{"uin":"HDFHLIP26054V102526","name":"Easy Health","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526","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":"Revision","kind":"product","status":"active","approved_on":"2022-05-20","withdrawn_on":null,"summary":"Easy Health is an HDFC ERGO indemnity health policy sold in Standard and Exclusive plans, on an individual or family floater basis, with sum insured from Rs. 1 lakh to Rs. 50 lakh and cover in India only. It has a 30-day initial wait, 24 months for listed illnesses, 36 months for pre-existing diseases, and a 10% yearly cumulative bonus up to 100% irrespective of claims.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:54.354343+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":["Standard","Exclusive"],"display":"Standard and Exclusive","note":"Each variant is sold as Easy Health Individual (individual sum insured) or Easy Health Family (family floater). The prospectus marks daily cash for accompanying a child, newborn baby, recovery benefit and maternity as Exclusive variant only.","quote":"Plan | Standard | Exclusive ... Easy Health Individual | Upto 1% of Base Sum Insured ... Easy Health Family | Upto 1% of Base Sum Insured ... Note: *# Benefits are covered under “Exclusive” Variant only","sources":[{"clause":"5.3(a)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-5-3-a"},{"clause":"Section I","heading":"Inpatient Benefits","page":2,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-section-i"}],"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 runs for 1 year or 2 years; sum insured and benefits apply per Policy Year.","display":"1 year or 2 years","note":"The prospectus suitability section says 'The policy will be issued for a period for 2 year(s) period, the sum insured & benefits will applicable on Policy Year basis', while its examples also show 1 year policies; its cumulative bonus clause mentions a '2/3 year Policy Period'.","quote":"1 Year Policy Time Interval (calculated from policy risk start date) ... 2 Year Policy Time Interval ((calculated from policy risk start date) ... In policies with a 2year Policy Period, the application of above guidelines of Cumulative Bonus shall be post completion of each policy year. ... d) The policy will be issued for a period for 2 year(s) period, the sum insured & benefits will applicable on Policy Year basis.","sources":[{"clause":"5.1","heading":"Cumulative Bonus","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-5-1"},{"clause":null,"heading":"1 Year Policy Time Interval (calculated from policy risk start date)","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-year-policy-time-interval-calculated-from-poli"},{"clause":null,"heading":"2 Year Policy Time Interval ((calculated from policy risk start date)","page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-year-policy-time-interval-calculated-from-poli"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-s1"}],"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":"Planned hospitalisation: at least 48 hours before admission. Emergency hospitalisation: within 24 hours of the start of hospitalisation. Benefits that depend on an accepted in-patient claim: within 7 days of discharge.","display":"48 hours before planned admission; within 24 hours of emergency admission","note":"For reimbursement the prospectus says the insurer 'must be informed no later than 7 days of completion of such treatment, consultation or procedure'. Documents are due within 15 days of the earlier of the insurer's request or discharge.","quote":"If any treatment for which a claim may be made is to be taken and that treatment requires Hospitalisation: | Immediately and in any event at least 48 hours prior to the Insured Person’s admission. ... If any treatment for which a claim may be made is to be taken and that treatment requires Hospitalisation in an Emergency: | Within 24 hours of the start of the Insured Person’s Hospitalisation. ... For all benefits which are contingent on Our prior acceptance of a claim under Section B-1)a): | Within 7 days of the Insured Person’s discharge post-hospitalisation. ... within 15 days of the earlier of Our request or the Insured Person’s discharge from Hospitalisation or completion of treatment ... HDFC ERGO General Insurance Limited must be informed no later than 7 days of completion of such treatment, consultation or procedure using the Claim Intimation Form.","sources":[{"clause":"2(f)","heading":"Tier 6","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-f"},{"clause":"Excl11(b)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-excl11-b"}],"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, receipts and prescriptions","All medical reports, case histories, investigation reports, treatment papers, discharge summaries","A precise diagnosis of the treatment","A detailed list of the medical services and treatments with a unit price for each","Prescriptions naming the Insured Person, with drug prices and payment receipts","Pre and post investigation, treatment and follow up records for the present ailment","Investigation, treatment and follow up records for past ailments since first diagnosis","Treating doctor's certificate on missing information","Copy of settlement letter from other insurance company or TPA","Stickers and invoice of implants used during surgery","Copy of MLC and FIR for accident claims","NEFT and KYC details","Legal heir certificate"],"display":"Claim form, original bills, medical reports and discharge summary, prescriptions, implant invoices, MLC/FIR for accidents, NEFT and KYC, and others","note":"To be provided within 15 days of the earlier of the insurer's request or discharge; the list is 'not limited to' these documents.","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, diagnostic bill and any attachments thereto like receipts or prescriptions ... 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. ... 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) since their first diagnoses or detection ... ix) Treating doctors 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 earlier of Our request or the Insured Person’s discharge from Hospitalisation or completion of treatment ... Such documentation will include but is not limited to the following:","sources":[{"clause":"2(f)","heading":"Tier 6","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-f"}],"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":"Reimbursement claims are settled or rejected within 15 days from receipt of claim intimation; delay earns interest at 2% above the bank rate. Cashless pre-authorisation is decided within 1 hour of the request and the final bill within 3 hours of the discharge request.","display":"15 days from intimation (reimbursement); cashless approval within 1 hour, final bill within 3 hours","note":"The cashless turnaround times are from the prospectus and CIS.","quote":"i) The Company shall (other than cashless), settle or reject a claim,as the case may be, within 15 days from the date of receipt of intimation of claims.. ... ii) 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. ... TAT for preauthorization of cashless facility: Decision on cashless authorization to be provided within 1 hour from the time of receipt of request. ... TAT for cashless final bill authorization: Within 3 hours of the receipt of discharge authorization request from the hospital.","sources":[{"clause":"1(b)(i)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-b-i"},{"clause":"1(b)(ii)","heading":null,"page":28,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-b-ii"},{"clause":"Excl11(c)","heading":null,"page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-excl11-c"}],"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":["Any illness in the first 30 days, except accidents (Excl03)","Listed diseases and procedures until 24 months of continuous coverage (Excl02)","Pre-existing diseases until 36 months of continuous coverage (Excl01)","Investigation & Evaluation (Excl04)","Rest Cure, rehabilitation and respite care (Excl05)","Obesity/ Weight Control surgery not meeting the set conditions (Excl06)","Cosmetic or plastic Surgery (Excl08)","Hazardous or Adventure sports as a professional (Excl09)","Breach of law (Excl10)","Alcoholism, drug or substance abuse (Excl12)","Sterility and Infertility (Excl17)","Maternity, except under the maternity benefit (Excl18)","Treatment availed outside India","War, nuclear, chemical and biological weapons; intentional self injury or attempted suicide","Dental treatment unless requiring Hospitalisation"],"display":"Waiting periods (30 days, 24 months listed illnesses, 36 months pre-existing), cosmetic surgery, obesity surgery, hazardous sports, alcoholism, infertility, maternity outside the benefit, treatment outside India, war, self injury, dental, and others","note":"See permanent_exclusions for the full list, including non-medical items in List I of Annexure I.","quote":"i) 30-day waiting period: Code – Excl03 ... 