{"uin":"HDFHLIP27065V032627","name":"Health Wallet","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627","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":"2020-09-21","withdrawn_on":null,"summary":"Health Wallet is a health indemnity policy available on individual and family floater basis with basic sum insured options from Rs. 3 lakh to Rs. 50 lakh. It has 30 days initial waiting period, 36 months pre-existing disease waiting period, restore benefit equal to 100% of basic sum insured and an optional aggregate deductible.","analysis":{"state":"machine","analysed_at":"2026-10-19 19:53:03.703183+00","note":"First pass: one AI reading; every stated fact carries a verbatim quote found in the cited clause, but it has not been reviewed. Check the clause before relying on it."},"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":"quote-verified","value":["Health Wallet Individual","Health Wallet - Family Floater"],"display":"Health Wallet Individual; Health Wallet - Family Floater","note":null,"quote":"Schedule of benefits - Health Wallet Individual ... Schedule of benefits Health Wallet - Family Floater","sources":[{"clause":null,"heading":"Schedule of benefits - Health Wallet Individual","page":44,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-schedule-of-benefits-health-wallet-individual"},{"clause":null,"heading":"Schedule of benefits Health Wallet - Family Floater","page":45,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-schedule-of-benefits-health-wallet-family-floate"}],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"quote-verified","value":"The policy is issued for 1, 2 or 3 years.","display":"1/2/3 year(s)","note":null,"quote":"The policy will be issued for a period of 1/2/3 year(s).","sources":[{"clause":"3(i)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-3-i"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"quote-verified","value":"For emergency hospitalisation, notice with full particulars must be sent within 24 hours from the date emergency hospitalisation is required or before discharge, whichever is earlier. For planned hospitalisation, notice must be sent at least 48 hours before admission.","display":"Emergency: within 24 hours or before discharge, whichever is earlier; planned: at least 48 hours before admission","note":null,"quote":"Notice with full particulars shall be sent to the Company as under:\na) Within 24 hours from the date of emergency Hospitalization required or before the Insured Person’s discharge from Hospital, whichever is earlier.\nb) At least 48 hours prior to admission in Hospital in case of a planned Hospitalization.","sources":[{"clause":"1","heading":"Claim Procedure","page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-5"}],"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":"quote-verified","value":["Our claim form, duly completed and signed","Original Bills","All reports and records","A precise diagnosis","A detailed list of the individual medical services and treatments provided and a unit price for each","Prescriptions","All pre and post investigation, treatment and follow up (consultation) records","All investigation, treatment and follow up records pertaining to the past ailment(s)","Treating doctor’s certificate regarding missing information","Copy of settlement letter from other insurance company or TPA","Stickers and invoice of implants used during surgery","Copy of MLC (Medico legal case) records and FIR (First information report)","NEFT and KYC requirements","Legal heir certificate"],"display":"Claim form, original bills, reports and records, diagnosis, detailed break-up, prescriptions, investigation and follow-up records, past ailment records, treating doctor’s certificate, other insurer or TPA settlement letter, implant stickers and invoice, MLC/FIR for accident claims, NEFT/KYC and legal heir certificate","note":null,"quote":"Such documentation will include but is not limited to the following:\na) Our claim form, duly completed and signed for on behalf of the Insured Person.\nb) Original Bills ... c) All reports and records ... d) A precise diagnosis ... e) A detailed list of the individual medical services and treatments provided and a unit price for each (detailed break up). ... f) Prescriptions ... g) All pre and post investigation, treatment and follow up (consultation) records ... h) All investigation, treatment and follow up records pertaining to the past ailment(s) since their first diagnoses or detection ... i) Treating doctor’s certificate regarding missing information ... j) Copy of settlement letter from other insurance company or TPA ... k) Stickers and invoice of implants used during surgery ... l) Copy of MLC (Medico legal case) records and FIR (First information