Easy Health Family Plan
MAKE HEALTHCARE
EASY & STRESSFREE
WITH HDFC ERGO.
Staying healthy and saving money are now just a walk away.
Make every step count with “Stay Active” benefit and earn up to 8% discount on
renewal premium.
With our ‘Stay Active’ you and your family can now walk your way to healthier and
happier life.
With Stay Active and other uncomplicated benefits, the Easy Health Insurance Plan not
only helps you stay healthy but also financially protects you in illness. The Easy Health
Plan comes in three variants with multiple sum insured options to choose from to suit
your requirements.
Family Health Insurance Plan with attractive benefits
Introducing
HOW DOES A FAMILY FLOATER POLICY WORK?
Suppose Mr. Kumar, his wife and their son are covered for
Rs. 1 Lakh each, under a regular Health Insurance Plan.
They would have then paid a premium for 3 policies of `1
Lakh each. In an unforeseen situation, if the medical bill for
hospitalisation of their son amounts to `1.8 Lakh, the regular
policy would cover only up to `1 Lakh, while the remaining
amount of `80,000 would have been paid by Mr. Kumar even
though there is no claim on the other two policies. But if Mr.
& Mrs. Kumar opt for an Easy Health Family Insurance Plan
under any variant, the cover of ` 3 Lakh would be shared
among the entire Kumar family.
This means, the family individually and together, enjoy an
insurance cover of up to Rs. 3 Lakh (total claim made by
the family to be of `3 Lakh). Hence for a similar situation as
above, Mr. Kumar would benefit while claiming the complete
`1.8 Lakh under the Family Floater Policy.
The Easy Health Family Plan is available in 3 variants:
Standard, Exclusive and Premium. The cover amount ranges
from `2,00,000 to `50,00,000 based on the product variant.
The plan provides for in-patient hospitalisation expenses and
is designed to cover expenses such as: diagnostic procedures,
boarding and lodging, the intensive care unit, operation
theatre, anesthesia, blood, oxygen, surgical appliances, cost
of prosthetic and other devices or equipment (if implanted
internally during a surgical procedure), medicines, drugs and
consumables, nursing and medical practitioner charges as
per the policy schedule.
Benefits Standard Exclusive
Sum Insured per Policy per Policy
Year (
`in Lakh)
2.00, 3.00, 4.00, 5.00, 7.5,
10, 15
3.00, 4.00, 5.00 7.50,10.00 15.00,20.00, 25.00, 50.00
1 a) In-patient Treatment Covered
1 b) Pre -hospitalisation Covered
1 c) Post -hospitalisation Covered
1 d) Day Care Procedures Covered
1 e) Domiciliary Treatment Covered
1 f) Organ Donor Covered
1 g) Ambulance Cover Up to
`2000 per hospitalisation
1 h) Ayush Benefit Covered
1 i) Daily Cash for choosing Shared
Accommodation
`500 / day, maximum
Rs.3,000
`500 / day, maximum
Rs.3,000
`800 / day, maximum
Rs.4,800
`1000 / day, maximum Rs.6,000
2 a) Daily Cash for accompanying
an insured child
Not Covered
`300 / day, maximum
`9,000
`500 / day, maximum
`15,000
`800 / day, maximum `24,000
2 b) Newborn baby Not Covered Additional Benefit on payment of additional premium
Benefits Standard Exclusive
2 c) Recovery Benefit Not Covered Not Covered
`10,000 (>10 days of hospitalisation)
2 d) Emergency Air Ambulance Not Covered Not Covered Up to
`2.5 Lacs / hospitalisation
3 a) Maternity Expenses
Not Covered
Normal Delivery
`15,000*
Caesarean Delivery
`25,000* (*Including Pre/
Post Natal limit of
`1,500
and New Born limit of
`2,000) [Waiting Period
4 years]
Normal Delivery
`25,000* Caesarean
Delivery
`40,000*
(*Including Pre/Post Natal
limit of
`2,500 and New
Born limit of
`3,500)
[Waiting Period
4 years]
Normal Delivery
`30,000* Caesarean
Delivery
`50,000* (*Including Pre/Post Natal
limit of
`5,000 and New Born limit of `5,000)
[Waiting Period of 3 Years]
3 b) Outpatient Dental Treatment
Waiting Period 3 years
Not Covered Not Covered
3 c) Spectacles, Contact Lenses,
Hearing Aid Every 3
rd
Year
Not Covered Not Covered
3 d) E-Opinion in respect of a
Critical Illness
Not Covered Not Covered
4 Critical Illness Rider
Optional, if opted then the
Critical Illness Sum Insured
50% or 100% of In-patient Sum
Insured subject to minimum of
`100,000
Optional, if opted then the Critical Illness Sum Insured
50% or 100% of In-patient Sum Insured
Optional, if opted then the Critical Illness
Sum Insured 50% or 100% of In-patient
Sum Insured up to a maximum of
`10 Lacs
5 Health Checkup
Up to 1% of Sum Insured per
Policy up to
`5,000, only once
at the end of a block of every
continuous four claim free years
Up to 1% of Sum Insured / Policy subject to a Maximum of
`5,000 / Insured Person, only once at
the end of a block of every continuous three policy years.