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 ... ii. Specified disease/procedure waiting period: Code – Excl02 ... Expenses related to the treatment of the listed Conditions, surgeries/treatments shall be excluded until the expiry of 24 months of continuous coverage ... iii. Pre-Existing Diseases: Code – Excl01 ... 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 ... Excl04 Investigation & Evaluation: Code – Excl04 ... Excl05 Rest Cure, rehabilitation and respite care: Code – Excl05 ... 4) Obesity/ Weight Control: Code – Excl06 Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Excl08 Cosmetic or plastic Surgery: Code- Excl08 ... 2) Hazardous or Adventure sports: Code – Excl09 Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... 1) Breach of law: Code – Excl10 ... 3) Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... Excl17 Sterility and Infertility: Code – Excl17 ... 13) Maternity (except to the extent provided for under Section B.3)a):Code – Excl18 ... 5) Treatment availed outside India. ... 1) Treatment arising from or consequent upon war or any act of war, invasion, act of foreign enemy, (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind. 2) Intentional self injury or attempted suicide while sane or insane. ... 16) Dental treatment and surgery of any kind, unless requiring Hospitalisation","sources":[{"clause":"1(i)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-i"},{"clause":"1(a)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-a"},{"clause":"1(c)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-c"},{"clause":"1(a)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-a-2"},{"clause":"1(f)","heading":"List of specific diseases/procedures","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-f"},{"clause":"1(a)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-a-3"},{"clause":"2","heading":"Standard General exclusions","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-3"},{"clause":"Excl08","heading":"Cosmetic or plastic Surgery: Code- Excl08","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl08"},{"clause":"Excl04","heading":"Investigation & Evaluation: Code – Excl04","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl04"},{"clause":"Excl05","heading":"Rest Cure, rehabilitation and respite care: Code – Excl05","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl05"},{"clause":"Excl05(a)(ii)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl05-a-ii"},{"clause":"Excl17","heading":"Sterility and Infertility: Code – Excl17","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl17"},{"clause":"3","heading":"Specific Exclusions","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-3-2"}],"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 022 6158 2020 / 022 6234 6234 or www.hdfcergo.com. Level 1: the Complaints & Grievance Cell (grievance@hdfcergo.com, 18002677444). Level 2: if not satisfied or no response within 15 days, the Chief Grievance Officer (cgo@hdfcergo.com). Then the Insurance Ombudsman.","display":"Call 022 6158 2020 / 022 6234 6234; then the Complaints & Grievance Cell (grievance@hdfcergo.com); then the Chief Grievance Officer (cgo@hdfcergo.com)","note":"Postal address for both levels: D-301, 3rd Floor, Eastern Business District (Magnet Mall), LBS Marg, Bhandup (West), Mumbai 400078. Senior citizen helpline 022 6158 2026 (seniorcitizen@hdfcergo.com); women 022 6158 2055. Complaints can also go to the CIO website or IRDAI Bima Bharosa.","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) HDFC ERGO General Insurance Company Limited ... You can also write an email to grievance@hdfcergo.com 3. Call on 18002677444 (operational Monday - Saturday 9AM to 6PM) ... 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 ... the Insured Person may also approach the office of Insurance Ombudsman of the respective area/region","sources":[{"clause":"1(q)","heading":null,"page":34,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-q"}],"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":"Easy Health Individual: Standard Rs. 1, 1.5, 2, 2.5, 3, 4, 5, 7.5, 10 or 15 lakh; Exclusive Rs. 3, 4, 5, 7.5, 10, 15, 20, 25 or 50 lakh per insured person. Easy Health Family: Standard Rs. 2, 3, 4, 5, 7.5, 10 or 15 lakh; Exclusive Rs. 3 to 50 lakh per policy.","display":"Rs. 1 lakh to Rs. 50 lakh (Standard up to 15 lakh; Exclusive 3 to 50 lakh)","note":"Some benefit limits differ by Exclusive sum insured band (3 to 5 lakh, 7.5 to 10 lakh, 15 to 50 lakh). The optional Critical Illness sum insured is covered under optional_covers.","quote":"Sum Insured per Insured Person per Policy Year (Rs. in Lakh) | 1.00, 1.50, 2.00, 2.50, 3.00, 4.00, 5.00,7.5,10,15 | 3.00, 4.00, 5.00 | 7.50,10.00 | 15.00,20.00, 25.00, 50.00 ... Sum Insured per Policy per Policy Year (Rs. in Lakh) | 2.00, 3.00, 4.00, 5.00,7.50,10.00,15.00 | 3.00, 4.00, 5.00 | 7.50,10.00 | 15.00,20.00, 25.00, 50.00 ... Basic Sum Insured: The sum insured would Range from Rs. 1 Lac to Rs. 50 Lacs","sources":[{"clause":null,"heading":"Schedule of Benefits – Easy Health Individual","page":45,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-individual"},{"clause":null,"heading":"Schedule of Benefits – Easy Health Family","page":47,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-family"},{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-s1"}],"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":"Accidents are covered from day one. Does not apply once the insured has more than twelve months of continuous coverage. Applies afresh to any increase in sum insured.","quote":"i) 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, provided the same are covered. ... b) This exclusion shall not, however, apply if the insured person has continuous coverage for more than twelve months. ... c) The within referred waiting period is made applicable to the enhanced sum insured in the event of granting higher sum insured subsequently.","sources":[{"clause":"1(i)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-i"},{"clause":"1(a)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-a"},{"clause":"1(b)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-b"},{"clause":"1(c)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-c"}],"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":"Applies afresh to any increase in sum insured; reduced by prior continuous cover under portability or migration. Cover after 36 months requires the disease to have been declared and accepted.","quote":"iii. 