{"uin":"HDFHLIP21131V012021","name":"health Koti Suraksha","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021","insurer":{"slug":"hdfc-ergo-general-insurance","name":"HDFC ERGO General Insurance Company Limited","url":"https://indiainsurances.com/insurer/hdfc-ergo-general-insurance"},"line":"health","category":"health-indemnity","category_name":"Health insurance (hospitalisation)","irdai_type":"Individual","kind":"product","status":"unknown","approved_on":"2020-07-30","withdrawn_on":null,"summary":"my:health Koti Suraksha is an HDFC ERGO health policy with a hospitalisation section (Platinum, Titanium and Super top up plans, sum insured Rs 50 lacs or Rs 1 Crore) and a Personal Accident section. It has a 30 day initial, 24 month specific and 36 month pre-existing disease waiting period, pays 60 days pre and 180 days post hospitalisation costs, and prices the premium by city tier.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:53.256014+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"cross-checked","value":["Koti Suraksha - Platinum","Koti Suraksha - Titanium","Koti Suraksha - Super top up"],"display":"Platinum, Titanium, Super top up","note":"From the plan chart in the prospectus (Annexure I); the policy wording does not name the plans.","quote":"S. No | Coverages | Koti Suraksha - Platinum | Koti Suraksha - Titanium | Koti Suraksha - Super top up","sources":[{"clause":null,"heading":"Plans Under the policy: attached as an Annexure 1","page":59,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-plans-under-the-policy-attached-as-an-annexure-1"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"The policy can be issued for 1 year, 2 years or 3 years.","display":"1, 2 or 3 years","note":"From the prospectus. The policy is renewable at the end of each term.","quote":"This policy can be issued for 1 year/ 2 years/ 3 years.","sources":[{"clause":null,"heading":"4. Policy period","page":47,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-4-policy-period"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"Cashless: within 24 hours of an emergency hospitalisation, or at least 72 hours before a planned one. Reimbursement: within 48 hours of admission or before discharge, whichever is earlier.","display":"Within 24 hours (emergency) or 72 hours before (planned); reimbursement within 48 hours of admission or before discharge","note":"Home Healthcare claims: immediately on diagnosis of Illness. Late notice can be condoned on merits if the delay was beyond the claimant's control.","quote":"Claim Intimation Timelines | Within 24 hours of the Hospitalization | At least 72 hours prior to the planned Hospitalization ... Within 48 hours of admission or before discharge from the Hospital, whichever is earlier ... We will condone such delay on merits where the delay has been proved to be for reasons beyond the claimant","sources":[{"clause":"1","heading":"Notification of a Claim","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-4"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Completely filled claim form, duly signed and stamped","Photo ID & Age Proof","Copy of claim intimation letter / Claim Intimation Number","Hospital's Registration Certificate (non-network hospital)","Original Discharge Card / Day Care Summary / Transfer Summary","Original final hospital bill with payment receipts","Original invoice and implant stickers for implants","Previous consultation papers","Original diagnostic reports with prescription and bills","Original medicine / pharmacy bills with prescription","MLC / FIR Copy (accidental cases only)","Death Summary and Death Certificate (death claims only)","Pre and Post-Operative Imaging reports","Indoor case papers with nursing sheet (wherever required)","KYC documents (claims above Rs 1 lakh)","Duly filled NEFT form with cancelled blank cheque","Settlement letter and paid claim copies from other insurer (partial settlement)"],"display":"Claim form, ID and age proof, discharge summary, original bills, reports, KYC, NEFT form and more","note":"List for reimbursement claims under Section 1 (Health). It also asks for alcohol history in accident cases and the vaccination invoice. Personal Accident claims have their own document lists by cover.","quote":"i) Completely filled claim form, duly signed (by claimant/proposer) and stamped (by hospital). ... ii) Photo ID & Age Proof ... iii) Copy of claim intimation letter / reference of Claim Intimation Number in the absence of main claim documents ... iv) Copy of the Hospital’s Registration Certificate/Hospital Registration number in case of hospitalization in any non-network hospital ... v) Original Discharge Card / Day Care Summary / Transfer Summary ... vi) Original final hospital bill with all original deposit and final payment receipt ... vii) Original invoice with payment receipt and implant stickers for all implants used during surgeries ... viii) All previous consultation papers indicating history and treatment details ... ix) All original diagnostic reports (including imaging and laboratory) along with prescription by Medical Practitioner and invoice / bill ... x) All original medicine / pharmacy bills along with prescription by Medical Practitioner ... xi) MLC / FIR Copy – in Accidental cases only ... xiii) Copy of Death Summary and copy of Death Certificate (in death claims only) ... xiv) Pre and Post-Operative Imaging reports ... xv) Copy of indoor case papers with nursing sheet detailing medical history of the patient, treatment details, and patient’s progress (to be submitted wherever required by the insurer). ... xvii) KYC documents (in all claims above Rs 1 lakh) ... xviii) Duly filled NEFT form with cancelled blank cheque ... xix) Settlement letter(s), copy (-ies) of payment receipts, and entire certified copy of paid claims in case of partial claim settlement from other insurer.","sources":[{"clause":"2","heading":"List of documents for Reimbursement Claims","page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-2-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"The insurer settles or rejects a claim within 15 days from the date of receipt of intimation; if payment is delayed it pays interest at 2% above the bank rate.","display":"15 days from receipt of intimation","note":"CIS: cashless pre-authorisation decision within 1 hour; final bill authorisation within 3 hours of the discharge request.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of intimation. ... the Company shall be liable to pay interest to the Policyholder from the date of receipt of intimation to the date of payment of claim at a rate 2% above the bank rate. ... Decision on cashless authorization to be provided within 1 hour from the time of receipt of request ... Within 3 hours of the receipt of discharge authorization request from the hospital.","sources":[{"clause":"4","heading":"Claim Settlement (Provision for Penal Interest) – Applicable to Section 1 Health","page":63,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-4-5"},{"clause":"Section 2(i)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125#c-section-2-i"},{"clause":"Section 2(ii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125#c-section-2-ii"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Pre-existing diseases until 36 months of continuous coverage (Excl01)","Listed conditions, surgeries and treatments until 24 months of continuous coverage (Excl02)","Any illness within 30 days from the first policy commencement, except accidents (Excl03)","Admission primarily for diagnostic and evaluation purposes (Excl04)","Rest cure, rehabilitation and respite care (Excl05)","Cosmetic or plastic surgery (Excl08)","Hazardous or adventure sports as a professional (Excl09)","Alcoholism, drug or substance abuse (Excl12)","Sterility