{"uin":"HDFHLIP26048V052526","name":"Energy","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526","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":"disease-specific","category_name":"Disease-specific cover","irdai_type":null,"kind":"product","status":"active","approved_on":"2018-03-28","withdrawn_on":null,"summary":"Energy is an HDFC ERGO hospitalisation policy for people aged 18 to 65 with Type 1 or Type 2 diabetes, IFG, IGT and/or hypertension, sold as Silver and Gold plans with sums insured from Rs. 2 lakh to Rs. 50 lakh for treatment in India only. Pre-existing diseases and listed illnesses wait 24 months, conditions linked to diabetes and hypertension are not part of the pre-existing disease waiting period, and there is no initial waiting period.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:54.146956+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":["Silver Plan","Gold Plan"],"display":"Silver Plan and Gold Plan","note":"The plans differ in the wellness programme: in Gold the insurer conducts and pays for the twice-yearly check-ups (or reimburses up to Rs.2000/- at an approved centre); in Silver the check-up costs are borne by you. A 20% co-payment can be opted with either plan.","quote":"Variant1. Silver Plan ... Variant 2: Gold Plan ... Please note that the costs incurred for these tests will have to be borne by You. ... the cost of the same shall be borne by Us. If You choose to undertake medical check-up from a diagnostic center which is approved by Us, We will reimburse upto Rs.2000/- against actual diagnostic bill ... If opted and mentioned on the Policy Schedule that a Co-payment is effective ... shall bear 20% of the eligible claim amount","sources":[{"clause":null,"heading":"III. Renewal Benefits 1. Wellness Programme for Diabetes and Hypertension Variant1. Silver Plan","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-iii-renewal-benefits-1-wellness-programme-for-di"},{"clause":null,"heading":"Variant 2: Gold Plan","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-variant-2-gold-plan"},{"clause":"7(a)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-7-a-2"},{"clause":"7(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-7-b-4"},{"clause":null,"heading":"15. Co-Payment","page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-15-co-payment"}],"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 is issued for 1 year; sum insured and benefits apply on a policy year basis.","display":"1 year","note":"The instalment table also mentions a Multi-Year / Yearly option and the cumulative bonus clause mentions 2/3 year Policy Periods, but both documents say the policy is issued for 1 year.","quote":"The Policy will be issued for a period of 1yearand the Sum Insured & benefits will be applicable on Policy Year basis. ... The policy will be issued for a period of 1 year.","sources":[{"clause":null,"heading":"2. Specific General Terms","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-specific-general-terms"},{"clause":null,"heading":"Energy - Prospectus","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-energy-prospectus"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"conflicting","value":"Tell the insurer or its TPA at least 48 hours before admission for planned hospitalisation, and within 24 hours of admission in an emergency.","display":"48 hours before planned admission; within 24 hours of emergency admission","note":"Prospectus says: 'Please contact our designated TPA atleast 7 days prior to an event which might give rise to a claim' and, for reimbursement, the TPA 'must be informed no later than 7 days of completion of such treatment'. The prospectus also asks for cashless authorisation at least 48 hours before planned hospitalisation.","quote":"Immediately and in any event at least 48 ... hours prior to the Insured Person’s admission. ... requires Hospitalisation in an Emergency. | Within 24 hours of the Insured Person’s admission to Hospital. ... Intimation & Assistance - Please contact our designated TPA atleast 7 days prior to an event which might give rise to a claim. For any emergency situations, kindly contact our TPA within 24 hours of the event. ... Our TPA must be informed no later than 7 days of completion of such treatment, consultation or procedure using the Claim Intimation Form.","sources":[{"clause":null,"heading":"2. Specific General Terms","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-specific-general-terms"},{"clause":"4.01(III)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-4-01-iii"}],"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":["Claim form, duly completed and signed","Original bills and receipts or prescriptions","All reports and records, including medical reports, case histories, investigation reports, discharge summaries","A