Benefits under 3b), 3c), 3d) and 5) are subject to pre-authorisation by HDFC ERGO General Insurance Company Limited.
FEATURES & BENEFITS
Schedule of benefits of Easy Health product variants are depicted in the chart below:
POINTS TO REMEMBER
• Easy Health Insurance Plan will oer cover to persons from the age of 5 years onwards. A dependent child can be
covered from the 91 day if either parent is covered under this policy and there is no limit on maximum entry age. There
is no maximum cover ceasing age in this policy.
• The cover will be valid for a period of 1 or 2 year(s) as opted. An additional 7.5% discount is oered on premium for
opting a 2 year policy.
• An individual and/or his family members namely spouse, dependent children, dependent parents, parent-in-law,
grandparents and grandchildren are eligible for buying this cover.
• The cover will be provided on a floater sum insured basis.
• Please note that your premium at renewal may change due to a change in your age, location or changes in the applicable
tax rate.
• A maximum of 6 members can be added in a single policy. In a family floater policy, a maximum of 2 adults and a
maximum of 5 children can be included in a single policy. The 2 adults can be a combination of Self, Spouse and either
set of Parents or Grandparents or Parents in law.
OTHER BENEFITS
Pre-hospitalisation: The medical expenses that you incur due to illness during the 60 days immediately before you are
hospitalised.
Post-hospitalisation: The medical expenses you incur in the 90 days immediately after you are discharged from hospital.
Day Care procedures: The medical expenses for all day-care procedures, which do not require 24 hours hospitalisation
due to technological advancement, are covered.
AYUSH benefit: The Medical expenses for for only Inpatient care treatment taken under Ayurveda, Unani, Sidha
Homeopathy, Yoga & Naturopathy.
Cumulative bonus: You get a Cumulative Bonus (CB) of 10% for every claim-free year accumulating up to 100% (in the
event of a claim, CB will be reduced by 10% of SI on the next renewal).
Portability: If you are insured with some other company’s health insurance and you want to shift to us on renewal, you
can. Our Portability Policy is customer friendly and aims to achieve the transfer of most of the accrued benefits and makes
due allowances for waiting periods etc.
Additional cover for critical illness (optional): You can opt for an additional cover for Critical Illness which covers for
Cancer of specified severity, Open Chest CABG, Myocardial Infarction (First heart attack of specific severity), Kidney failure
requiring regular dialysis, Major organ/bone marrow transplant, Multiple sclerosis with persisting symptoms, Permanent
paralysis of limbs and Stroke resulting in permanent symptoms. This is an optional benefit and can be opted as per your
need. The sum insured for Critical Illness can be either 50% or 100% of your basic sum insured subject to a minimum of
Rs 1 Lac and maximum of Rs. 10 Lacs.
Cashless hospitalisation: Easy Health enables to you get treated on a cashless basis across 13,000+ healthcare providers*
all over India.
Quick turnaround time: You don’t have to worry about pre-authorization with us.
Easy upgrade: This health plan comes with an easy upgrade option. You can upgrade your cover to the next slab at the
time of your policy renewal.