and infertility (Excl17)","Maternity, childbirth and termination of pregnancy (Excl18)","War, invasion, nuclear, chemical or biological attack","Intentional self-injury or suicide","Treatment taken on Outpatient basis","Non-Medical expenses such as food, laundry and attendant charges"],"display":"Waiting periods, standard IRDAI exclusions, OPD, non-medical expenses, war, self-injury","note":"Section 1 (Health) exclusions. Non-medical expenses are paid up to the limit if the Non-Medical Expenses optional cover is chosen. The waiting periods apply also to Temporary Total Disablement due to Illness under Section 2.","quote":"i) Pre-existing Diseases: Code – Excl01: ... shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with insurer. ... ii) Specified Disease/Procedure waiting period: Code – Excl02: ... a) Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage ... ii) 30-day waiting period: Code – Excl03: ... a) Expenses related to the treatment of any illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident ... i) Investigation & Evaluation: Code - Excl04: ... a) Expenses related to any admission primarily for diagnostic and evaluation purposes only are excluded. ... ii. Rest Cure, rehabilitation and respite care: Code – Excl05: ... v. Cosmetic or plastic surgery: Code – Excl08: ... vi. Hazardous or Adventure Sports: Code - Excl09: Expenses related to any treatment necessitated due to participation as a professional in Hazardous or Adventure sports ... ix. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... xiv. Sterility and Infertility: Code – Excl17: Expenses related to sterility and infertility. ... xv. Maternity: Code – Excl18: ... a) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ... b) Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy period. ... i) War or any act of war, invasion, act of foreign enemy ... Nuclear, Chemical or Biological attack or weapons, radiation of any kind. ... iii) Any Insured Person committing or attempting to commit intentional self-injury or attempted suicide or suicide while mentally sound or unsound. ... xiii) Non-Medical expenses such as Food charges (other than patient’s diet provided by hospital), laundry charges, attendant charges ... xiv) Treatment taken on Outpatient basis","sources":[{"clause":"Section 1","heading":"B. Exclusions & Waiting Period","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-section-1-3"},{"clause":null,"heading":"Illnesses","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-illnesses"},{"clause":"1","heading":"Obesity related cardiomyopathy","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-3"},{"clause":"Excl16","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-excl16"},{"clause":null,"heading":"IV. Specific Permanent Exclusions","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-iv-specific-permanent-exclusions"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"First call HDFC ERGO on 022 6158 2020 / 022 6234 6234 or use www.hdfcergo.com. If not satisfied, write to the Complaints & Grievance Cell (grievance@hdfcergo.com, 18002677444), then to the Chief Grievance Officer (cgo@hdfcergo.com) if there is no reply within 15 days.","display":"HDFC ERGO: 022 6158 2020 / 022 6234 6234, then grievance@hdfcergo.com, then cgo@hdfcergo.com","note":"Senior citizens: seniorcitizen@hdfcergo.com. The prospectus and CIS list a senior citizen number 022 6242 6226; the wording lists 022 6158 2026. After these levels, the Insurance Ombudsman or bimabharosa.irdai.gov.in.","quote":"First Point of Contact | Call us at 022 6158 2020 / 022 6234 6234/www.hdfcergo.com ... Level 1 | For lack of a response or if the response provided does not meet your expectation, you can: 1. Write to The Complaints & Grievance Cell (C&G Cell) ... You can also write an email to grievance@hdfcergo.com 3. Call on 18002677444 ... Level 2 | If you're not satisfied with the resolution or if no response was received within 15 days, you can: 1. Write to the Chief Grievance Officer ... You can also write an email to cgo@hdfcergo.com","sources":[{"clause":"7","heading":"Grievance Redressal Procedure","page":65,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-7-4"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Base Sum Insured of Rs. 50 lacs or Rs. 1 Crore for the Health section, in all three plans.","display":"Rs. 50 lacs or Rs. 1 Crore","note":"From the prospectus. Super Top Up plan premium tables show 45,00,000 or 95,00,000 in excess of 5,00,000. Personal Accident sum insured options range from 10,000 to 10 crores.","quote":"Sum Insured options available:\n• Rs. 50 lacs\n• Rs. 1 Crore ... Base Sum Insured | 50 lacs and 1 cr | 50 lacs and 1 cr | 50 lacs and 1 cr","sources":[{"clause":"1(a)(iii)","heading":null,"page":2,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-1-a-iii"},{"clause":null,"heading":"Plans Under the policy: attached as an Annexure 1","page":59,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-plans-under-the-policy-attached-as-an-annexure-1"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply to accidents, or if the Insured Person has continuous coverage for more than twelve months. Applies afresh to any enhanced Sum Insured.","quote":"ii) 30-day waiting period: Code – Excl03:\na) Expenses related to the treatment of any illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident, provided the same are covered.","sources":[{"clause":null,"heading":"Illnesses","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-illnesses"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Reduced by prior continuous coverage under portability. Applies afresh to any Sum Insured increase. Coverage after 36 months requires the disease to have been declared and accepted.","quote":"i) Pre-existing Diseases: Code – Excl01:\na) Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with insurer.","sources":[{"clause":"Section 1","heading":"B. Exclusions & Waiting Period","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-section-1-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months","note":"Not applicable to accidents. If a listed condition is also pre-existing, the longer waiting period applies.","quote":"ii) Specified Disease/Procedure waiting period: Code – Excl02:\na) Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with us. This exclusion shall not be applicable for claims arising due to an Accident.","sources":[{"clause":"Section 1","heading":"B. Exclusions & Waiting Period","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-section-1-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"cross-checked","value":["Non infective Arthritis","Pilonidal sinus","Diseases of gall bladder including cholecystitis","calculus diseases of Urogenital system e.g.Kidney stone,Urinary Bladder Stone","Benign tumors, cysts, nodules, polyps including breast lumps","Pancreatitis","Ulcer and erosion of stomach and duodenum","Polycystic ovarian diseases","All forms of Cirrhosis","Gastro Esophageal Reflux Disorder (GERD)","Sinusitis, Rhinitis","Perineal Abscesses","Perianal Abscesses","Skin tumors","Cataract","Fissure/fistula in anus, Haemorrhoids","Gout and rheumatism","Tonsillitis","Osteoarthritis and osteoporosis","Fibroids ( fibromyoma)","Benign Hyperplasia of Prostate","Adenoidectomy, tonsillectomy","Tympanoplasty, Mastoidectomy","Hernia","Dilatation and curettage (D&C)","Nasal concha resection","Surgery for prolapsed inter vertebral disc","Myomectomy for fibroids","Surgery of Genito urinary system","Surgery for varicose veins and varicose ulcers","Surgery on prostate","Cholecystectomy","Surgery for Perianal Abscesses","Hydrocele/Rectocele","Joint replacement surgeries","Surgery for Nasal septum deviation","Ligament, Tendon and Meniscal tear","Endometriosis","Prolapsed