report), in case of claims arising out of an accident ... m) Regulatory requirements as amended from time to time, currently mandatory NEFT (to enable direct credit of claim amount in bank account) and KYC (recent ID/Address proof and photograph) requirements\nn) Legal heir certificate","sources":[{"clause":"1","heading":"Claim Procedure","page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-5"}],"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":"quote-verified","value":"Other than cashless claims, the company shall settle or reject a claim within 15 days from the date of receipt of intimation of claims. If payment is delayed, interest is payable from the date of receipt of intimation to the date of payment at 2% above the bank rate.","display":"Other than cashless: settle or reject within 15 days from claim intimation; delay interest at 2% above bank rate","note":null,"quote":"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. ⚫ In the case of delay in the payment of a claim, the Company shall be liable to pay interest to the policyholder from the date of receipt of intimation to the date of payment of claim at a rate 2% above the bank rate.","sources":[{"clause":"1(f)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-f-2"}],"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":"quote-verified","value":["Expenses related to the treatment of any illness within 30 days","Expenses related to the treatment of the listed Conditions, surgeries/treatments","Expenses related to the treatment of a pre-existing disease (PED) and its direct complications","Expenses related to any admission primarily for diagnostic and evaluation purposes only","Expenses related to any admission primarily for enforced bed rest","Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions","Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex","Expenses for cosmetic or plastic surgery or any treatment to change appearance","Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof","Sterility and Infertility","Maternity","War or similar situations","Intentional self injury or attempted suicide","Treatment taken on Outpatient basis","Treatment availed outside India, except for claims arising under Emergency Worldwide Care benefit"],"display":"Main exclusions include the 30-day waiting period, 24-month specified disease/procedure waiting period, 36-month PED waiting period, diagnostic-only admission, enforced bed rest, obesity treatment unless conditions are met, change-of-gender treatment, cosmetic surgery, alcohol/drug abuse, infertility, maternity, war, intentional self-injury, OPD treatment and treatment outside India except Emergency Worldwide Care","note":null,"quote":"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. ... Expenses related to the treatment of the listed Conditions, surgeries/treatments as mentioned in the table below shall be excluded until the expiry of 24 months ... Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 36 months ... Expenses related to any admission primarily for diagnostic and evaluation purposes only are excluded. ... Rest Cure, rehabilitation and respite care: Code – Excl05: Expenses related to any admission primarily for enforced bed rest ... Obesity/Weight control: Code – Excl06: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Change-of-Gender treatments - Code – Excl07:Expenses related to any treatment, including surgical management, to change characteristics of the body to those of the opposite sex. ... Cosmetic or plastic surgery: Code – Excl08:Expenses for cosmetic or plastic surgery or any treatment to change appearance ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.Code – Excl12 ... Sterility and Infertility –Code – Excl17 -Expenses related to sterility and infertility. ... Maternity:Code – Excl18 ... War or similar situations: Treatment arising from or consequent upon war or any act of war ... Intentional self injury or attempted suicide while sane or insane. ... Treatment taken on Outpatient basis ... Treatment availed outside India, except for claims arising under Emergency Worldwide Care benefit","sources":[{"clause":"1(I)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-i-2"},{"clause":"1(III)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-iii"},{"clause":"1(VI)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-vi"},{"clause":"2","heading":"Standard exclusions","page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-3"},{"clause":"2(ii)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-ii"},{"clause":"2(d)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-d"},{"clause":"3","heading":"Specific Exclusions","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#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":"quote-verified","value":"First