Tax benefits: With the Easy Health Family Health Insurance Plan you can presently avail tax benefits for the premium
amount under Section 80D of the Income Tax Act. (Tax benefits are subject to changes in Tax Laws)
Modern treatment methods: Our customer deserves the best and the latest medical treatment. Now we cover modern
treatment methods like robotic surgeries, stem cell therapy, oral chemotherapy etc. Refer Annexure I for modern treatment
methods being covered (if taken as in-patient or domiciliary hospitalisation or day care treatment basis)
Extended coverage: We would now be covering treatment of genetic disorders, injury or illness associated with hazardous
activities, neurodegenerative disorders like parkinson, alzheimer, peritoneal dialysis.
Refer Annexure II for conditions or treatments which will be covered now.
1) 7.5% Discount on premium if Insured Person is paying premium of 2 years in advance as a single
premium.
2) Stay Active - We will oer a discount at each renewal if the insured member achieves the average
step count target on the mobile application provided by us. In an individual policy, the average
step count would be calculated per adult member and in a floater policy it would be an average
of all adult members covered. Dependent children covered either in individual or floater plan will
not be considered for calculation of average steps.
In individual policies the discount percentage (%) would be applied on premium applicable per
insured member (Dependent Children are not eligible for this stay active discount) and in a floater
policy it would be applied on premium applicable on policy.
DISCOUNTS
Average Step Count Renewal Discount
5,000 or below 0%
5,001 to 8,000 2%
8,001 to 10,000 5%
Above 10,000 8%
The discount provided would be as per the table below:
The mobile app must be downloaded within 30 days of the policy risk start date to avail this benefit.
The average step count completed by an Insured member would be tracked on this mobile application.
We reserve the right to remove or reduce any count of steps if found to be achieved in unfair manner
by manipulation.
• All treatments within the first 30 days of cover except any accidental injury
• Any preexisting condition will be covered after a waiting period of 3 years
• Congenital external diseases, cosmetic surgery
• Abuse of intoxicant or hallucinogenic substances like intoxicating drugs and alcohol
• Hospitalisation due to war or an act of war or due to a nuclear, chemical or biological weapon and
radiation of any kind
• Pregnancy, dental treatment, external aids and appliances unless covered under the specific Easy
Health Floater Insurance Plan
• 2 years waiting period for specific diseases like cataract, hernia, joint replacement surgeries, surgery
of hydrocele etc
• Items of personal comfort and convenience
• Experimental, investigative and unproven treatment devices and pharmacological regimens.
Please refer to the Policy Wording for the complete list of exclusions
EXCLUSIONS
TERMS OF RENEWAL
• A health insurance policy shall be renewable except on grounds of established fraud or non-
disclosure or misrepresentation by the insured, provided the policy is not withdrawn and also
subject to conditions stated under Moratorium clause.
• The Company shall endeavour to give notice for Renewal. However, the Company is not under
obligation to give any notice for Renewal
• Renewal of a health insurance policy shall not be denied on the ground that the insured had
made a claim or claims in the preceding policy years, except for benefit based policies where the
policy terminates following payment of the benefit covered under the policy like critical illness
policies.
• The company shall condone a delay in renewal up to the grace period from the due date of
renewal without considering such condonation as a break in policy.
• No loading shall apply on renewals based on individual claims experience
• The Company shall not resort to fresh underwriting unless there is an increase in sum insured. In
case increase in sum insured is requested by the Policyholder, the Insurer may underwrite only
to the extent of increased sum insured.
• Renewal premium due can be paid prior to the due date as per norms set out by the Company.
• Grace Period - Grace Period of 30 days for renewing the Policy is provided under this Policy.
• Maximum Age - There is no maximum cover ceasing age on renewal in this policy.
• Waiting Period - The Waiting Periods mentioned in the policy wording will get reduced by 1 year
on every continuous renewal of your Easy Health Insurance Policy.
• Renewal premium are subject to change with prior approval from IRDAI. Any change in benefits
or premium (other than due to change in Age) will be done with the approval of the Insurance
Regulatory and Development Authority and will be intimated at least 3 months in advance.
• In the likelihood of this policy being withdrawn in future, intimation will be sent to insured person
about the same 3 months prior to expiry of the policy. Insured Person will have the option to
migrate to similar indemnity health insurance policy available with us at the time of renewal
with all the accrued continuity benefits such as cumulative bonus, waiver of waiting period etc;
provided the policy has been maintained without a break.