Uterus","Rectal Prolapse","Varicocele","Retinal detachment","Glaucoma","Nasal polypectomy","Hysterectomy","Fissurectomy, Haemorrhoidectomy, Fistulectomy","ENT surgeries"],"display":"Listed illnesses and surgeries (see list)","note":"The table prints 'Fissure/fistula in anus, Haemorrhoids including Gout and rheumatism' as one cell; listed here as two items. The prospectus repeats the list and also lists Benign Hyperplasia of Prostate twice.","quote":"Non infective Arthritis | Pilonidal sinus ... Diseases of gall bladder including cholecystitis | calculus diseases of Urogenital system e.g.Kidney stone,Urinary Bladder Stone | Benign tumors, cysts, nodules, polyps including breast lumps ... Pancreatitis | Ulcer and erosion of stomach and duodenum | Polycystic ovarian diseases ... All forms of Cirrhosis | Gastro Esophageal Reflux Disorder (GERD) | Sinusitis, Rhinitis ... Perineal Abscesses | Perianal Abscesses | Skin tumors ... Cataract | Fissure/fistula in anus, Haemorrhoids including Gout and rheumatism | Tonsillitis ... Osteoarthritis and osteoporosis | Fibroids ( fibromyoma) | Benign Hyperplasia of Prostate ... Adenoidectomy, tonsillectomy | Tympanoplasty, Mastoidectomy | Hernia ... Dilatation and curettage (D&C) | Nasal concha resection | Surgery for prolapsed inter vertebral disc ... Myomectomy for fibroids | Surgery of Genito urinary system | Surgery for varicose veins and varicose ulcers ... Surgery on prostate | Cholecystectomy | Surgery for Perianal Abscesses ... Hydrocele/Rectocele | Joint replacement surgeries | Surgery for Nasal septum deviation ... Ligament, Tendon and Meniscal tear ... Endometriosis | Prolapsed Uterus | Rectal Prolapse ... Varicocele | Retinal detachment | Glaucoma ... Nasal polypectomy | Hysterectomy | Fissurectomy, Haemorrhoidectomy, Fistulectomy, ENT surgeries","sources":[{"clause":null,"heading":"Illnesses","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-illnesses"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"Counted separately for any enhanced sum insured, from the date of enhancement. Prospectus and CIS state it as 5 continuous years.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":"1(VI)","heading":null,"page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-vi"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. You can port the whole policy, with all family members, to another insurer by applying at least 30 days but not earlier than 60 days before the renewal date, and keep accrued waiting-period credit as per IRDAI portability guidelines.","display":"Yes, with waiting-period credit; apply 30 to 60 days before renewal","note":"Applies to Section 1 (Health). Migration to another HDFC ERGO product is also allowed at least 30 days before renewal.","quote":"IX) Portability (Applicable to Section 1 – Health) The Insured Person will have the option to port the Policy to other insurers by applying to such Insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to Portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":"1(IX)","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-ix"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes, lifetime renewal","note":"The words 'lifetime renewal' are in the prospectus; the wording sets no maximum renewal age.","quote":"Entry age limit of 65 years with lifetime 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","sources":[{"clause":"4","heading":"Entry age limit of 65 years with lifetime renewal","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-4"},{"clause":"1(VIII)","heading":null,"page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-viii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No. No loading applies on renewals based on individual claims experience, and renewal cannot be refused because of past claims.","display":"No loading for claims","note":"Medical underwriting loading set at inception (up to 100% per condition, 150% per person) continues at renewal; it can be reduced under Health Incentives.","quote":"iii) No loading shall apply on renewals based on individual claims experience ... We will not apply any additional loading on Your policy premium at Renewal based on claim experience in Your Policy. ... i) 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","sources":[{"clause":"1(iii)","heading":null,"page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-iii-4"},{"clause":"7(III)","heading":null,"page":66,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-7-iii-4"},{"clause":"1(i)","heading":null,"page":61,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-i-4"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Investigation & Evaluation (Excl04)","Rest Cure, rehabilitation and respite care (Excl05)","Obesity/Weight control surgery not meeting the conditions (Excl06)","Change-of-Gender treatments (Excl07)","Cosmetic or plastic surgery (Excl08)","Hazardous or Adventure Sports (Excl09)","Breach of Law (Excl10)","Excluded Providers (Excl11)","Alcoholism, drug or substance abuse or any addictive condition (Excl12)","Health hydros, nature cure clinics, spas or similar establishments (Excl13)","Dietary supplements and substances that can be purchased without prescription (Excl14)","Correction of eye sight due to refractive error less than 7.5 dioptres (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity (Excl18)","War, invasion, Nuclear, Chemical or Biological attack or weapons, radiation","Intentional self-injury, attempted suicide or suicide","Participation in naval, military or air force operation","Investigative treatment for Sleep-apnoea, General debility or exhaustion","Congenital external diseases, defects or anomalies","Stem cell harvesting","Spinal subluxation, manipulation of the skeletal structure or muscle stimulation","Circumcisions (unless necessitated by Illness or Injury)","Convalescence, sanatorium treatment, private duty nursing or long-term nursing care","Preventive care, nutritional and electrolyte supplements","Vaccination including inoculation and immunisations (Except post Animal bite treatment)","Non-Medical expenses","Treatment taken on Outpatient basis","Hearing aids, spectacles or contact lenses","Alopecia, baldness, wigs, Optometric therapy","Treatment not Reasonable and Customary or not Medically Necessary","Artificial limbs, external durable medical equipment, wheelchairs, crutches, cochlear implants (unless Accident)","Claims arising due to Non-disclosure of Pre-existing Illness or Material fact"],"display":"Standard exclusions Excl04 to Excl18 and the policy's own specific exclusions","note":"Section 1 (Health). Excl15 and Excl16 are quoted from the prospectus because the wording text is broken at that point. The wording also lists claims within an opted Aggregate Deductible as not payable.","quote":"i) Investigation & Evaluation: Code - Excl04: ... ii. Rest Cure, rehabilitation and respite care: Code – Excl05: ... iii. Obesity/Weight control: Code – Excl06: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions: ... iv. Change-of-Gender treatments: Code – Excl07: ... v. Cosmetic or plastic surgery: Code – Excl08: ... vi. Hazardous or Adventure Sports: Code - Excl09: ... vii. Breach of Law: Code – Excl10: ... viii. Excluded Providers: Code – Excl11: ... ix. Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... x. Treatments received in health hydros, nature cure clinics, spas or similar establishments ... Code – Excl13 ... xi. Dietary supplements and substances that can be purchased without prescription ... Code – Excl14 ... xii) Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. Code – Excl15 ... xiii) Unproven Treatments – Expenses related to any unproven treatment, services and supplies for or in connection with any treatment. ... Code – Excl16 ... xiv. Sterility and Infertility: Code – Excl17: ... xv. Maternity: Code – Excl18: ... i) War or any act of war, invasion, act of foreign enemy ... Nuclear, Chemical or Biological attack or weapons, radiation of any kind. ... iii) Any Insured Person committing or attempting to commit intentional self-injury or attempted suicide or suicide while mentally sound or unsound. ... iv) Any Insured Person’s participation or involvement in naval, military or air force operation. ... v) Investigative treatment for Sleep-apnoea, General debility or exhaustion (“run-down condition”). ... vi) Congenital external diseases, defects or anomalies, ... vii) Stem cell harvesting. ... viii) Investigative treatments for analysis and adjustments of spinal subluxation,diagnosis and treatment by manipulation of the skeletal structure or for muscle stimulation by any means ... ix) Circumcisions (unless necessitated by Illness or Injury and forming part of treatment). ... x) Any Convalescence, sanatorium treatment, private duty nursing or long-term nursing care. ... xi) Preventive care,; and other nutritional and electrolyte supplements ... xii) Vaccination including inoculation and immunisations (Except post Animal bite treatment), ... xiii) Non-Medical expenses ... xiv) Treatment taken on Outpatient basis ... xv) The provision or fitting of hearing aids, spectacles or contact lenses. ... xvi) Any treatment and associated expenses for alopecia, baldness including corticosteroids and topical immuno therapy wigs, toupees, hair pieces,any non-surgical hair replacement methods, Optometric therapy. ... xvii) Any treatment or part of a treatment that is not of a Reasonable and Customary charge, not Medically Necessary ... xviii) Expenses for Artificial limbs and/or device used for diagnosis or treatment (except when used intra-operatively).prosthesis, corrective devices external durable medical equipment of any kind, wheelchairs, crutches, and oxygen concentrator for bronchial asthma/ COPD conditions, cost of cochlear implant(s) unless necessitated by an Accident. ... xix) Any Claim arising due to Non-disclosure of Pre-existing Illness or Material fact as sought to be declared on the Proposal form.","sources":[{"clause":null,"heading":"Illnesses","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-illnesses"},{"clause":"1","heading":"Obesity related cardiomyopathy","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-3"},{"clause":"Excl16","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-excl16"},{"clause":null,"heading":"IV. Specific Permanent Exclusions","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-iv-specific-permanent-exclusions"},{"clause":"11(d)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-11-d-3"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"You may cancel with 7 days' written notice and get a pro-rata refund of premium for the unexpired policy period. No refund if any claim has been admitted or any benefit availed.","display":"Pro-rata refund for the unexpired period; none if a claim was admitted","note":"Instalment policies: after an admissible claim, future instalments for the year are adjusted in the claim and no premium is refunded that year. No refund if the insurer cancels for fraud, non-disclosure or misrepresentation.","quote":"i) The Policyholder may cancel this policy by giving 7 days’ written notice and in such an event, the Company shall refund to the Insured a pro-rata premium for the unexpired Policy Period. ... iv) Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where any claim has been admitted or any benefit has been availed by the Insured Person under the Policy.","sources":[{"clause":"5(i)","heading":null,"page":64,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-5-i"},{"clause":"5(iv)","heading":null,"page":64,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-5-iv"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"Health section: India only, except where Emergency Worldwide Coverage or Overseas Treatment applies. Personal Accident section: worldwide, except covers stated as India only.","display":"India (Health); worldwide (Personal Accident)","note":"Emergency Worldwide Coverage (25% of Base SI, max 25 lacs) and Overseas Treatment are covered in Titanium and Super top up and shown as Not Applicable for Platinum in the plan chart.","quote":"Section 1- Health This Policy provides coverage in India, except under the policies with Emergency Worldwide Coverage and Overseas treatment as may be specified in the on the Schedule of Coverage in the Policy Schedule. Section 2 – Personal Accident This Policy provides coverage Worldwide, except under the covers specifically mentioning as covered in India only under the terms and conditions.","sources":[{"clause":null,"heading":"1. Geography","page":66,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-geography"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"New individual policies only, not renewals or porting/migration. Refund less medical examination and stamp duty costs, or proportionate risk premium if cover has started.","quote":"The Insured Person shall be allowed free look period of 30 days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.","sources":[{"clause":"1(I)","heading":null,"page":59,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-i"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days (15 days for monthly instalments)","note":"Monthly instalments: 15 days; yearly, half-yearly and quarterly: 30 days.","quote":"i) A Grace Period of 30 days is available for Renewal of the Policy. ... Monthly | 15 days","sources":[{"clause":null,"heading":"4. Grace Period","page":67,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-4-grace-period"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"Proposer and adult dependents: 18 to 65 years. Children: 91 days to 25 years.","display":"18 to 65 years (children 91 days to 25 years)","note":"From the prospectus. Critical Illness and Hospital Cash add-ons: entry from 18 years (children 91 days), maximum 'Lifetime Entry'.","quote":"• Minimum Entry Age – 18 Years • Maximum Entry Age – 65 Years ... • Minimum Entry Age – 91 days • Maximum Entry Age - 25 years","sources":[{"clause":null,"heading":"Base Cover","page":46,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-base-cover"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"cross-checked","value":["Yearly","Half Yearly","Quarterly","Monthly"],"display":"Yearly, half-yearly, quarterly, monthly","note":"Policy terms of 1, 2 or 3 years.","quote":"If the Insured Person has opted for Payment of Premium on an installment basis i.e. Yearly, Half Yearly, Quarterly or Monthly, as mentioned in the Policy Schedule","sources":[{"clause":null,"heading":"1. Premium Payment in Instalments","page":62,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-premium-payment-in-instalments"}],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"cross-checked","value":["Non-Medical Expenses cover","Aggregate deductible","Emergency Medical Expenses (Emergency Worldwide Coverage)","Overseas Treatment","Waiver of Disease Capping","Waiver of Room Rent Capping","Waiting period Modification Option","Medical Evacuation","Sum Insured Rebound","Waiver of Co-Payment","Cumulative Bonus – Booster","Personal Accident: Burns","Personal Accident: Preventive Health Check-up","Personal Accident: Last Rites","Personal Accident: Dependent Children Education Benefit","Personal Accident: Renewal Premium Benefit","Personal Accident: Parental Care Benefit","Personal Accident: Medical Evacuation","my:health Critical Illness Add on","my:health Hospital Cash Benefit Add on"],"display":"11 Health options, Personal Accident options, Critical Illness and Hospital Cash add-ons","note":"Availability depends on the plan: Titanium and Super top up include several of these as covered (plan chart). Emergency Medical Expenses and Hospital Cash under Personal Accident also have their own options (Global, co-payment, Companion Benefit, Hospital Cash ICU, Time Deductible modification).","quote":"IV. | Optional Covers under Section 1 | 22 ... 