precise diagnosis of the treatment","Detailed list of medical services and treatments with unit price (detailed break up)","Prescriptions naming the Insured Person, with drug prices and receipt","All pre and post investigation, treatment and follow up records for the present ailment","Investigation, treatment and follow up records of past ailments related to the claim","Treating doctor's certificate regarding missing information","Copy of settlement letter from other insurance company or TPA","Stickers and invoice of implants used during surgery","MLC and FIR copies for accident claims","NEFT and KYC (recent ID/Address proof and photograph)","Legal heir certificate"],"display":null,"note":"Documents are to be given within 15 days of the insurer's request or of discharge or completion of treatment; the insurer may ask for more documents if it suspects non-disclosure or fraud. The prospectus asks for the signed claim form and documents within 15 days of the incident.","quote":"i) Our claim form, duly completed and signed for on behalf of the Insured Person. ... ii) Original Bills (including but not limited to pharmacy purchase bill, consultation bill, and diagnostic bill) and any attachments thereto like receipts or prescriptions in support of any amount claimed ... iii) All reports and records, including but not limited to all medical reports, case histories/indoor case papers, investigation reports, treatment papers, discharge summaries. ... iv) A precise diagnosis of the treatment for which a claim is made. ... v) A detailed list of the individual medical services and treatments provided and a unit price for each (detailed break up). ... vi) Prescriptions that name the Insured Person and in the case of drugs: the drugs prescribed, their price and a receipt for payment. ... vii) All pre and post investigation, treatment and follow up (consultation) records pertaining to the present ailment for which claim is being made ... viii) All investigation, treatment and follow up records pertaining to the past ailment(s) related to the claim ... ix) Treating doctor’s certificate regarding missing information in case histories ... x) Copy of settlement letter from other insurance company or TPA ... xi) Stickers and invoice of implants used during surgery ... xii) Copy of MLC (Medico legal case) records and FIR (First information report), in case of claims arising out of an accident ... currently mandatory NEFT (to enable direct credit of claim amount in bank account) and KYC (recent ID/Address proof and photograph) requirements ... xiv) Legal heir certificate ... within 15 days of the either of Our request or the Insured Person’s discharge from Hospitalisation or completion of treatment ... Please send the duly signed claim form and all the information/documents mentioned therein to your designated TPA within 15 days of the occurrence of the Incident.","sources":[{"clause":null,"heading":"2. Specific General Terms","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-specific-general-terms"},{"clause":"4.01(III)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-4-01-iii"}],"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 receipt of intimation; if payment is delayed it pays interest at 2% above the bank rate from the date of intimation to payment.","display":"Within 15 days of receiving intimation","note":"Interest at 2% above the bank rate for delayed payment.","quote":"(1) The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt intimation. ... (2) In the case of delay in the payment of a claim, 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.","sources":[{"clause":"16","heading":"Claim Settlement (Provision of Penal Interest)","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-16"}],"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":["Listed conditions and surgeries for 24 months (Excl02)","Pre-existing diseases for 24 months (Excl01)","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)","Treatment for alcoholism, drug or substance abuse (Excl12)","Maternity (Excl18)","War or similar situations","Intentional self-injury or attempted suicide","Non-Medical expenses","Treatment taken on Outpatient basis","Treatment availed outside India","Dental treatment unless requiring Hospitalisation"],"display":null,"note":"Complications of Type 2 Diabetes, IFG, IGT, Type 1 Diabetes and Hypertension are not part of the pre-existing disease waiting period. Waiting periods do not apply to claims from an Accident (specified disease list).","quote":"shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with us ... i) Specified disease/procedure waiting period: Code - Excl02 ... ii.Pre-Existing Diseases: Code - Excl01 ... a) Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage ... 