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 36 months of continuous coverage after the date of inception of the first policy with insurer. ... b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase. ... then waiting period for the same would be reduced to the extent of prior coverage ... d) Coverage under the policy after the expiry of 36 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by insurer.","sources":[{"clause":"1(f)","heading":"List of specific diseases/procedures","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-f"},{"clause":"1(a)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-a-3"},{"clause":"1(b)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-b-3"},{"clause":"1(c)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-c-3"},{"clause":"1(d)","heading":null,"page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-d-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":"Not applied to accidents or where the underlying cause is cancer. If the condition is also pre-existing, the longer waiting period applies. Applies afresh to any increase in sum insured.","quote":"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 after the date of inception of the first policy with us. This exclusion shall not be applicable for claims arising due to an accident or underlying cause is cancer(s). ... b) In case of enhancement of sum insured the exclusion shall apply afresh to the extent of sum insured increase. ... c) 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(c)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-c"},{"clause":"1(a)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-a-2"},{"clause":"1(b)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-b-2"},{"clause":"1(c)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-c-2"}],"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":"conflicting","value":["Sinusitis","Rhinitis","Tonsillitis","Adenoidectomy","Mastoidectomy","Tonsillectomy","Tympanoplasty","Surgery for nasal septum deviation","Nasal concha resection","Nasal polypectomy","Surgery for Turbinate hypertrophy","Cysts, polyps including breast lumps","Polycystic ovarian disease","Fibroids (fibromyoma)","Hysterectomy","Non infective arthritis","Gout and Rheumatism","Osteoarthritis and Osteoporosis","Surgery for prolapsed inter vertebral disk","Joint replacement surgeries","Calculus diseases of gall bladder including Cholecystitis","Pancreatitis","Fissure/fistula in anus, hemorrhoids, pilonidal sinus","Ulcer and erosion of stomach and duodenum","Gastro Esophageal Reflux Disorder (GERD)","All forms of cirrhosis","Perineal Abscesses","Perianal Abscesses","Cholecystectomy","Surgery of hernia","Calculus diseases of Urogenital system","Benign Hyperplasia of prostate","Surgery on prostate","Surgery for Hydrocele/ Rectocele","Cataract","Surgery of varicose veins and varicose ulcers","Internal tumours, cysts, nodules, polyps, skin tumours"],"display":"ENT (sinusitis, tonsillectomy...), gynaecological (cysts, fibroids, hysterectomy), orthopaedic (arthritis, joint replacement, disc surgery), gastrointestinal (gall stones, hernia, piles, GERD), urogenital (kidney stones, prostate, hydrocele), cataract, varicose veins, internal tumours and cysts","note":"List from the policy wording. The prospectus list differs: it adds Adenomyosis, Endometriosis, Prolapsed Uterus, Ligament, Tendon and Meniscal tear, Cholelithiasis, Rectal Prolapse, Varicocele, Retinal detachment and Glaucoma, lists 'Prolapsed inter vertebral disk' as an illness, and reads 'Benign tumors of Non infectious etiology' for the general row. The CIS says the policy document prevails in a conflict. Cirrhosis due to alcohol is excluded altogether.","quote":"a. | Ear, Nose, Throat (ENT) | • Sinusitis • Rhinitis • Tonsillitis | • Adenoidectomy • Mastoidectomy • Tonsillectomy • Tympanoplasty • Surgery for nasal septum deviation • Nasal concha resection • Nasal polypectomy • Surgery for Turbinate hypertrophy ... b. | Gynaecological | • Cysts, polyps including breast lumps • Polycystic ovarian disease | Hysterectomy ... • Fibroids (fibromyoma) ... c. | Orthopaedic | • Non infective arthritis • Gout and Rheumatism • Osteoarthritis and Osteoporosis | • Surgery for prolapsed inter vertebral disk • Joint replacement surgeries ... d. | Gastrointestinal | • Calculus diseases of gall bladder including Cholecystitis • Pancreatitis • Fissure/fistula in anus, hemorrhoids, pilonidal sinus • Ulcer and erosion of stomach and duodenum • Gastro Esophageal Reflux Disorder (GERD) • All forms of cirrhosis ... • Perineal Abscesses • Perianal Abscesses | • Cholecystectomy • Surgery of hernia ... e. | Urogenital | • Calculus diseases of Urogenital system Example: Kidney stone, Urinary bladder stone. • Benign Hyperplasia of prostate | • Surgery on prostate • Surgery for Hydrocele/ Rectocele ... f. | Eye | • Cataract ... • Surgery of varicose veins and varicose ulcers ... • Internal tumours, cysts, nodules, polyps, skin tumours ... • Polycystic ovarian disease • Fibromyoma • Adenomyosis • Endometriosis • Prolapsed Uterus ... • Cataract • Retinal detachment • Glaucoma","sources":[{"clause":"1(f)","heading":"List of specific diseases/procedures","page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-f"},{"clause":"5.3(f)","heading":"List of specific diseases/procedures","page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-5-3-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":"Counts separately for any increase in sum insured, from the date of enhancement.","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(j)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-j"}],"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 the accrued continuity benefits in waiting periods.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit carried over","note":"Migration to other HDFC ERGO products is also allowed by applying at least 30 days before renewal.","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 as per IRDAI guidelines related to Portability. ... the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability. ... l) Migration The Insured Person will have the option to migrate the Policy to other health insurance products/plans offered by the Company by applying for Migration of the policyatleast30 days before the policy renewal date","sources":[{"clause":"1(k)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-k"},{"clause":"1(l)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-l"}],"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 on renewal","note":"From the prospectus. The policy wording says renewal may be refused only for established fraud, non-disclosure or misrepresentation, or if the product is withdrawn.","quote":"c) There is no maximum cover ceasing age on renewals of the subject policy. ... There shall be no cover ceasing age on renewal. ... e) Renewal of 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":null,"page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-s1"},{"clause":"Excl11(d)(ii)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-excl11-d-ii"},{"clause":"1(e)","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-e-2"}],"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 loading is applied on renewal based on individual claims experience. Claims do reduce the favourable claims experience discount (for example 15% with no claims, 9% after a claim in one of the last two years, 0% after claims in both).","display":"No claim-based loading; the claims experience discount is reduced after claims","note":"Renewal cannot be denied because claims were made in earlier years.","quote":"c) No loading shall apply on renewals based on individual claims experience ... In case of claim in both last policy year & year prior to last policy year | 0% | 0% ... In case of claim in EITHER last policy year OR year prior to last policy year | 9% | 9% ... In case of NO claim in last policy year & NO claim in year prior to last policy year | 15% | 15% ... a) 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 ... m. Favourable Claims Experience Discount This policy is eligible for a discount on premium basis Hospitalization