Eligibility Criteria of Koti Suraksha Plan

The HDFC ERGO Koti Suraksha Plan is designed for individuals and families who want high sum insured health coverage with long term financial security. Eligibility depends on factors such as the age of the proposer and insured members, policy type selected, and compliance with the insurer’s underwriting guidelines. Applicants must meet the minimum and maximum entry age limits as mentioned below:

Why Choose Koti Suraksha Personal Accident Plan?

HDFC ERGO health Koti Suraksha plan is a comprehensive accident cover designed to give you strong financial support, income protection, and peace of mind. It offers high protection ranging from ₹10 lakh to ₹5 crore, ensuring strong financial support during accidental emergencies. Here is the complete benefit breakdown:

1. Accidental Death Benefit – If the insured person dies due to an accident, the nominee receives the full Sum Insured. For lower sum insured options, the coverage scales proportionately. With a ₹10 lakh sum insured, the available coverage is ₹5 lakh, while a ₹25 lakh sum insured provides coverage of ₹12.5 lakh. As the sum insured increases to ₹50 lakh, the coverage goes up to ₹25 lakh, and the same ₹25 lakh coverage continues even if you choose a ₹1 crore sum insured. On the higher end, plans with a ₹2 crore sum insured offer coverage of ₹25 lakh, and this coverage remains capped at ₹25 lakh even if the sum insured is increased to ₹3 crore or ₹5 crore.

2 . Disappearance Benefit – If the insured person goes missing due to an accident and is not traceable, the insurer pays the full Sum Insured and benefit will be given same as Accidental Death Sum insured.

3. Comatose Benefit (Accident Only) – A lump sum payout is provided if the insured enters a coma due to an accident. The coverage amount increases with the sum insured up to a certain limit. For a ₹10 lakh sum insured, the coverage provided is ₹5 lakh, while opting for a ₹25 lakh sum insured increases the coverage to ₹12.5 lakh. Once the sum insured reaches ₹50 lakh, the coverage goes up to ₹25 lakh. Beyond this point, even if you choose a higher sum insured of ₹1 crore, ₹2 crore, ₹3 crore, or even ₹5 crore, the coverage remains capped at ₹25 lakh.

4. Permanent Disability (PTD + PPD) – Covers Permanent Total Disability and Permanent Partial Disability due to an accident, payout will be given full sum insured, based on severity and amount paid as sum insured.

5. Temporary Total Disability (TTD) - Weekly income replacement in case you cannot work due to accidental injury Up to 104 Weeks. The weekly benefit amount increases in line with the sum insured up to a defined limit. With a ₹10 lakh sum insured, the weekly benefit is ₹10,000, which rises to ₹25,000 per week for a ₹25 lakh cover and ₹50,000 per week if you opt for a ₹50 lakh sum insured. Once the sum insured reaches ₹1 crore, the weekly benefit is capped at ₹1 lakh per week. This same ₹1 lakh weekly benefit continues even if you choose a higher sum insured of ₹2 crore, ₹3 crore, ₹4 crore, or ₹5 crore.

6. Emergency Medical Expenses – Covers medical treatment costs due to an accident. Benefit amount Rs. 1, 00,000 will be given and it applicable for all Sum Insured.

7. Dependent Child Education Benefit – Supports your child's education in case of accidental death or permanent disability. The education benefit increases steadily as the sum insured goes up. With a ₹10 lakh sum insured, the education benefit provided is ₹1 lakh, which rises to ₹2.5 lakh for a ₹25 lakh cover and ₹5 lakh when the sum insured is ₹50 lakh. If you opt for a ₹1 crore sum insured, the education benefit increases to ₹10 lakh. At higher coverage levels, the benefit continues to scale up ₹20 lakh for a ₹2 crore sum insured, ₹30 lakh for ₹3 crore, ₹40 lakh for ₹4 crore, and reaches a maximum of ₹50 lakh when the sum insured is ₹5 crore.

8. Last Rites Benefit (Accident Only) – This plan provides a fixed funeral expense benefit of ₹10,000, applicable across all Sum Insured options.

9. Parental Care Benefit – The plan covers medical expenses of dependent parents in the event of the insured’s accidental death or disability, with a benefit of ₹50,000 for Sum Insured options from ₹10 lakh to ₹50 lakh, and ₹1,00,000 for Sum Insured options ranging from ₹1 crore to ₹5 crore

10. Broken Bones Benefit – The plan provides coverage for the treatment of accidental fractures, offering a fixed benefit of ₹1,00,000 across all Sum Insured options.

11. Burns benefit – The plan offers coverage for accidental burn injuries, providing a benefit of ₹50,000 for Sum Insured options between ₹10 lakh and ₹50 lakh, and ₹75,000 for Sum Insured options ranging from ₹1 crore to ₹5 crore.

12. Hospital Cash Benefit Per Day - The plan provides a daily cash payout during hospitalization caused by an accident, offering ₹3,000 per day for Sum Insured options from ₹10 lakh to ₹1 crore, and ₹5,000 per day for Sum Insured options ranging from ₹2 crore to ₹5 crore.

Exclusions in HDFC ERGO My Health Koti Suraksha

Like any health insurance policy, the HDFC ERGO Koti Suraksha Plan also comes with certain exclusions that policyholders should be aware of. Understanding these limitations in advance helps avoid confusion during claim settlement and ensures better policy clarity. It is always recommended to read the exclusion section carefully to know what is not covered under the Koti Suraksha health insurance plan. Here are list of exclusions in this plan:

1. Investigation & Evaluation Exclusions
2. Rest Cure, Rehabilitation & Respite Care
3. Obesity & Weight-Control Treatment Exclusions
4. Change-of-Gender Treatments
5. Cosmetic & Plastic Surgery Exclusions
6. Hazardous or Adventure Sports
7. Breach of Law
8. Excluded Providers
9. Alcoholism & Substance Abuse
10. Treatments in Non-Recognized Facilities
11. Dietary Supplements & Non-Prescribed Medicines
12. Refractive Error Exclusion
13. Unproven Treatments