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 ... viii) Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... xiv) Maternity: Code – Excl18: ... ii) Hazardous or Adventure sports: Code – Excl09: ... Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... i) War or similar situations ... ii) Intentional self-injury or attempted suicide while sane or insane. ... xii) Non-Medical expenses ... xiii) Treatment taken on Outpatient basis ... xx) Treatment availed outside India ... xxiii) Dental treatment and surgery of any kind, unless requiring Hospitalisation.","sources":[{"clause":"1(a)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-a"},{"clause":"1(i)","heading":"Specified disease/procedure waiting period","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-i"},{"clause":"1(f)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-f"},{"clause":"1(a)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-a-2"},{"clause":"2","heading":"Standard Exclusions","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-2"},{"clause":"2(I)(d)(ii)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-i-d-ii"},{"clause":"Excl14","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-excl14"},{"clause":"Excl14(ii)","heading":"Hazardous or Adventure sports","page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-excl14-ii"},{"clause":"3","heading":"Specific Exclusions","page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-3"}],"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 contact HDFC ERGO at care@hdfcergo.com, by phone (022 6234 6234 / 0120 6234 6234) or at the grievance cell of any branch; escalate to grievance@hdfcergo.com and then the Chief Grievance Officer at cgo@hdfcergo.com; then the Insurance Ombudsman.","display":"HDFC ERGO first (care@hdfcergo.com, 022 6234 6234, any branch grievance cell), then grievance@hdfcergo.com, then cgo@hdfcergo.com","note":"Prospectus gives the first point of contact as 022 6158 2020 / 022 6234 6234, Level 1 as the Complaints & Grievance Cell (grievance@hdfcergo.com, 18002677444) and Level 2 as the Chief Grievance Officer (cgo@hdfcergo.com) if no response within 15 days. Senior citizen line: seniorcitizen@hdfcergo.com.","quote":"Contact Points | First Contact Point | Escalation level 1 | Escalation level 2 ... Call - : 022 6234 6234 / 0120 ... Write to us at | care@hdfcergo.com | grievance@hdfcergo.com | cgo@hdfcergo.com ... Insured person may also approach the grievance cell at any of the company’s branches with the details of grievance. ... the insured person may also approach the office of Insurance Ombudsman of the respective area/region ... 0120 6234 6234 ... First Point of Contact | Call us at 022 6158 2020 / 022 6234 6234/www.hdfcergo.com ... You can also write an email to grievance@hdfcergo.com 3. Call on 18002677444 ... 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","sources":[{"clause":"9","heading":"Grievance Redressal Procedure","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-9"},{"clause":null,"heading":"Redressal of Grievance","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-redressal-of-grievance"}],"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":"conflicting","value":"Rs. 2, 3, 5, 10, 20, 25 or 50 lakh, for both Gold and Silver Plans.","display":"Rs. 2, 3, 5, 10, 20, 25 or 50 lakh","note":"Prospectus says: 'Offered are Rs. 200,000; 300,000; 500,000; 10,00,000; 15,00,000; 20,00,000; 25,00,000; 50,00,000' and its premium tables include Rs. 15,00,000, but the Schedule of Benefits in both documents omits 15 lakh. Individual sum insured basis only.","quote":"Gold Plan: ... Sum Insured – (Rs. In Lakhs) | 2.00, 3.00, 5.00, 10.00, 20.00, 25.00, 50.00 ... Silver Plan: ... Sum Insured: Offered are Rs. 200,000; 300,000; 500,000; 10,00,000; 15,00,000; 20,00,000; 25,00,000; 50,00,000","sources":[{"clause":null,"heading":"Schedule of Benefits","page":42,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-schedule-of-benefits"},{"clause":null,"heading":"Energy - Prospectus","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-energy-prospectus"}],"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":0},"display":"None (no 30-day general waiting period)","note":"From the prospectus; the policy wording lists no general initial waiting period.","quote":"f) There will be no general waiting period of 30 days applicable in this product.","sources":[{"clause":null,"heading":"Energy - Prospectus","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-energy-prospectus"}],"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":24},"display":"24 months","note":"Conditions arising from Type 2 Diabetes Mellitus, IFG, IGT, Type 1 Diabetes and Hypertension are not part of this waiting period. Applies afresh to any sum insured increase; reduced for prior continuous cover under portability.","quote":"a) Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first