claims","sources":[{"clause":"1(c)","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-c-6"},{"clause":"2(c)(iii)","heading":null,"page":39,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-c-iii"},{"clause":"1(a)","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-a-6"}],"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 set conditions (Excl06)","Change-of-Gender treatments (Excl07)","Cosmetic or plastic Surgery (Excl08)","Hazardous or Adventure sports as a professional (Excl09)","Breach of law (Excl10)","Excluded Providers (Excl11)","Alcoholism, drug or substance abuse or any addictive condition (Excl12)","Treatments in heath 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, except to the extent provided under the maternity benefit (Excl18)","War, invasion, nuclear weapons/materials, chemical and biological weapons, radiation","Intentional self injury or attempted suicide","Participation in naval, military or air force operation","Prosthetic and other devices which are self-detachable/removable without surgery","Treatment availed outside India","Treatment at a healthcare facility that is not a Hospital or Day Care Centre","Circumcisions (unless necessitated by Illness or injury)","Non allopathic treatment except under the Ayush benefit","Conditions for which treatment could have been done on an outpatient basis","Preventive care, vaccination including inoculation and immunisations (except post-bite treatment)","Hearing aids, spectacles or contact lenses; alopecia, baldness, wigs, or toupees; elastic stockings, diabetic test strips","Sleep apnoea","Congenital external diseases, defects or anomalies","Expenses incurred by the insured on organ donation","Spinal subluxation adjustments and manipulation of the skeletal structure","Dental treatment and surgery of any kind, unless requiring Hospitalisation","Non medical expenses mentioned in List 1 of Annexure I","Treatment by a Medical Practitioner outside his discipline, or who is a member of the Insured Person's family","Treatment not of a reasonable charge and not Medically Necessary","Drugs or treatments not supported by a prescription","Specific time bound or lifetime exclusion(s) specified in the Schedule","Admission for Intra-articular or Intra-lesional injections, Zolendronic acid or IV immunoglobulin infusion"],"display":"Standard exclusions Excl04 to Excl18 and the product's own specific exclusions (war, self injury, treatment outside India, sleep apnoea, congenital external anomalies, dental, non-medical items, and others)","note":"Excl18 maternity is lifted to the extent of the maternity benefit in the Exclusive variant. Excluded providers: expenses up to stabilisation are paid in life threatening situations or after an accident.","quote":"Excl04 Investigation & Evaluation: Code – Excl04 ... Excl05 Rest Cure, rehabilitation and respite care: Code – Excl05 ... 4) Obesity/ Weight Control: Code – Excl06 Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Excl07 Change-of-Gender treatments: Code – Excl07 ... Excl08 Cosmetic or plastic Surgery: Code- Excl08 ... 2) Hazardous or Adventure sports: Code – Excl09 Expenses related to any treatment necessitated due to participation as a professional in hazardous or adventure sports ... 1) Breach of law: Code – Excl10 ... Excl11 Excluded Providers: Code – Excl11 ... 3) Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof. Code – Excl12 ... 11) Treatments received in heath hydros, nature cure clinics, spas or similar establishments ... Code – Excl13 ... 12) Dietary supplements and substances that can be purchased without prescription ... Code – Excl14 ... 5) Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres: Code – Excl15 ... 8) Unproven Treatments: ... Excl16 ... Excl17 Sterility and Infertility: Code – Excl17 ... 13) Maternity (except to the extent provided for under Section B.3)a):Code – Excl18 ... 1) Treatment arising from or consequent upon war or any act of war, invasion, act of foreign enemy, (whether war be declared or not or caused during service in the armed forces of any country), civil war, public defence, rebellion, revolution, insurrection, military or usurped acts, nuclear weapons/materials, chemical and biological weapons, radiation of any kind. 2) Intentional self injury or attempted suicide while sane or insane. 3) Any Insured Person’s participation or involvement in naval, military or air force operation. ... 4) Prosthetic and other devices which are self-detachable/removable without surgery involving anaesthesia 5) Treatment availed outside India. 6) Treatment at a healthcare facility that is not a Hospital or Day Care Centre 7) Circumcisions (unless necessitated by Illness or injury and forming part of treatment) 8) Any Non allopathic treatment except to the extent of coverage provided for under ’Ayush benefit’. 9) Conditions for which treatment could have been done on an outpatient basis without any Hospitalization. 10) Preventive care, vaccination including inoculation and immunisations (except in case of post-bite treatment) 11) Provision or fitting of hearing aids, spectacles or contact lenses including optometric therapy, any treatment and associated ... expenses for alopecia, baldness, wigs, or toupees, medical supplies including elastic stockings, diabetic test strips ... 12) Sleep apnoea. ... 13) Congenital external diseases, defects or anomalies ... 14) Expenses incurred by the insured on organ donation ... 15) Treatment and supplies for analysis and adjustments of spinal subluxation, diagnosis and treatment by manipulation of the skeletal structure ... 16) Dental treatment and surgery of any kind, unless requiring Hospitalisation ... 17) Any non medical expenses mentioned in List 1 of Annexure I ... 18) Treatment rendered by a Medical Practitioner which is outside his discipline or the discipline for which he is licensed. ... 19) Treatments rendered by a Medical Practitioner who is a member of the Insured Person’s family or stays with him ... 20) Any treatment or part of a treatment that is not of a reasonable charge and not Medically Necessary. ... 21) Drugs or treatments which are not supported by a prescription. ... 22) Any specific time bound or lifetime exclusion(s) applied by Us and specified in the Schedule and accepted by the insured. ... 23) Admission for administration of Intra-articular or Intra-lesional injections, Supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc.) or IV immunoglobulin infusion ... However, in case of life threatening situations or following an accident, expenses up to the stage of stabilization are payable but not the complete claim.","sources":[{"clause":"2","heading":"Standard General exclusions","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-3"},{"clause":"Excl08","heading":"Cosmetic or plastic Surgery: Code- Excl08","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl08"},{"clause":"Excl07","heading":"Change-of-Gender treatments: Code – Excl07","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl07"},{"clause":"Excl16","heading":null,"page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl16"},{"clause":"Excl04","heading":"Investigation & Evaluation: Code – Excl04","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl04"},{"clause":"Excl05","heading":"Rest Cure, rehabilitation and respite care: Code – Excl05","page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl05"},{"clause":"Excl05(a)(ii)","heading":null,"page":26,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl05-a-ii"},{"clause":"Excl17","heading":"Sterility and Infertility: Code – Excl17","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl17"},{"clause":"Excl11","heading":"Excluded Providers: Code – Excl11","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-excl11"},{"clause":"3","heading":"Specific Exclusions","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-3-2"}],"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 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","note":"For instalment policies with an admissible claim, future instalments of the year are adjusted in the claim and no refund applies that year.","quote":"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. ... 