1. | Non-Medical Expenses cover | 23 ... 2. | Aggregate deductible | 23 ... 3. | Emergency Medical Expenses | 23 ... 4. | Overseas Treatment | 23 ... 5. | Waiver of Disease Capping: | 24 ... 6. | Waiver of Room Rent Capping | 24 ... 7. | Waiting period Modification Option | 24 ... 8. | Medical Evacuation | 24 ... 9. | Sum Insured Rebound | 24 ... 10. | Waiver of Co-Payment | 25 ... 11. | Cumulative Bonus – Booster | 25 ... i. | Burns | 35 ... IV | Optional Covers under Section 2 – Personal Accident | 45 ... i. | Preventive Health Check-up | 45 ... ii. | Last Rites | 46 ... iii. | Dependent Children Education Benefit | 46 ... iv. | Renewal Premium Benefit | 47 ... v. | Parental Care Benefit | 47 ... vi. | Medical Evacuation | 47 ... 3. Emergency Worldwide Coverage ... • my: health Hospital Cash Benefit Add-on: Daily cash benefit ... • my:health Critical Illness: Comprehensive policy with coverage for 50 Critical Illnesses","sources":[{"clause":null,"heading":"Table of Contents","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-table-of-contents"},{"clause":null,"heading":"3. Emergency Worldwide Coverage","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-3-emergency-worldwide-coverage"},{"clause":"Section A","heading":"IV - Optional Cover under Section A.I","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-7"}],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"For instalment premiums, cover continues during the grace period. For renewal of a non-instalment policy, there is no cover for the period without premium, and any illness contracted during the grace period is treated as pre-existing.","display":"Yes for instalment premiums; no for annual renewal","note":null,"quote":"Any Illness, disease or condition contracted during Grace Period will not be covered and will be treated as Pre-existing diseases. ... iv) If premium is paid in instalments then coverage will be available during the grace period also. (Note: In case of non-instalment premium payment, coverage shall not be available for the period for which no premium is received).","sources":[{"clause":null,"heading":"4. Grace Period","page":67,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-4-grace-period"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for the hospital room, or the room category allowed. If you take a costlier room, other bills can be cut in proportion.","status":"cross-checked","value":"Platinum: up to a Single Standard AC Room. Titanium and Super top up: actuals.","display":"Single Standard AC Room (Platinum); actuals (Titanium, Super top up)","note":"Plan chart from the prospectus. Platinum can remove the cap with the optional Waiver of Room Rent Capping.","quote":"Insured Person is eligible for Room Rent category of up to Single Standard AC Room. ... i | Room Rent | Single Standard AC Room | Actuals | Actuals","sources":[{"clause":"1(a)(i)","heading":"Room Rent & Proportionate deduction","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-a-i"},{"clause":"Section A","heading":"I - Coverages","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-4"}],"law":[]},{"key":"room_category","label":"Room category allowed","section":"Limits and co-pay","meaning":"Shared room, single private room or any room, by plan, when the limit is a room type rather than a rupee amount.","status":"cross-checked","value":"Single Standard AC Room (Platinum plan); no room limit in Titanium and Super top up.","display":"Single Standard AC Room","note":"Titanium and Super top up: actuals (plan chart).","quote":"Insured Person is eligible for Room Rent category of up to Single Standard AC Room. ... i | Room Rent | Single Standard AC Room | Actuals | Actuals","sources":[{"clause":"1(a)(i)","heading":"Room Rent & Proportionate deduction","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-a-i"},{"clause":"Section A","heading":"I - Coverages","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-4"}],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"cross-checked","value":"ICU charges are paid at actuals in all plans.","display":"Actual","note":"From the plan chart in the prospectus.","quote":"ii) Intensive Care Unit charges ... ii | ICU | Actual | Actual | Actual","sources":[{"clause":"1","heading":"Medical Expenses","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-2"},{"clause":"Section A","heading":"I - Coverages","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-4"}],"law":[]},{"key":"proportionate_deduction","label":"Proportionate deduction","section":"Limits and co-pay","meaning":"If you choose a room above your limit, whether the insurer reduces associated charges (doctor fees, tests, procedures) by the same proportion.","status":"cross-checked","value":"Yes. If the room exceeds the eligible category, Room Rent and all Associated Medical Expenses are paid in the same proportion, except in hospitals that do not bill associated expenses by room category.","display":"Yes, if the room is above the eligible category","note":"Relevant to Platinum, which has the room limit; Titanium and Super top up pay room rent at actuals.","quote":"In case of admission to a room exceeding the aforesaid category, the reimbursement/payment of Room Rent charges including all Associated Medical Expenses incurred at Hospital shall be effected in the same proportion as the admissible rate per day bears to the actual rate per day of Room Rent charges. This condition is not applicable in respect of Hospitals where differential billing for Associated Medical Expenses is not followed based on Room Rent.","sources":[{"clause":"1(a)(i)","heading":"Room Rent & Proportionate deduction","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-a-i"}],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"The share of every admissible claim you pay yourself, and when it applies (age, zone, choice of hospital).","status":"cross-checked","value":"20% co-payment for lives with pre-existing disease at inception and lives with entry age above 60 (Platinum and Titanium). A 20% co-payment also applies if treated in a city of a higher premium tier than the one paid for.","display":"20% (PED or entry age above 60); 20% zone co-pay","note":"Super top up: not applicable. PED co-pay only during the PED waiting period. Zone co-pay waived for room rent up to Rs. 5,000 per day or accident cases. Plan chart also shows Waiver of Co-Payment as 'Waived' for Titanium and Super top up, and optional co-pay of 10%/15%/20% under Personal Accident Emergency Medical Expenses.","quote":"Co-payment –Mandatory 20% Co-Payment for all lives with PED at inception (if applicable), and lives with age at entry above 60 years (if applicable) ... Co-payment - 20% | 20% - for PED and age > 60 | 20% - for PED and age > 60 | Not Applicable ... However,if Insured Person avails a treatment in Tier 1a cities, 20% Co-Payment shall be applicable on admissible claim amount. ... b) The Co-payment in respect of Insured Person with Pre-existing diseases will be applicable only during waiting period applicable to Pre-existing diseases.","sources":[{"clause":null,"heading":"4. Policy period","page":47,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-4-policy-period"},{"clause":"Section A","heading":"I - Coverages","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-4"},{"clause":null,"heading":"6. Premium Tier (Applicable to Section 1 