policy with insurer. ... Any condition or illness, complication or ailment arising out of or connected to the below mentioned conditions shall not be considered as part of this waiting period. ... a) Type 2 Diabetes Mellitus ... b) Impaired Fasting Glucose (IFG) ... c) Impaired Glucose Tolerance (IGT) ... d) Type 1 Diabetes ... e) Hypertension ... b) In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of sum of Sum Insured increase. ... then waiting period for the same would be reduced to the extent of prior coverage.","sources":[{"clause":"1(a)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-a-2"},{"clause":"1(d)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-d-2"},{"clause":"1(a)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-a-3"},{"clause":"1(b)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-b-3"},{"clause":"1(c)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-c-3"},{"clause":"1(d)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-d-3"},{"clause":"1(e)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-e-2"},{"clause":"1(b)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-b-2"},{"clause":"1(c)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-c-2"}],"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":"Does not apply to claims from an Accident. If a listed condition is also pre-existing, the longer waiting period applies.","quote":"a) Expenses related to the treatment of the listed Conditions, surgeries/treatments as mentioned in the table below 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. ... If any of the specified disease/procedure falls under the waiting period specified for Pre-existing diseases, then the longer of the two waiting periods shall apply.","sources":[{"clause":"1(a)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-a"},{"clause":"1(c)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-c"}],"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":["Sinusitis","Rhinitis","Tonsillitis","Adenoidectomy","Mastoidectomy","Tonsillectomy","Tympanoplasty","Surgery for nasal septum deviation","Surgery for Turbinate hypertrophy","Nasal concha resection","Nasal polypectomy","cysts, polyps including breast lumps","Polycystic ovarian disease","Fibromyoma","Adenomyosis","Endometriosis","Prolapsed Uterus","Hysterectomy","Non infective arthritis","Gout and Rheumatism","Osteoarthritis","Ligament, Tendon and Meniscal tear","Prolapsed inter vertebral disk","Joint replacement surgeries","Cholelithiasis","Cholecystitis","Pancreatitis","Fissure/fistula in anus, Haemorrhoids, Pilonidal sinus","Gastro Esophageal Reflux Disorder (GERD), Ulcer and erosion of stomach and duodenum","Cirrhosis","Perineal and Perianal Abscess","Rectal Prolapse","Cholecystectomy","Surgery of hernia","Calculus diseases of Urogenital system including Kidney, ureter, bladder stones","Benign Hyperplasia of prostate","Varicocele","Surgery on prostate","Surgery for Hydrocele/ Rectocele","Cataract","Retinal detachment","Glaucoma","Surgery of varicose veins and varicose ulcers","Benign tumors of Non infectious etiology"],"display":null,"note":"Alcoholic cirrhosis is permanently excluded. The prospectus adds examples for benign tumors: cysts, nodules, polyps, lump, growth.","quote":"• Sinusitis • Rhinitis • Tonsillitis | • Adenoidectomy • Mastoidectomy • Tonsillectomy • Tympanoplasty • Surgery for nasal septum deviation • Surgery for Turbinate hypertrophy • Nasal concha resection • Nasal polypectomy ... • cysts, polyps including breast lumps • Polycystic ovarian disease • Fibromyoma • Adenomyosis • Endometriosis • Prolapsed Uterus | • Hysterectomy ... • Non infective arthritis • Gout and Rheumatism • Osteoarthritis • Ligament, Tendon and Meniscal tear | • Joint replacement surgeries ... • Prolapsed inter vertebral disk ... • Cholelithiasis • Cholecystitis • Pancreatitis • Fissure/fistula in anus, Haemorrhoids, Pilonidal sinus ... • Gastro Esophageal Reflux Disorder (GERD), Ulcer and erosion of stomach and duodenum • Cirrhosis (However Alcoholic cirrhosis is permanently excluded) • Perineal and Perianal Abscess • Rectal Prolapse | • Cholecystectomy • Surgery of hernia ... • Calculus diseases of Urogenital system including Kidney, ureter, bladder stones • Benign Hyperplasia of prostate • Varicocele | • Surgery on prostate • Surgery for Hydrocele/ Rectocele ... f. | Eye | • Cataract • Retinal detachment • Glaucoma ... g. | Others | • Surgery of varicose veins and varicose ulcers ... • Benign tumors of Non infectious etiology","sources":[{"clause":"1(f)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-f"}],"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 afresh from the date of enhancement for any increase in sum insured. The prospectus states 