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. ... 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":"1(f)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-f-2"}],"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. The policy covers only medical treatment taken within India and pays in Indian Rupees.","display":"India only","note":"Emergency air ambulance applies only when the insured is in India and treatment is required in India.","quote":"This Policy only covers medical treatment taken within India. All payments under this Policy will only be made in Indian Rupees within India. ... The insured person is in India and the treatment is required in India only and not overseas in any condition whatsoever","sources":[{"clause":"2(a)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-a"},{"clause":"2","heading":"Additional Benefits","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-2"}],"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 ported policies. Refund is the premium less medical examination and stamp duty costs, or less proportionate risk premium if cover has started. The CIS first says 'within 30 days from the beginning of the policy' and then repeats thirty days from receipt of the policy document.","quote":"The Insured Person shall be allowed free look period of thirty 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. ... 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 ii) where the risk has already commenced and the option of return of the Policy is exercised by the Insured Person, a deduction towards the proportionate risk premium for period of cover ... You may cancel the insurance policy if you do not want it, within 30 days from the beginning of the policy.","sources":[{"clause":"1(g)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-g"},{"clause":"Excl18(d)(iv)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/139#c-excl18-d-iv"}],"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":"30 days for yearly, half yearly and quarterly payment; 15 days for monthly.","quote":"Option 1 | Multi-Year / Yearly | 30 days ... Option 4 | Monthly | 15 Days","sources":[{"clause":"1(p)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-p"}],"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 91 days with no maximum entry age; adult dependents from 18 years. Children from 91 days to 5 years only with a parent insured.","display":"91 days and above; no maximum entry age","note":"From the prospectus. The policy wording says dependent parents, parents-in-law and grandparents must have been below 65 years at first joining (the prospectus dependents list leaves this out), children and grandchildren are covered from 91 days to 25 years, and babies aged 1 to 90 days only with the Newborn Baby Benefit.","quote":"a) This policy covers persons in the age group of 91 days and above. The Minimum entry age for Adult Dependent is 18 years. There is no limit on maximum entry age. ... b) Child between 91 days and 5 years can be insured provided either parent is getting insured under this Policy. ... Your children / Grandchildren Aged between 91 days and 25 years ... Children Aged between 1 to 90 Days can be covered if Newborn Baby Benefit is added by payment of additional premium ... iii) Your natural parents or parents that have legally adopted You, provided that the parent was below 65 years at his initial participation in the Easy Health Policy","sources":[{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-s1"},{"clause":"Def. 8","heading":"Dependents","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-def-8-2"}],"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":["Multi-Year / Yearly","Half Yearly","Quarterly","Monthly"],"display":"Yearly (or two years in advance), half yearly, quarterly, monthly","note":"A 6% discount applies when two years' premium is paid in advance as a single premium. Instalments can be paid by auto debit/ECS.","quote":"Option 1 | Multi-Year / Yearly | 30 days ... Option 2 | Half Yearly | 30 days ... Option 3 | Quarterly | 30 days ... Option 4 | Monthly | 15 Days ... An additional discount of 6% will be provided if insured person is paying two year premium, in advance as a single premium. ... If Option of Premium payment by instalment is opted through auto Debit/ECS facility","sources":[{"clause":"1(p)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-p"},{"clause":"2(f)","heading":"Tier 6","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-f"},{"clause":null,"heading":"Instalment premium payment through Auto Debit/ECS Facility","page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-instalment-premium-payment-through-auto-debit-ec"}],"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":["Critical Illness (Optional benefit)","Newborn baby (Exclusive, additional premium)","Individual Personal Accident Rider","Hospital Daily Cash","Protector Rider","Critical Advantage Rider","ABCD Chronic Care","Parenthood","Optima Wellbeing"],"display":"Critical Illness lump sum; Newborn baby cover; add-ons: Personal Accident, Hospital Daily Cash, Protector, Critical Advantage, ABCD Chronic Care, Parenthood, Optima Wellbeing","note":"Critical Illness pays 50% or 100% of the in-patient sum insured as a lump sum if the insured survives 30 days after first diagnosis (Standard: minimum Rs 100,000, maximum Rs. 10 Lacs; highest Exclusive band: maximum Rs 10 Lacs). The add-ons are listed in the prospectus.","quote":"4 Critical Illness (Optional benefit) ... This benefit is optional and effective only if mentioned in the Schedule. ... 2 b) Newborn baby | Not Covered | Additional Benefit on payment of additional premium ... Add on – Covers: ‘Easy health’ offers following Add on Covers: ... • lndividual Personal Accident Rider ... • Hospital Daily Cash ... • Protector Rider ... • Critical Advantage Rider ... • ABCD Chronic Care ... • Parenthood ... • Optima Wellbeing (Add on) ... ii. The Insured Person survives for at least 30 days following such diagnosis. ... Optional, if opted then the Critical Illness Sum Insured 50% or 100% of In-patient Sum Insured subject to minimum of Rs 100,000 upto a maximum of Rs. 10 Lacs","sources":[{"clause":"4","heading":"Critical Illness (Optional benefit)","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-4"},{"clause":null,"heading":"Schedule of Benefits – Easy Health Individual","page":45,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-individual"},{"clause":null,"heading":"Easy Health Family","page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-easy-health-family"}],"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 premium is paid in instalments: cover continues during the grace period. With non-instalment payment there is no cover for the period for which no premium is received.","display":"Covered for instalment payers; not for single annual payment","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":"1(p)","heading":null,"page":33,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-p"}],"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":"not-stated","value":null,"display":null,"note":"Hospital room rent or boarding is listed as a covered in-patient expense, but no daily room limit or room category is printed, and the CIS sub-limit list does not mention room rent. A daily cash of Rs.500 to Rs.1000 per day (maximum Rs.3,000 to Rs.6,000) is paid for choosing shared accommodation in a Network Hospital if hospitalisation exceeds 48 hours.","quote":null,"sources":[],"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":"not-stated","value":null,"display":null,"note":"No room category limit is printed. Daily cash for choosing shared accommodation: Rs.500 per day (max Rs.3,000) to Rs.1000 per day (max Rs.6,000) by plan and sum insured, if hospitalisation exceeds 48 