• Sum Insured Enhancement - Sum Insured can be enhanced only at the time of renewal subject to
no claim have been lodged/ paid under the policy. If the insured increases the sum insured one
grid up, no fresh medicals shall be required.
• In cases where the sum insured increase is more than one grid up, the case shall be subject to
medicals. In case of increase in the Sum Insured waiting period will apply afresh in relation to the
amount by which the Sum Insured has been enhanced. However the quantum of increase shall
be at the discretion of the company.
• Any Insured Person in the policy has the option to migrate to similar indemnity health insurance
policy available with us at the time of renewal subject to underwriting with all the accrued
continuity benefits such as cumulative bonus, waiver of waiting period etc; provided the policy
has been maintained without a break as per portability/migration guidelines issued by IRDAI.
STATUTORY WARNING
Section 41 of Insurance Act 1938 as amended by Insurance Laws Amendment Act, 2015 (Prohibition of Rebates):
No person shall allow or oer to allow, either directly or indirectly, as an inducement to any person to take out
or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any rebate
of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor shall any
person taking out or renewing or continuing a Policy accept any rebate, except such rebate as may be allowed
in accordance with the published prospectuses or tables of the insurers. Any person making default in complying
with the provision of this section shall be liable for a penalty which may extend to 10 lakh rupees.
DISCLAIMER
This is only a summary of the product
features. The actual benefits available
are as described in the policy, and will
be subject to the policy terms, conditions
and exclusions. Please seek the advice of
your insurance advisor if you require any
further information or clarification.
ANNEXURE I: Modern Treatment Methods covered now
S.No Additional Procedures covered
1 Oral chemotherapy
2 Stem cell therapy
3 Deep Brain stimulation
4 Uterine Artery Embolization & HIFU
5
Immunotherapy- Monoclonal Antibody to be given
as injection
6 Stereotactic radio surgeries
7 Robotic surgeries
8 Intra vitreal injections
9 Bronchical Thermoplasty
10
Vaporisation of the prostrate (Green laser
treatment or holmium laser treatment)
11 IONM - (Intra Operative Monitoring) Neuro
12 Balloon Sinuplasty
13
Any other treatment using advanced technology,
as per the product design.
ANNEXURE II: Conditions and Treatments covered now
S.No. Additional treatments/conditions covered
1
Injury or illness due to participation in hazardous
activities pursued for adventure purposes
2
Treatment for correction of eye sight due to
refractive error beyond +/- 7.5 dioptres
3 Genetic diseases or disorders
4
Neurodegenerative disorders like Parkinson’s,
Alzheimer’s
5 Any mental illness, stress or psychological disorders
6 Peritoneal dialysis
7
Expenses related to any admission primarily for
enteral feedings
8
Obesity/Weight control treatment (if specified
conditions are met)
9
Post Hospitalisation expenses for Domiciliary treat-
ment
10 Age Related Macular Degeneration (ARMD)
11
Expenses on Artificial life maintenance (including
life support machine use) up to the vegetative
state, irrespective of whether such treatment
results in recovery of restoration of previous state
of health or not
Terms and conditions apply. HDFC ERGO General Insurance Company Limited. IRDAI Reg. No. 146. CIN: U66030MH2007PLC177117. Registered & Corporate
Oce: 1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more details on the risk factors, terms and
conditions, please read the policy document carefully before concluding a sale. UIN: Easy Health - HDFHIP25004V082425. UID: 15556.
• Fill the application form stating your personal information and health profile. Ensure that the information given in the form is
complete and accurate.
• Handover the application form and the premium amount in your preferred mode of payment along with necessary documents
to the company representative.
• Pre-policy check, if applicable due to age, health declaration and cover opted will be organized at a network center near you.
On acceptance of your policy we would reimburse up to 100% of cost incurred by you to conduct these tests. In case your
proposal is declined, no reimbursement will be provided.
• Based on the details, we may accept or revise our oer to give you an optimal plan as per your profile. This will be done with
your consent. In case we do not accept your policy we will inform you with a proper reason. In case of acceptance, the final
policy document and kit will be sent to you.
BUYING PROCEDURE