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. ... Wherever, the sum insured is enhanced, completion of sixty continuous months would be applicable from the date of enhancement of sums insured only on the enhanced limits. ... After completion of 5 continuous years under this Policy no look back would be applied.","sources":[{"clause":"5","heading":"Moratorium Period","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-5"},{"clause":null,"heading":"Moratorium Period","page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-moratorium-period"}],"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 policy to another insurer by applying at least 30 days, but not earlier than 60 days, before the renewal date, and keep the accrued continuity benefits in waiting periods.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit kept","note":"Credit applies if continuously covered without lapses. Portability applies to the previous sum insured and accrued bonus, not to any additional increased sum insured.","quote":"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 ... the proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability. ... has been continuously covered without any lapses ... Portability/migration benefit will be offered to the extent of sum of previous sum insured and accrued multiplier bonus, portability/migration benefit shall not apply to any other additional increased Sum Insured.","sources":[{"clause":"12","heading":"Portability","page":28,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-12"},{"clause":null,"heading":"2. Cumulative Bonus","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-cumulative-bonus"}],"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, no cover ceasing age","note":"No cover ceasing age is from the prospectus; the wording says renewal can be refused only for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn.","quote":"b) There is no maximum cover ceasing age in this policy. ... 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":null,"heading":"Energy - Prospectus","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-energy-prospectus"},{"clause":"8","heading":"Renewal of Policy","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-8"}],"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.","display":"No loading for claims","note":"Risk loading (up to 100% per condition, 150% overall) can apply at commencement, renewal or sum insured increase based on declarations and health status, not on claims. Renewal premium may change with age.","quote":"iii) No loading shall apply on renewals based on individual claims experience ... The maximum risk loading applicable for an individual will not exceed 100% per diagnosis / medical condition and an overall risk loading of 150% per individual. ... Please note that your premium at renewal may change due to a change in your age","sources":[{"clause":"8","heading":"Renewal of Policy","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-8"},{"clause":null,"heading":"2. Specific General Terms","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-specific-general-terms"},{"clause":null,"heading":"Premium Rates","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-premium-rates"}],"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 (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 (Excl12)","Health hydros, nature cure clinics, spas (Excl13)","Dietary supplements without prescription (Excl14)","Refractive error less than 7.5 dioptres (Excl15)","Unproven Treatments (Excl16)","Sterility and Infertility (Excl17)","Maternity (Excl18)","War or similar situations","Intentional self-injury or attempted suicide","Naval, military or air force operation","Investigative treatment for Sleep-apnoea, General debility","Congenital external diseases, defects or anomalies","Stem cell harvesting","Circumcisions unless necessitated by Illness or Injury","Convalescence, sanatorium treatment, private duty nursing or long-term nursing care","Preventive care and nutritional supplements","Vaccination (except post Animal bite treatment)","Non-Medical expenses","Treatment taken on Outpatient basis","Hearing aids, spectacles or contact lenses","Alopecia, baldness, wigs","Artificial limbs, external durable medical equipment, cochlear implants unless due to Accident","Claims due to Non-disclosure of Pre-existing Illness or Material fact","Treatment availed outside India","Treatment at a healthcare facility which is NOT a Hospital","Non-allopathic treatment except In-patient AYUSH cover","Dental treatment unless requiring Hospitalisation","Pancreatic islet transplantation","Treatment by a family member Medical Practitioner","Admission for Intraarticular or Intra-lesional injections, Zolendronic acid or IV immunoglobulin","Alcoholic cirrhosis","Investigative treatments for spinal sub