hours.","quote":null,"sources":[],"law":[]},{"key":"icu_limit","label":"ICU limit","section":"Limits and co-pay","meaning":"The most the policy pays per day for intensive care.","status":"not-stated","value":null,"display":null,"note":"Intensive Care Unit is listed as a covered in-patient expense; no ICU limit is printed. The shared accommodation daily cash is not paid for time in an intensive care unit.","quote":null,"sources":[],"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":"not-stated","value":null,"display":null,"note":"The documents say nothing about proportionate deduction of associated charges.","quote":null,"sources":[],"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":"No co-payment applies when an insured person from a lower tier city takes treatment in a higher tier city.","display":"No zone co-payment for treatment in a higher tier city","note":"The documents print no other co-payment.","quote":"No co-payment shall apply if Insured Person from a lower tier avails a treatment in higher tier. For example: Insured Person buying policy from Tier 4 can avail treatment in Tier 1 without any co-payment","sources":[{"clause":"2(f)","heading":"Tier 6","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-f"}],"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":"not-stated","value":null,"display":null,"note":"Only the standard definition of Deductible is printed; no deductible amount for this product is stated.","quote":null,"sources":[],"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":["Maternity, normal delivery: Rs. 15,000 / Rs. 25,000 / Rs. 30,000 by Exclusive sum insured band","Maternity, caesarean delivery: Rs. 25,000 / Rs. 40,000 / Rs. 50,000 by Exclusive sum insured band","Emergency ambulance: Rs.2000 per hospitalisation","Emergency air ambulance: Rs.2.5 Lacs per hospitalisation"],"display":"Benefit limits only: maternity, road ambulance and air ambulance","note":"The CIS sub-limit list names only benefit limits (ambulance, daily cash, recovery benefit, air ambulance, maternity, health check-up, critical illness) and no caps on named illnesses such as cataract or joint replacement. Maternity is in the Exclusive variant only; air ambulance only in the higher Exclusive band(s).","quote":"1 g) Emergency Ambulance | Upto Rs.2000 per hospitalisation ... 2 d) Emergency Air Ambulance | Not covered | Not covered | Upto Rs.2.5 Lacs per hospitalisation ... 3 a) Maternity Expenses | Not Covered | Normal Delivery Rs. 15,000* Caesarean Delivery Rs. 25,000* ... Normal Delivery Rs. 25,000* Caesarean Delivery Rs. 40,000* ... Normal Delivery Rs. 30,000* Caesarean Delivery Rs. 50,000* ... The policy will pay only up to the limits specified here under for the following diseases/ procedures: Base Cover (limits basis plan/sum insured chosen): 1. Emergency Ambulance: Upto Rs. 2K per hospitalisation","sources":[{"clause":null,"heading":"Schedule of Benefits – Easy Health Individual","page":45,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-individual"},{"clause":"Excl18(d)(i)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/139#c-excl18-d-i"}],"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":"Only if the in-patient, day care or domiciliary claim is admitted.","quote":"b) Pre-Hospitalization Medical Expenses for consultations, investigations and medicines incurred upto 60 days before the date of admission to the Hospital (Inpatient or Day Care or Domiciliary treatment)","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"}],"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":90},"display":"90 days","note":"Only if the in-patient, day care or domiciliary claim is admitted.","quote":"c) Post-Hospitalization Medical Expenses for consultations, investigations and medicines incurred upto 90 days after discharge from Hospitalisation (Inpatient or Day Care or Domiciliary treatment).","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"}],"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 treatment or surgical procedures under general or local anaesthesia needing a stay of less than 24 hours in a Hospital or Day Care Centre. Treatment usually taken on an out-patient basis is not covered.","display":"Covered (procedures needing less than 24 hours under anaesthesia)","note":"Defined by type of treatment; no list of day care procedures is printed.","quote":"d) Day Care Procedures Medical treatment or surgical procedure which is undertaken under general or local anaesthesia, which require admission in a Hospital/Day Care Centre for stay less than 24 hours. ... 1. Treatment that can be and is usually taken on an Out-Patient basis is not covered","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"}],"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 the patient cannot be moved to a hospital or no hospital room is available, including pre and post expenses of 60 and 90 days. Treatment of less than 3 days is not covered.","display":"Covered if hospital not possible; treatment must exceed 3 days","note":null,"quote":"e) Domiciliary Treatment Medical treatment for an Illness/disease/injury which in the normal course would require care and treatment at a Hospital but is actually taken while confined at home under any of the following circumstances: 1. The condition of the Patient is such that he/she is not in a condition to be removed to a Hospital or, 2. The Patient takes treatment at home on account of non availability of room in a Hospital. Pre and Post Hospitalisation expenses for consultations, investigations and medicines incurred upto 60 days before hospitalisation and 90 days after hospitalization respectively will be covered in case of domiciliary treatment. ... 1. Treatment of less than 3 days (Coverage will be provided for expenses incurred in first three days only if treatment period is greater than 3 days)","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"}],"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 treatment under Ayurveda, Unani, Sidha, Homeopathy and Yoga & Naturopathy in an AYUSH Hospital is covered up to the Sum Insured.","display":"Covered up to the sum insured (in-patient, AYUSH Hospital)","note":"Not covered for evaluation or investigation only, or outside India.","quote":"h) Ayush Treatment Coverage upto Sum Insured only for Inpatient care expenses incurred on treatment taken under the below systems of medicine in an ... AYUSH Hospital a. Ayurveda, b. Unani, c. Sidha, d. Homeopathy, e. Yoga & Naturopathy ... 2. Hospitalisation for evaluation, Investigation only ... 3. Treatment availed outside India","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"}],"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":"No modern treatment cover or cap is printed. The specific exclusions list admission for intra-articular or intra-lesional injections, Zolendronic acid or IV immunoglobulin infusion.","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":"Covered: the organ donor's medical and surgical expenses for harvesting the organ when the insured person is the recipient. The donor's pre and post hospitalisation expenses are not covered.","display":"Covered (harvesting costs; not donor's pre/post expenses)","note":"Requires an admitted in-patient claim for the recipient and compliance with the Transplantation of Human Organs Act, 1994.","quote":"f) Organ Donor: Medical and surgical expenses of the organ donor for harvesting the organ where an Insured Person is the recipient. ... 