advantage for individuals already managing these lifestyle diseases and looking for immediate financial protection.

1. In patient hospitalization - The plan covers in-patient hospitalisation expenses when the insured person is admitted to a hospital for more than 24 hours. Covered costs include hospital room charges, nursing care, ICU expenses, doctor’s fees, anaesthesia, blood, oxygen, operation theatre charges, surgical appliances, medicines, drugs, consumables, diagnostic tests, and the cost of prosthetics or medical devices if implanted during treatment.

2. Pre & Post Hospitalization - Policyholders also receive pre- and post-hospitalisation coverage, helping manage medical expenses incurred 30 days before and 60 days after hospital admission. In addition, the plan includes day care procedure coverage for treatments or surgeries that require less than 24-hour hospitalisation due to medical advancements, but would otherwise have needed a longer stay.

3 . Ambulance Expenses - For emergencies, the policy provides ambulance expense coverage up to ₹2,000 per hospitalisation. It also covers organ donor expenses, including the medical and surgical costs involved in harvesting an organ for transplant, which can significantly reduce the financial burden during critical treatments.

4. Shared Accommodation Benefit - A unique shared accommodation benefit is available if the insured chooses a shared room in a network hospital. Under this feature, certain exclusions related to non-medical expenses are waived, offering added savings. The plan further supports diabetes management through an HbA1c check-up benefit, reimbursing up to ₹750 per claim for the test upon submission of payment receipts.

5. Restore Benefit - Another important feature is the Restore Benefit, which provides an instant 100% restoration of the basic sum insured once it is partially or fully used during the policy year. This ensures continued financial protection even after a major claim.

6. Cumulative Bonus - The HDFC Ergo Energy Plan also offers an attractive Cumulative Bonus benefit, where the policyholder can earn a 10% increase in Sum Insured for every claim-free policy year, up to a maximum of 100% of the base Sum Insured. A key advantage is that this bonus is designed to be irrespective of claims, meaning the accumulated bonus is not reduced even if a claim is made, as per policy terms.

Wellness Benefit Offered By HDFC Ergo Energy Plan

This plan includes two complete wellness health check-ups in every policy year, designed to help you track your overall health and detect problems early. The first wellness test focuses on basic but essential parameters like HbA1c (for diabetes control), blood pressure monitoring, and BMI, which give a quick picture of your daily health status.

The second wellness test is more detailed and advanced. It covers important blood tests such as HbA1c, fasting blood sugar (FBS), total cholesterol, HDL, LDL, triglycerides, creatinine, total protein, serum albumin, liver enzymes like SGOT, SGPT, GGT, bilirubin, and the cholesterol HDL ratio. Along with blood tests, it also includes ECG, blood pressure monitoring, BMI check, and a doctor consultation, making it a complete preventive health check-up.

Under the Gold Plan, these wellness tests are available on a cashless basis if done at network diagnostic centers, which means you don’t have to pay anything upfront. If you choose a non network but company-approved center, the insurer will reimburse up to ₹2,000 at the end of the policy year. However, if the tests are done at a non network center, neither reimbursement nor reward points will be provided. This makes it important to select the right center to get full wellness benefits without losing money. The appropriate level of discount in renewal premium would be computed as per below table, wellness support helps you monitor your condition and provides you special offers for health products that may you need. Reward point is as follows:

Exclusions of HDFC Ergo Energy Plan

HDFC Ergo Energy Health Insurance Plan has certain exclusions that policyholders should understand before buying. Expenses related to pre-existing diseases are not covered during the initial waiting period, and treatment for specific illnesses listed by HDFC Ergo is also excluded for a defined time. The plan does not cover cosmetic or aesthetic treatments, unless they are medically necessary due to an accident. Here are the exclusion applicable under Energy plan:

1. Any pre-existing condition (other than diabetes or hypertension) will be covered after a waiting period of 2 years 

2. Congenital external diseases, cosmetic surgery

3. Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol.

4. Hospitalisation due to war or an act of war or due to a nuclear, chemical or biological weapon and radiation of any kind Pregnancy, external aids and appliances.

5. 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery of hydrocele, etc. 

6. Non-medical expenses Experimental, investigative and unproven treatment devices and pharmacological regimens.