luxation, manipulation of the skeletal structure or muscle stimulation","Treatment not of a Reasonable and Customary charge, not Medically Necessary, or not supported by a prescription","Prosthetic and other devices which are self-detachable /removable without surgery","Treatment by a Medical Practitioner outside his discipline"],"display":null,"note":"Excl14 code is printed in the prospectus; in the wording the code is cut off. Time bound exclusions of up to 36 months may also be specified in the Schedule. Non-medical expenses are waived for Shared Accommodation in a Network Hospital.","quote":"i) Investigation & Evaluation: Code - Excl04: ... ii) Rest Cure, rehabilitation and respite care: Code – Excl05 ... iii) Obesity/Weight control: Code – Excl06 ... iv) Change-of-Gender treatments: Code – Excl07 ... v) Cosmetic or plastic surgery: Code – Excl08 ... vi) Breach of Law: Code – Excl10 ... vii) Excluded Providers: Code – Excl11 ... viii) Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... ix) Treatments received in health hydros, nature cure clinics, spas or similar establishments ... Code – Excl13 ... x) Dietary supplements and substances that can be purchased without prescription, including but not limited to Vitamins, minerals and organic substances unless prescribed by a Medical Practitioner as part of Hospitalization claim or day care procedure.Code – Excl14 ... xi) Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres. Code – Excl15 ... xii) Unproven Treatments ... Code – Excl16 ... xiii) Sterility and Infertility: Code – Excl17 ... xiv) Maternity: Code – Excl18: ... ii) Hazardous or Adventure sports: Code – Excl09: ... i) War or similar situations ... ii) Intentional self-injury or attempted suicide while sane or insane. ... iii) Any Insured Person’s participation or involvement in naval, military or air force operation. ... iv) Investigative treatment for Sleep-apnoea, General debility or exhaustion ... v) Congenital external diseases, defects or anomalies ... vi) Stem cell harvesting ... viii) Circumcisions (unless necessitated by Illness or Injury and forming part of treatment). ... ix) Any Convalescence, sanatorium treatment, private duty nursing or long-term nursing care. ... x) Preventive care, and other nutritional and electrolyte supplements ... xi) Vaccination including inoculation and immunisations (Except post Animal bite treatment) ... xii) Non-Medical expenses ... xiii) Treatment taken on Outpatient basis ... xiv) The provision or fitting of hearing aids, spectacles or contact lenses. ... xv) Any treatment and associated expenses for alopecia, baldness including corticosteroids and topical immunotherapy wigs, ... xvii) 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. ... xviii) Any Claim arising due to Non-disclosure of Pre-existing Illness or Material fact ... xx) Treatment availed outside India ... xxi) Treatment at a healthcare facility which is NOT a Hospital. ... xxii) Any non-allopathic treatment except to the extent of coverage provided for under 'In-patient Hospitalization treatment' cover ... xxiii) Dental treatment and surgery of any kind, unless requiring Hospitalisation. ... xxiv) Expense related to pancreatic islet transplantation. ... xxvi) Treatments rendered by a Medical Practitioner who is a member of the Insured Person’s family ... xxvii) Admission for administration of Intraarticular or Intra-lesional injections, Supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc.) or IV immunoglobulin infusion ... Cirrhosis (However Alcoholic cirrhosis is permanently excluded) ... vii) Investigative treatments for analysis and adjustments of spinal sub luxation, diagnosis and treatment by manipulation of the skeletal structure or for muscle stimulation by any means ... xvi) Any treatment or part of a treatment that is not of a Reasonable and Customary charge, not Medically Necessary; treatments or drugs not supported by a prescription. ... xix) Prosthetic and other devices which are self-detachable /removable without surgery involving anaesthesia ... xxv) Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed. ... xxviii) Any specific time bound exclusion(s) not exceeding 36 months applied by Us and specified in the Schedule and accepted by the insured. ... If the Insured Person is Hospitalised in Shared Accommodation in a Network Hospital, the exclusion related to non-medical expenses shall be waived.","sources":[{"clause":"2","heading":"Standard Exclusions","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-2"},{"clause":"2(I)(d)(ii)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-i-d-ii"},{"clause":"Excl14","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-excl14"},{"clause":"Excl14(ii)","heading":"Hazardous or Adventure sports","page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-excl14-ii"},{"clause":"3","heading":"Specific