3. The organ donor’s Pre and Post- Hospitalisation expenses.","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"cross-checked","value":"Road ambulance in an emergency up to Rs. 2000 per hospitalisation. Emergency air ambulance up to the lower of actual expenses or Rs. 2.5 Lacs per hospitalisation, where the plan includes it.","display":"Up to Rs. 2000 per hospitalisation; air ambulance up to Rs. 2.5 Lacs in some Exclusive bands","note":"Air ambulance is not covered in the Standard variant. The schedule row has three entries ('Not covered | Not covered | Upto Rs.2.5 Lacs') for four columns, so which Exclusive sum insured bands get it is unclear. Return transport by air is excluded; air ambulance only within India.","quote":"g) Ambulance: Expenses incurred on a transportation of Insured Person to a Hospital for treatment in case of an emergency, subject to Rs. 2000 per Hospitalisation. ... The amount payable in case of Air ambulance facility shall be either the actual expenses or Rs. 2.5 Lacs per hospitalization, hichever is lower ... 2 d) Emergency Air Ambulance | Not covered | Not covered | Upto Rs.2.5 Lacs per hospitalisation ... The insured person is in India and the treatment is required in India only ... 2. Expenses incurred in return transportation to the insured’s home by air ambulance is excluded.","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"},{"clause":"2","heading":"Additional Benefits","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-2"},{"clause":null,"heading":"Schedule of Benefits – Easy Health Individual","page":45,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-individual"}],"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":"not-stated","value":null,"display":null,"note":"No restoration or refill of the sum insured is described.","quote":null,"sources":[],"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":"cross-checked","value":"Cumulative Bonus of 10% of the Base Sum Insured at each renewal without a break, irrespective of claims, up to a maximum of 100% of the Basic Sum Insured.","display":"10% a year irrespective of claims, up to 100%","note":"In a family floater the bonus applies at policy level. Lost if there is a break in policy.","quote":"On Renewal of this Policy with the Company without a break, a sum equal to 10% of the Base Sum Insured of the expiring Policy shall be provided as multiplier benefit irrespective of any claims ... a) The maximum multiplier bonus will not exceed 100% of the Basic Sum Insured in any Policy Year. ... b) In Family Floater policy, the Cumulative Bonus shall be available on Family Floater basis at policy level ... subject to there being no Break in Policy","sources":[{"clause":"5.1","heading":"Cumulative Bonus","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-5-1"}],"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":"In-patient treatment includes medicines, drugs & consumables, but items in List I of Annexure I (for example gloves, masks, nebulizer kit, crepe bandage) are not paid.","display":"Medicines, drugs & consumables covered; List I items such as gloves and masks not paid","note":"Items in Lists II to IV are subsumed into room, procedure or treatment costs and allowed within the scope of cover.","quote":"• Medicines, drugs & consumables; ... 17) Any non medical expenses mentioned in List 1 of Annexure I ... List I - Items for which coverage is not available in the policy ... 16 | CREPE BANDAGE ... 38 | NEBULIZER KIT ... 56 | GLOVES ... 60 | MASK ... Items mentioned under List II, List III and List IV are allowed if these are within the scope of coverage","sources":[{"clause":"1","heading":"Inpatient Benefits: This section of benefits is applicable when","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-2"},{"clause":"3","heading":"Specific Exclusions","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-3-2"},{"clause":"Annexure I","heading":null,"page":49,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-annexure-i"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"cross-checked","value":"Exclusive variant only: Normal Delivery Rs. 15,000 to 30,000 and Caesarean Delivery Rs. 25,000 to 50,000 by sum insured band, including pre/post natal and newborn limits, limited to 2 deliveries or terminations in a lifetime. Waiting period 6 years (4 years in the 15 to 50 lakh band) for Individual, 4 years (3 years) for Family. Not covered in Standard.","display":"Exclusive only: Rs. 15,000 to 50,000; 3 to 6 years waiting","note":"Middle band (7.5 to 10 lakh): Normal Rs. 25,000, Caesarean Rs. 40,000. Only the insured's spouse can claim; pre and post hospitalisation expenses and ectopic pregnancy are not paid under this benefit (ectopic pregnancy is covered under in-patient treatment). CIS: Individual 48/72 months, Family 36/48 months.","quote":"3 a) Maternity Expenses | Not Covered | Normal Delivery Rs. 15,000* Caesarean Delivery Rs. 25,000* (* Including Pre/Post Natal limit of Rs.1,500 and New Born limit of Rs.2,000) [Waiting Period of 6 years] ... Normal Delivery Rs. 30,000* Caesarean Delivery Rs. 50,000* (* Including Pre/Post Natal limit of Rs. 5,000 and New Born limit of Rs.5,000) [Waiting Period of 4 Years] ... 15.00,20.00, 25.00, 50.00 ... [Waiting Period 4 years] ... [Waiting Period of 3 Years] ... limited to 2 deliveries or terminations or either during the lifetime of the Insured Person ... Normal Delivery Rs. 25,000* Caesarean Delivery Rs. 40,000* ... 1) Pre- and post-hospitalisation expenses under 1-b) and 1-c) 2) Ectopic pregnancy under this benefit (although it shall be covered under 1a) 3) Claim for Dependents other than ... Insured Person’s spouse under this Policy. ... • Individual : 48/72 months • Family : 36/48 months","sources":[{"clause":"3","heading":"Additional Benefit not related to Sum Insured","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-3"},{"clause":null,"heading":"Schedule of Benefits – Easy Health Individual","page":45,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-individual"},{"clause":null,"heading":"Schedule of Benefits – Easy Health Family","page":47,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-family"},{"clause":"Excl18(d)(i)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/139#c-excl18-d-i"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"cross-checked","value":"Exclusive variant only. The maternity benefit pays the newborn's medically necessary treatment up to a New Born limit (Rs.2,000 to Rs.5,000). Full in-patient cover for the newborn is an Additional Benefit on payment of additional premium, if a proposal is submitted within 90 days after birth and a maternity claim has been accepted.","display":"Up to Rs.2,000 to Rs.5,000 in maternity; full cover for extra premium (Exclusive)","note":"Cover under the newborn benefit starts from the date the premium is received.","quote":"iii. Medical Expenses incurred for the medically necessary treatment of the new born baby upto the amount stated in the Schedule of Benefits unless the new born baby is covered under 2b) ... New Born limit of Rs.2,000 ... New Born limit of Rs.5,000 ... 2 b) Newborn baby | Not Covered | Additional Benefit on payment of additional premium ... provided a proposal form is submitted for the insurance of the newborn baby within 90 days after the birth, and We have accepted the same and received the premium sought. ... This Benefit is applicable if Maternity benefit is opted and We have accepted a maternity claim under this Policy.","sources":[{"clause":"2","heading":"Additional Benefits","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-2"},{"clause":"3","heading":"Additional Benefit not related to Sum Insured","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-3"},{"clause":null,"heading":"Schedule of Benefits – Easy Health Individual","page":45,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-schedule-of-benefits-easy-health-individual"}],"law":[]},{"key":"mental_illness","label":"Mental illness","section":"Cover","meaning":"Cover for in-patient treatment of mental illness.