only)","page":68,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-6-premium-tier-applicable-to-section-1-only"},{"clause":null,"heading":"Illnesses","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-illnesses"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"An amount of each claim or each year that you bear before the policy pays.","status":"cross-checked","value":"None unless the Aggregate Deductible option is chosen; that option (Super top up plan) is Rs 5 lakh, 10 lakh or 25 lakh per policy year.","display":"None unless opted (Super top up: Rs 5, 10 or 25 lakh aggregate)","note":"Can be chosen only at first inception and cannot be removed later. The plan chart calls it optional for Super top up, but the Super Top Up premium tables only price cover 'in Excess of' 5,00,000, 10,00,000 or 25,00,000. Cumulative Bonus and Sum Insured Rebound do not apply with it.","quote":"2 | Aggregate Deductible | Not Applicable | Not Applicable | Optional 5 lacs/10lacs/25lacs ... the Insured Person shall bear an amount equal to the Aggregate Deductible specified in the Schedule of Coverage on Policy Schedule for all admissible claim amounts assessed by Us in respect of all claims made by Insured Person in a Policy Year.","sources":[{"clause":"Section A","heading":"IV - Optional Cover under Section A.I","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-7"},{"clause":null,"heading":"2. Aggregate deductible","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-2-aggregate-deductible"}],"law":[]},{"key":"disease_sublimits","label":"Disease or procedure sub-limits","section":"Limits and co-pay","meaning":"Caps on what is paid for named treatments (cataract, knee replacement...), even if the sum insured is higher.","status":"cross-checked","value":["Cataract per eye: Rs 75,000","Surgeries for Benign Tumors / Cysts / Nodule / Polyp: Rs 75,000","Stone in Urinary System: Rs 75,000","Hernia Related: Rs 75,000","Appendisectomy: Rs 75,000","Hysterectomy: Rs 75,000","Fissures / Piles / Fistulas: Rs 75,000","Cellulites / Abscess: Rs 75,000"],"display":"Rs 75,000 each for 8 listed procedures","note":"The plan chart shows Disease Capping 'Applicable' in all three plans, but Waiver of Disease Capping as optional in Platinum and 'Waived' in Titanium and Super top up. The CIS gives 'Capping on Disease/Procedure : INR 75K'.","quote":"Procedure | Sub-Limits (Rs)\nCataract per eye | 75,000\nSurgeries forBenign - Tumors / Cysts / Nodule / Polyp | 75,000\nStone in Urinary System | 75,000\nHernia Related | 75,000\nAppendisectomy | 75,000\nHysterectomy | 75,000\nFissures / Piles / Fistulas | 75,000\nCellulites / Abscess | 75,000","sources":[{"clause":"1(a)(ii)","heading":"Procedure Sub-limits","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-a-ii"}],"law":[]},{"key":"pre_hospitalisation","label":"Pre-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days before admission that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":60},"display":"60 days","note":null,"quote":"We will pay for the Pre- Hospitalization Medical Expenses incurred during the 60 days immediately before Hospitalization of an Insured Person","sources":[{"clause":"4","heading":"Pre-Hospitalization cover","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-4-2"}],"law":[]},{"key":"post_hospitalisation","label":"Post-hospitalisation cover","section":"Cover","meaning":"Medical costs in the days after discharge that are paid if related to the hospitalisation.","status":"cross-checked","value":{"unit":"days","amount":180},"display":"180 days","note":null,"quote":"We will pay for the Post Hospitalization Medical Expenses incurred upto180 days from the date Insured Person is discharged from Hospital ... Post-hospitalisation (treatment after discharge from hospital) within 180 days from date of discharge","sources":[{"clause":"5","heading":"Post-Hospitalization cover","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-5-2"},{"clause":"Section 1","heading":"Health","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125#c-section-1"}],"law":[]},{"key":"day_care","label":"Day-care treatments","section":"Cover","meaning":"Treatments needing less than 24 hours in hospital (chemotherapy, dialysis, cataract) and whether all or only listed ones are covered.","status":"cross-checked","value":"Covered: Medical Expenses for Day Care Treatment in a Hospital or Day Care Centre; the CIS lists all day care procedures requiring less than 24 hours of hospitalization.","display":"All day care procedures covered","note":null,"quote":"We will pay for the Medical Expenses under Section 1.A.I.1 on Hospitalization of Insured Person in Hospital or Day Care Centre for Day Care Treatment. ... 6. All Day Care procedures requiring less than 24 hours of hospitalization","sources":[{"clause":"6","heading":"Day Care Procedures","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-6-2"},{"clause":"Section 1","heading":"Health","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125#c-section-1"}],"law":[]},{"key":"domiciliary","label":"Treatment at home","section":"Cover","meaning":"Whether treatment at home is covered when hospital admission is not possible or a doctor advises it.","status":"cross-checked","value":"Covered when prescribed by the treating doctor and the patient cannot be moved to hospital or no hospital room is available. Home Healthcare (hospital-level treatment at home) is also covered, cashless only.","display":"Yes","note":null,"quote":"We will pay the Medical Expenses incurred on Domiciliary Hospitalization of the Insured Person prescribed by treating Medical Practitioner provided that:\ni) the condition of the Insured Person is such that he/she could not be removed to a Hospital or\nii) the Medical Necessary Treatment is taken at Home on account of non-availability of room in Hospital ... Insured Person can avail Hospitalization at Home under Home Healthcare for Medically Necessary Treatment of Illnesses , if prescribed by treating Medical Practitioner. ... This Cover can be availed through Cashless Facility only","sources":[{"clause":"3","heading":"Domiciliary Hospitalization","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-3-2"},{"clause":"2","heading":"Home Healthcare","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-2-2"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"cross-checked","value":"In-patient AYUSH treatment (Ayurvedic, Unani, Siddha, Homeopathy, Yoga & Naturopathy) in an AYUSH Hospital is covered: up to Rs 50,000 in Platinum, at actuals in Titanium and Super top up.","display":"Covered; Rs 50,000 (Platinum), actuals (Titanium, Super top up)","note":"Limits from the plan chart in the prospectus. The CIS describes Alternative Treatment as paid 'upto Sum Inured' without a plan limit.","quote":"We will indemnify the Medical Expenses covered under Section 1.A.I.1 only on In-patient care of Insured Person in an AYUSH Hospital upto the limits specified in the policy schedule only for the below mentioned Alternative Treatments ... 8 | Alternative Treatment | Rs 50,000 | At Actuals | At Actuals","sources":[{"clause":"9","heading":"Alternative Treatments","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-9-2"},{"clause":"Section A","heading":"I - Coverages","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-4"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention robotic surgery, immunotherapy, oral chemotherapy or similar treatments. Stem cell harvesting is excluded.","quote":null,"sources":[],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 2","url":"https://indiainsurances.com/law/irdai-health-mc-2024"}]},{"key":"organ_donor","label":"Organ donor expenses","section":"Cover","meaning":"Whether the donor's hospital costs for an organ transplant are paid.","status":"cross-checked","value":"Yes. The donor's hospitalisation for harvesting the organ is paid when an Insured Person is the recipient: up to 5% of Sum Insured in Platinum, at actuals in Titanium and Super top up. Donor's pre and post hospitalisation costs are excluded.","display":"Yes; 5% of Sum Insured (Platinum), actuals (others)","note":null,"quote":"We will pay Medical Expenses covered under Section 1.A.I.1 towards organ donor’s Hospitalization for harvesting of the donated organ where an Insured Person is the recipient ... iii) The Organ Donor’s Pre-Hospitalization and Post-Hospitalization expenses are excluded under the Policy ... 