Exclusions","page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-3"},{"clause":"4.01(I)(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-4-01-i-i"},{"clause":"1(f)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-1-f"},{"clause":"7","heading":"Shared Accommodation Benefit","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-7"}],"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 can cancel with 7 days' written notice and get a pro-rata refund of premium for the unexpired policy period, but 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 or benefit availed","note":"For instalment policies, after an admissible claim future instalments for the policy year are adjusted in the claim and no premium is refunded during that policy year.","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. ... v) 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. ... ii) Note : For Policies where premium is paid by instalment : In case of admissible claim under the Policy, future instalment for the current Policy Year will be adjusted in the claim amount and no refund of any premium will be applicable during the Policy Year.","sources":[{"clause":"17","heading":"Cancellation","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-17"}],"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":"India only.","display":"India only","note":null,"quote":"This Policy only covers medical treatment taken within India. All payments under this Policy will only be made in Indian Rupees within India.","sources":[{"clause":null,"heading":"2. Specific General Terms","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-specific-general-terms"}],"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 policies only, not renewals or porting/migration. Refund is premium less medical examination expenses and stamp duty, or less proportionate risk premium if cover has started; only if no claim made.","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. ... The Free Look Period shall be applicable on new individual health insurance policies and not on renewals or at the time of porting/migrating the policy. ... If the insured has not made any claim during the Free Look Period, the insured shall be entitled to ... i) a refund of the premium paid less any expenses incurred by the Company on medical examination of the insured person and the stamp duty charges or ... a deduction towards the proportionate risk premium for period of cover","sources":[{"clause":"14","heading":"Free Look Period","page":28,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-14"}],"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":"15 days where premium is paid monthly.","quote":"1 | Multi-Year / Yearly | 30 days ... 2 | Half yearly | 30 days ... 3 | Quarterly | 30 days ... 4 | Monthly | 15 days","sources":[{"clause":"2","heading":"Premium payment in Instalments","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-3"}],"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":"From 18 years to 65 years.","display":"18 to 65 years","note":"From the prospectus; the policy wording does not print entry ages.","quote":"a) This policy covers persons in the age group 18 years to 65 years. The maximum entry age is restricted upto 65 years.","sources":[{"clause":null,"heading":"Energy - Prospectus","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-energy-prospectus"}],"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 or monthly","note":"The prospectus premium payment options table lists only Half Yearly (51.50% of annual premium) and Quarterly (26.25%) as instalment options. The grace table also mentions Multi-Year.","quote":"1 | Multi-Year / Yearly | 30 days ... 2 | Half yearly | 30 days ... 3 | Quarterly | 30 days ... 4 | Monthly | 15 days ... 1 | Half Yearly | 51.50% ... 2 | Quarterly | 26.25%","sources":[{"clause":"2","heading":"Premium payment in Instalments","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-3"},{"clause":null,"heading":"Premium payment Options","page":37,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-premium-payment-options"}],"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":["20% Co-payment (if opted and mentioned on the Policy Schedule)"],"display":"20% co-payment option","note":"The prospectus prints separate premium tables for No Co-payment and 20% Co-payment. No co-payment applies if an Insured Person from Tier 2 is treated in Tier 1. No other optional covers or add-ons are listed.","quote":"If opted and mentioned on the Policy Schedule that a Co-payment is effective, and a claim has been admitted under Section 1 then, the insured person shall bear 20% of the eligible claim amount payable under the Policy ... A. No Co-payment ... B. 20% Co-payment ... No co-payment shall apply