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention mental illness.","quote":null,"sources":[],"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":"Standard: up to 1% of Base Sum Insured, up to Rs.5000, once at the end of every block of four continuous claim free years. Exclusive: up to 1% of Base Sum Insured, maximum Rs.5,000, once at the end of every block of three continuous policy years.","display":"Up to 1% of sum insured (max Rs.5,000): every 4 claim-free years (Standard) or every 3 years (Exclusive)","note":"Easy Health Family: per policy rather than per person (the family schedule of benefits reads 'per Insured Person' for Exclusive). In a Standard family floater, any member's claim removes the check-up for the whole family. Not carried forward if not used.","quote":"Easy Health Individual | Upto 1% of Base Sum Insured per Insured Person upto Rs.5000, only once at the end of a block of every continuous four claim free years. | Upto 1% of Base Sum Insured subject to a Maximum of Rs.5,000 per Insured Person, only once at the end of a block of every continuous three policy years ... Easy Health Family | Upto 1% of Base Sum Insured per Policy upto Rs.5000 ... b) In case of family floater in Standard Variant, if any of the members have made a claim under this Policy, the health check-up benefit will not be offered to the whole family. ... Note: Preventive Health Check-up does NOT carry forward if not claimed in the policy year where Insured person is eligible to avail the same.","sources":[{"clause":"5.3(a)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-5-3-a"},{"clause":"5.3(b)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-5-3-b"},{"clause":"5.3(c)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-5-3-c"}],"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 usually taken on an out-patient basis is excluded. Out-patient benefits are offered only through the Optima Wellbeing add-on.","display":"Not covered (Optima Wellbeing add-on available)","note":null,"quote":"9) Conditions for which treatment could have been done on an outpatient basis without any Hospitalization. ... • Optima Wellbeing (Add on) : Covers expenses for various outpatient benefits.","sources":[{"clause":"3","heading":"Specific Exclusions","page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-3-2"},{"clause":null,"heading":"Easy Health Family","page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-easy-health-family"}],"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, in six tiers (Tier 1: Delhi, Surat, Gurugram, Faridabad, Ghaziabad, Greater Noida to Tier 6: Rest of India). No co-payment applies when someone from a lower tier is treated in a higher tier.","display":"Yes, premium by city tier (6 tiers)","note":"Tier 2: Mumbai, Thane, Navi Mumbai, Ahmedabad, Vadodara; Tier 3: Nashik, Rest of NCR and others; Tier 4: Kolkata, Rest of Gujarat, Telangana and others; Tier 5: rest of Maharashtra, Uttar Pradesh, Madhya Pradesh, Rajasthan, Haryana and others. Premium is re-rated pro rata on a mid-term move between zones.","quote":"The premium will be computed basis the city of residence provided by the insured person in the application form. ... a) Tier 1: Delhi, Surat, Gurugram, Faridabad, Ghaziabad, Greater Noida. ... f) Tier 6: Rest of India. ... No co-payment shall apply if Insured Person from a lower tier avails a treatment in higher tier. ... b) Tier 2: Mumbai, Mumbai Suburban, Thane, Navi Mumbai, Ahmedabad, Vadodara. ... c) Tier 3: Nashik, Rest of NCR, Amritsar, Ahmednagar, Mathura, Aligarh. ... d) Tier 4: Kolkata, Rest of Gujarat, Telangana, Agra, Ludhiana, Beed, Jalgaon, Indore, Gwalior. ... e) Tier 5: Rest of Maharashtra, Rest of Uttar Pradesh, Rest of Madhya Pradesh, Rest of Rajasthan, Rest of Haryana ... The premium will be modified in case of mid -term address change involving migration from one zone to another and would be calculated on pro-rata basis.","sources":[{"clause":"2(a)","heading":null,"page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-a"},{"clause":"2(a)","heading":"Tier 1","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-a-2"},{"clause":"2(f)","heading":"Tier 6","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-f"},{"clause":"2(b)","heading":"Tier 2","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-b"},{"clause":"2(c)","heading":"Tier 3","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-c"},{"clause":"2(d)","heading":"Tier 4","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-d"},{"clause":"2(e)","heading":"Tier 5","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-e"}],"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 network hospitals: the insurer pays the network hospital directly if notified at least 48 hours before planned treatment or within 24 hours after emergency treatment. Non-network hospitals are on reimbursement.","display":"Yes, at network hospitals","note":null,"quote":"vi) Cashless service: If any treatment, consultation or procedure for which a claim may be made is to be taken at a Network Hospital, then We will provide a cashless service by making payment to the extent of Our liability direct to the Network Hospital as long as We are given notice that the Insured Person wishes to take advantage of a cashless service accompanied by full particulars at least 48 hours before any planned treatment or Hospitalisation or within 24 hours after the treatment or Hospitalisation in the case of an emergency. ... At network centers claims would be settled on cashless basis and on reimbursement basis in non network centers","sources":[{"clause":"1(b)(vi)","heading":"Cashless service","page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-1-b-vi"},{"clause":"Excl11","heading":"Excluded Providers: Code – Excl11","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-excl11"}],"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":"The insurer itself: all claims are processed and settled by HDFC ERGO General Insurance.","display":"HDFC ERGO (in-house)","note":"From the prospectus. The policy wording defines a TPA 'as specified in the Schedule'.","quote":"All claims under this policy will be processed and settled by HDFC ERGO General Insurance Limited.","sources":[{"clause":"Excl11","heading":"Excluded Providers: Code – Excl11","page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-excl11"}],"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 (Easy Health Family)","note":"Up to 2 adults and 5 children in a floater; a 55% floater discount applies to all members except the oldest.","quote":"j) The policy offers option of covering on individual sum insured basis – Easy Health Individual Health Insurance Plan and on family floater basis – Easy Health Family Floater Insurance Plan. ... h) In a family floater policy, a maximum of 2 adults and a maximum of 5 children can be included in a single policy. ... In case of Family Floater policies Floater discount of 55% will be applied on all the members except the oldest member.","sources":[{"clause":null,"heading":null,"page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138#c-s1"},{"clause":"2(f)","heading":"Tier 6","page":35,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137#c-2-f"}],"law":[]}],"documents":[{"kind":"wording","label":"Easy Health (for policies with period of Insurance starting 03-March- 2026 onwards.)","pages":52,"fetched_at":"2026-10-16 07:11:37.915958+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/PolicyWordings_EasyHealth-114935539788.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/137"},{"kind":"prospectus","label":"Easy Health","pages":99,"fetched_at":"2026-10-16 07:11:37.915958+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/EasyHealth-103637918100.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/138"},{"kind":"cis","label":"Easy Health","pages":12,"fetched_at":"2026-10-16 07:11:37.915958+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/CIS_Website_EasyHealth-971824455457.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526/document/139"}],"versions":[{"uin":"HDFHLIP23024V072223","version":null,"approved_on":null},{"uin":"HDFHLIP26054V102526","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":"Easy Health (UIN HDFHLIP26054V102526), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/easy-health-hdfhlip26054v102526"}