9 | Organ Donor Expenses | 5% of Sum Insured | At Actuals | At Actuals","sources":[{"clause":"8","heading":"Organ Donor Expenses","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-8-2"},{"clause":"Section A","heading":"I - Coverages","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-4"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance per admissible claim: up to Rs 2,000 in Platinum and Rs 10,000 in Titanium and Super top up. Air ambulance only with the Medical Evacuation option, up to Rs 5 lakh.","display":"Road: up to 2,000 (Platinum) or 10,000 (others)","note":"Medical Evacuation (air ambulance) is optional for Platinum and covered in Titanium and Super top up; return transport home by air ambulance is excluded.","quote":"For each admissible Claim under Section 1.A.I.1 and A.I.6, We will pay for expenses incurred on Road Ambulance Services ... 7 | Road Ambulance | Up to 2,000 | Up to 10,000 | Up to 10,000 ... 8 | Medical Evacuation | Optional Upto 5 lac | Covered Upto 5 lac | Covered Upto 5 lac","sources":[{"clause":"7","heading":"Road Ambulance","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-7-2"},{"clause":"Section A","heading":"I - Coverages","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-4"},{"clause":"Section A","heading":"IV - Optional Cover under Section A.I","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-7"}],"law":[]},{"key":"restoration","label":"Restoration of sum insured","section":"Cover","meaning":"Whether the sum insured is refilled after it is used up in a year, how much, how often, and whether it works for the same illness.","status":"cross-checked","value":"Not in the base cover. The Sum Insured Rebound option adds an amount equal to the claim paid, up to the Basic Sum Insured in a policy year, for later hospitalisations.","display":"Only with Sum Insured Rebound (built in for Titanium)","note":"Plan chart: covered in Titanium, not applicable in Platinum and Super top up. Chemotherapy and dialysis: only once in the policy lifetime. A single claim cannot exceed Basic Sum Insured plus Cumulative Bonus. Unused rebound does not carry over. Not available with Aggregate Deductible.","quote":"We will add to the Sum Insured, an amount equivalent to the Claim amount paid under Basic Sum Insured, subject to maximum of Basic Sum Insured, on subsequent Hospitalization of the Insured Person during Policy Years ... i) Total Sum Insured added under this cover will not exceed the Basic Sum Insured in a Policy Year ... 9 | Sum Insured Rebound | Not Applicable | Covered Upto the claim amount | Not Applicable","sources":[{"clause":null,"heading":"9. Sum Insured Rebound","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-9-sum-insured-rebound"},{"clause":"Row 1(i)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-row-1-i"},{"clause":"Section A","heading":"IV - Optional Cover under Section A.I","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-7"}],"law":[]},{"key":"no_claim_bonus","label":"No-claim or cumulative bonus","section":"Cover","meaning":"How much the cover grows each year, the maximum, whether it depends on not claiming, and what happens after a claim.","status":"conflicting","value":"Cumulative Bonus of 50% of the Base Sum Insured on each renewal without a break, irrespective of claims, up to 100% of Basic Sum Insured.","display":"50% a year, irrespective of claims, up to 100%","note":"CIS says: '10% of the Basic Sum Insured maximum upto 100% ... irrespective of claims'. Prospectus plan chart: Platinum '10% of Sum Insured, maximum of 100%', Titanium and Super top up 'Not Applicable'; the prospectus's own Cumulative Bonus clause says 50%, as the wording does. Titanium has Cumulative Bonus Booster '50% of Sum Insured, maximum of 100%'. Not applicable if Aggregate Deductible is opted.","quote":"On Renewal of this Policy with the Company without a break, a sum equal to 50% of the Base Sum Insured of the expiring Policy shall be provided as Cumulative Bonus irrespective of any claims ... i. Cumulative Bonus can be accumulated upto 100% of Basic Sum Insured. ... Cumulative Bonus (10% of the Basic Sum ... Insured maximum upto 100% post completion of each policy year irrespective of claims) ... 4 | Cumulative Bonus | 10% of Sum Insured ,maximum of 100% | Not Applicable | Not Applicable","sources":[{"clause":null,"heading":"4. Cumulitive Bonus","page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-4-cumulitive-bonus"},{"clause":"Section 1","heading":"Health","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125#c-section-1"},{"clause":"4","heading":"Pre-hospitalisation of 60 days (treatment 1.A I 4","page":2,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125#c-4"},{"clause":"Section A","heading":"III - my:health Active","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-6"}],"law":[]},{"key":"consumables","label":"Consumables and non-medical items","section":"Cover","meaning":"Gloves, PPE, syringes and other items hospitals bill that standard policies exclude; whether this policy pays them.","status":"cross-checked","value":"Non-medical items such as gloves are excluded unless the Non-Medical Expenses optional cover is chosen, which pays up to 5% of the admissible claim amount. Medicines, drugs and consumables billed in hospital are part of Medical Expenses.","display":"Only with the Non-Medical Expenses cover (up to 5% of claim)","note":"Plan chart: optional in Platinum, covered in Titanium and Super top up.","quote":"v) Medicines, drugs and consumables ... xiii) Non-Medical expenses such as Food charges (other than patient’s diet provided by hospital), laundry charges, attendant charges, ambulance collar, ambulance equipment, baby food, baby utility charges and other such items. ... 56 | GLOVES ... We will pay for Non-Medical Expenses up to the limit mentioned in Schedule of Coverage in the Policy Schedule ... Upto 5% of admissible claim amount ... 1 | Non-Medical Expenses Cover | Optional Upto 5% of claim | Covered Upto 5% of claim | Covered Upto 5% of claim","sources":[{"clause":"1","heading":"Medical Expenses","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-2"},{"clause":null,"heading":"IV. Specific Permanent Exclusions","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-iv-specific-permanent-exclusions"},{"clause":"Annexure I","heading":"List of Non-Medical Expenses","page":73,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-annexure-i"},{"clause":null,"heading":"1. Non-Medical Expenses cover","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-non-medical-expenses-cover"},{"clause":null,"heading":"Sum Insured Available","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-sum-insured-available"},{"clause":"Section A","heading":"IV - Optional Cover under Section A.I","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-7"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Not covered. Childbirth expenses (except ectopic pregnancy), miscarriage (unless due to an accident) and medical termination of pregnancy are excluded.","display":"Not covered","note":null,"quote":"xv. Maternity: Code – Excl18:\na) Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy;\nb) Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy period.","sources":[{"clause":"Excl16","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-excl16"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"No cover from birth is described. Children can enter from 91 days; a New Born Baby can be added by financial endorsement with a birth certificate (prospectus and wording endorsement lists).","quote":null,"sources":[],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"cross-checked","value":"Covered when treatment is in a Mental Health Establishment, subject to the Mental Health Care Act, 2017 and other laws.","display":"Covered in a Mental Health Establishment","note":null,"quote":"iii) Mental Illness The Coverage for Mental illness is applicable if done in Mental Health Establishment and is subject to the provisions contained in the Mental Health Care Act, 2017, as amended from time to time and other applicable laws and Regulations","sources":[{"clause":"1(a)(iii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-a-iii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 3","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch III I","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(4)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 2(1)(s)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"},{"title":"The Mental Healthcare Act, 2017","section":"Section 21(1)","url":"https://indiainsurances.com/law/mental-healthcare-act-2017"}]},{"key":"health_checkup","label":"Health check-up","section":"Cover","meaning":"Free preventive check-ups and how often.","status":"cross-checked","value":"Preventive health check-up at a network provider after completion of each policy year or renewal, with listed tests (chest X-ray, stress test, blood sugar, lipid profile, ECG and others). Lapses if not used within 60 days.","display":"Every policy year, at network providers","note":"Covered in all three plans (plan chart).","quote":"Insured Person will be entitled for below list of tests after completion of each Policy Year/Renewal at our Network Provider; ... • This benefit will not be carried forward if not utilized within 60 days of end of Policy Year or Renewal. ... 1 | Preventive Health Checkup | Covered | Covered | Covered","sources":[{"clause":null,"heading":"III. my:health Active 1. Preventive Health Check-Up","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-iii-my-health-active-1-preventive-health-check-u"},{"clause":"Section A","heading":"III - my:health Active","page":60,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-section-a-6"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"cross-checked","value":"Not covered: treatment taken on an outpatient basis is excluded. Wellness services offer discounts on OPD only.","display":"Not covered","note":null,"quote":"xiv) Treatment taken on Outpatient basis ... • Discounts: on OPD, Pharmaceuticals, pharmacy, diagnostic centres","sources":[{"clause":null,"heading":"IV. Specific Permanent Exclusions","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-iv-specific-permanent-exclusions"},{"clause":"9(ii)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-9-ii-2"}],"law":[]},{"key":"zone_pricing","label":"Zone or city-based premium","section":"Premium","meaning":"Whether premium or co-pay depends on the city you are treated in.","status":"cross-checked","value":"Yes. Premium depends on the city of residence: Tier 1a (Delhi and NCR), Tier 1b (Mumbai, Pune, Surat, Ahmedabad, Vadodara and others) and Tier 2 (rest of India). Treatment in a higher tier city than the premium paid attracts a 20% co-payment.","display":"Yes, 3 premium tiers with 20% co-pay for higher-tier treatment","note":"Applies to Section 1 only. No zone co-pay for room rent up to Rs. 5,000 per day or treatment following an accident.","quote":"For the purpose of policy issuance, the premium will be computed basis the city of residence provided by the Insured Person in the proposal form. ... • Tier 1a: Delhi and NCR region\n• Tier 1b: Mumbai, Mumbai Suburban and Navi Mumbai, Pune, Surat, Ahmedabad, Vadodara\n• Tier 2: Rest of India ... However,if Insured Person avails a treatment in Tier 1a or Tier1b cities, 20% Co-Payment shall be applicable on admissible claim amount.","sources":[{"clause":null,"heading":"6. Premium Tier (Applicable to Section 1 only)","page":68,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-6-premium-tier-applicable-to-section-1-only"}],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"cross-checked","value":"Yes, at the insurer's Network Providers, after pre-authorisation; the insurer pays the authorised amount directly to the hospital. Home Healthcare is cashless only.","display":"Yes, at network hospitals","note":"Pre-authorisation is valid for 15 days. Cashless claims for hospitalisation outside India are also listed in the claims procedure.","quote":"i) Cashless facility can be availed only at Our Network Provider. ... iv) We will make payment for the Cashless authorized amount directly to the Network Provider.","sources":[{"clause":"3","heading":"Conditions for obtaining Cashless facility","page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-3-3"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"HDFC ERGO itself: claims are intimated to the insurer, which handles pre-authorisation, and claim documents go to HDFC ERGO.","display":"The insurer (HDFC ERGO)","note":"No TPA is named in the documents; TPA appears only in standard definitions.","quote":"You shall intimate the Claims to us through any available mode of communication as specified in the Policy, Health Card or our Website ... Claim Intimation: | Service No. 022-62346234 / 0120- 62346234 Email:healthclaims@hdfcergo.com ... Claim document submission at address | HDFC ERGO General Insurance Co. Ltd.","sources":[{"clause":"1","heading":"Notification of a Claim","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-1-4"},{"clause":"Section D","heading":"OTHER TERMS & CONDITIONS Contact Us","page":69,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123#c-section-d"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes (Health section)","note":"Floater applies to Section A (Health) and the Hospital Cash add-on; Personal Accident and Critical Illness add-on are individual sum insured only.","quote":"Floater Sum Insured Option: Self, Spouse, dependent children* and dependent parents/parents in law can be covered under floater option ... Floater Sum Insured-Where all members under the policy have a single sum insured limit which may be utilized by any or all members","sources":[{"clause":null,"heading":"Floater Sum Insured","page":47,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124#c-floater-sum-insured"},{"clause":"Row 4","heading":"Sum Insured","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125#c-row-4"}],"law":[]}],"documents":[{"kind":"wording","label":"my:health Koti Suraksha","pages":74,"fetched_at":"2026-10-16 07:11:36.579781+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/myhealth-koti-suraksha-pw-327779800227.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/123"},{"kind":"prospectus","label":"my:health Koti Suraksha","pages":74,"fetched_at":"2026-10-16 07:11:36.579781+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/prospectus/health/prospectus-my-health-koti-suraksha-597507667605.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/124"},{"kind":"cis","label":"myhealth Koti Suraksha","pages":25,"fetched_at":"2026-10-16 07:11:36.579781+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/cis---myhealth-koti-suraksha/PDF189-994362627141.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021/document/125"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"health Koti Suraksha (UIN HDFHLIP21131V012021), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-koti-suraksha-hdfhlip21131v012021"}