if Insured Person from Tier 2 avails a treatment in Tier 1.","sources":[{"clause":null,"heading":"15. Co-Payment","page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-15-co-payment"},{"clause":null,"heading":"1. Silver Plan","page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-1-silver-plan"},{"clause":null,"heading":"Mumbai Suburban and Navi Mumbai, Surat, Ahmedabad & Vadodara)","page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136#c-mumbai-suburban-and-navi-mumbai-surat-ahmedabad"},{"clause":null,"heading":"16. Premium Tier","page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-16-premium-tier"}],"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":"Yes if the premium is paid in instalments; with non-instalment (single) premium payment there is no cover for the period for which no premium is received.","display":"Covered if paying by instalments; not covered otherwise","note":null,"quote":"ii. 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":"2","heading":"Premium payment in Instalments","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-2-3"}],"law":[]},{"key":"disease","label":"Disease covered","section":"Cover","meaning":"The condition this policy is for.","status":"cross-checked","value":"Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), Type 1 diabetes and/or Hypertension.","display":"Diabetes (Type 1, Type 2, IFG, IGT) and/or Hypertension","note":"The policy covers hospitalisation for any covered illness or accident, not only these conditions; these conditions are not part of the pre-existing disease waiting period.","quote":"This Policy offers cover to individuals with Type 2 Diabetes Mellitus, Impaired Fasting Glucose (IFG), Impaired Glucose Tolerance (IGT), Type 1 diabetes and/or Hypertension.","sources":[{"clause":null,"heading":"Preamble","page":2,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-preamble"}],"law":[]},{"key":"payout","label":"Payout","section":"Cover","meaning":"Lump sum, staged, or hospital bills.","status":"cross-checked","value":"Hospital bills: medical expenses for in-patient treatment, pre and post hospitalisation, day care, organ donor and ambulance, up to the sum insured.","display":"Hospital bills (medical expenses) up to the sum insured","note":"Also reimburses HbA1C check-ups up to INR 750 per claim (two claims a year), and a Restore benefit adds 100% of the basic sum insured once a year. Ambulance up to Rs. 2000 per hospitalisation.","quote":"We will cover the Medical Expenses for: ... 1. In-Patient Treatment ... 2. Pre-Hospitalization Medical expenses ... 3. Post-Hospitalization Medical expenses ... 4. Day Care Procedures ... 5. Organ Donor ... 6. Ambulance Cover ... The insured person will be covered upto the Sum Insured limit under this policy. ... we will reimburse an amount of up to INR 750 on an each claim towards the expenses of HbA1C checkup ... A maximum of two claims can be made in a Policy year. ... Instant addition of 100% Basic Sum Insured ... The Sum Insured will be restored only once in a Policy Year. ... subject to Rs. 2000 per Hospitalisation.","sources":[{"clause":"Section B(I)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-section-b-i"},{"clause":null,"heading":"Preamble","page":2,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-preamble"},{"clause":null,"heading":"II. Other Benefits","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-ii-other-benefits"},{"clause":"7(b)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-7-b"},{"clause":"7(c)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135#c-7-c"}],"law":[]},{"key":"survival_period","label":"Survival period","section":"Waiting periods","meaning":"Days you must survive after diagnosis before payment.","status":"not-applicable","value":null,"display":null,"note":"The policy pays hospital bills (indemnity), not a lump sum on diagnosis, so there is no survival period.","quote":null,"sources":[],"law":[]}],"documents":[{"kind":"wording","label":"Energy (for policies with Period of Insurance starting 22-Aug-2025 onwards)","pages":42,"fetched_at":"2026-10-16 07:11:37.660718+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/energy-combined-pw-cis-919573709506.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/135"},{"kind":"prospectus","label":"Energy","pages":40,"fetched_at":"2026-10-16 07:11:37.660718+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/Energy_Prospectus-612487347347.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526/document/136"}],"versions":[{"uin":"APOHLIP18126V031718","version":null,"approved_on":null},{"uin":"HDFHLIP26048V052526","version":null,"approved_on":null}],"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":"Energy (UIN HDFHLIP26048V052526), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/energy-hdfhlip26048v052526"}