contact HDFC ERGO through the listed phone numbers or website. If response is lacking or unsatisfactory, write to the Complaints & Grievance Cell, email grievance@hdfcergo.com or call 18002677444; if still not satisfied or no response within 15 days, write to the Chief Grievance Officer or email cgo@hdfcergo.com before using the CIO/Ombudsman route.","display":"First point: 022 6158 2020 / 011 6158 2020 / www.hdfcergo.com; Level 1 C&G Cell / grievance@hdfcergo.com / 18002677444; Level 2 Chief Grievance Officer / cgo@hdfcergo.com","note":null,"quote":"First Point of Contact | Call us at 022 6158 2020 /011 6158 2020/www.hdfcergo.com\nLevel 1 | For lack of a response or if the response provided does not meet your expectation, you can: 1. Write to The Complaints & Grievance Cell (C&G Cell) ... You can also write an email to grievance@hdfcergo.com ... Call on 18002677444 ... Level 2 | If you're not satisfied with the resolution or if no response was received within 15 days, you can: 1. Write to the Chief Grievance Officer ... You can also write an email to cgo@hdfcergo.com","sources":[{"clause":"1(c)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-c-7"},{"clause":"2","heading":"You can also write an email to grievance@hdfcergo.com","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-4"},{"clause":"3","heading":"Call on 18002677444 (operational Monday - Saturday 9AM to 6PM)","page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-3-3"}],"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":"not-stated","value":null,"display":null,"note":null,"quote":null,"sources":[],"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":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Does not apply to accident claims, provided they are covered.","quote":"Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.","sources":[{"clause":"1(I)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-i-2"}],"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":"quote-verified","value":{"unit":"months","amount":36},"display":"36 months","note":"For enhanced sum insured, the waiting period applies afresh to the increase; portability/migration credit can reduce the waiting period.","quote":"Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with insurer.","sources":[{"clause":"1(VI)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-vi"}],"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":"quote-verified","value":{"unit":"months","amount":24},"display":"24 months","note":"If a listed disease/procedure also falls under PED waiting period, the longer waiting period applies.","quote":"Expenses related to the treatment of the listed Conditions, surgeries/treatments as mentioned in the table below shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with us. This exclusion shall not be applicable for claims arising due to an Accident.","sources":[{"clause":"1(III)","heading":null,"page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-iii"}],"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":"quote-verified","value":["Sinusitis Rhinitis Tonsillitis","Adenoidectomy, Mastoidectomy Tonsillectomy, Tympanoplasty Surgery for Nasal septum deviation Surgery for Turbinate hypertrophy Nasal concha resection Nasal polypectomy","Cysts, polyps including breast lumps Polycystic ovarian diseases Fibromyoma Adenomyosis Endometriosis Prolapsed Uterus","Hysterectomy","Non infective arthritis Gout and Rheumatism Osteoporosis Ligament, Tendon and Meniscal tear Prolapsed inter vertebral disk","Joint replacement surgeries","Cholelithiasis Cholecystitis Pancreatitis Fissure/fistula in anus, Hemorrhoids, Pilonidal sinus Gastro Esophageal Reflux Disorder (GERD), Ulcer and erosion of stomach and duodenum Cirrhosis Perineal and Perianal Abscess Rectal Prolapse","Cholecystectomy Surgery of hernia","Calculus diseases of Urogenital system including Kidney, ureter, bladder stones Benign Hyperplasia of prostate Varicocele","Surgery on prostate Surgery for Hydrocele/ Rectocele","Cataract Retinal detachment Glaucoma","Surgery of varicose veins and varicose ulcers","Benign tumors of Non infectious etiologye.eg. cysts, nodules, polyps, lump, growth, etc"],"display":"ENT, gynaecological, orthopaedic, gastrointestinal, urogenital, eye, varicose vein and benign tumour conditions/procedures listed in the policy","note":"Alcoholic cirrhosis is stated as permanently excluded in the same table.","quote":"List of specific diseases/procedure:\nOrgan / Organ System | Illness / diagnoses (irrespective of treatments medical or surgical) | Surgeries / procedure (irrespective of any illness / diagnosis other than cancers)\nEar, Nose & Throat (ENT) | Sinusitis Rhinitis Tonsillitis | Adenoidectomy, Mastoidectomy Tonsillectomy, Tympanoplasty Surgery for Nasal septum deviation Surgery for Turbinate hypertrophy Nasal concha resection Nasal polypectomy\nGynaecological | Cysts, polyps including breast lumps Polycystic ovarian diseases Fibromyoma Adenomyosis Endometriosis Prolapsed Uterus | Hysterectomy\nOrthopaedic | Non infective arthritis Gout and Rheumatism Osteoporosis Ligament, Tendon and Meniscal tear Prolapsed inter vertebral disk | Joint replacement surgeries\nGastrointestinal | Cholelithiasis Cholecystitis Pancreatitis Fissure/fistula in anus, Hemorrhoids, Pilonidal sinus Gastro Esophageal Reflux Disorder (GERD), Ulcer and erosion of stomach and duodenum Cirrhosis (However Alcoholic cirrhosis is permanently excluded) Perineal and Perianal Abscess Rectal Prolapse | Cholecystectomy Surgery of hernia\nUrogenital | Calculus diseases of Urogenital system including Kidney, ureter, bladder stones Benign Hyperplasia of prostate Varicocele | Surgery on prostate Surgery for Hydrocele/ Rectocele\nEye | Cataract Retinal detachment Glaucoma | Nil\nOthers | NIL | Surgery of varicose veins and varicose ulcers\nGeneral ( Applicable to all organ systems/organs whether or not described above) | Benign tumors of Non infectious etiologye.eg. cysts, nodules, polyps, lump, growth, etc | Nil","sources":[{"clause":"1(VI)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-vi"}],"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":"quote-verified","value":{"unit":"months","amount":60},"display":"sixty continuous months","note":"For enhanced sum insured, the sixty continuous months is counted from the enhancement date for the enhanced limits.","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. This period of sixty continuous months is called as moratorium period.","sources":[{"clause":"1(f)","heading":null,"page":27,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-f-2"}],"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":"quote-verified","value":"The insured person may port the entire policy with all family members to another insurer by applying at least 30 days before, but not earlier than 60 days from, the renewal date. If continuously covered without lapse under an Indian general/health insurer policy, accrued continuity benefits in waiting periods are given as per IRDAI portability guidelines.","display":"Can port to other insurers, applying at least 30 days before but not earlier than 60 days from renewal date; waiting-period continuity benefits as per IRDAI guidelines","note":null,"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. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed insured person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability.","sources":[{"clause":"1(b)","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-b-6"}],"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":"quote-verified","value":true,"display":"Yes, no maximum cover ceasing age on renewals","note":"Eligibility ages are from the prospectus.","quote":"There is no maximum cover ceasing age on renewals.","sources":[{"clause":"1","heading":"Suitability","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6948#c-1"}],"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":"quote-verified","value":"No loading shall apply on renewals based on individual claims experience.","display":"No loading on renewals based on individual claims experience","note":null,"quote":"No loading shall apply on renewals based on individual claims experience","sources":[{"clause":"1(c)","heading":null,"page":29,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-c-5"}],"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":"quote-verified","value":["Investigation & Evaluation: Code Excl04","Rest Cure, rehabilitation and respite care: Code – Excl05","Obesity/Weight control: Code – Excl06","Change-of-Gender treatments - Code – Excl07","Cosmetic or plastic surgery: Code – Excl08","Hazardous or Adventure sports: Code-Excl09","Breach of law: Code –Excl10","Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.Code – Excl12","Treatments received in health hydros, nature cure clinics, spas or similar establishments","Dietary supplements and substances that can be purchased without prescription","Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.Code – Excl15","Unproven Treatments","Sterility and Infertility –Code – Excl17","Maternity:Code – Excl18","War or similar situations","Intentional self injury or attempted suicide","Treatment availed outside India, except for claims arising under Emergency Worldwide Care benefit","Any specific time bound or lifetime exclusion(s) applied by Us and specified in the Schedule and accepted by the insured"],"display":"Permanent exclusions include Excl04 to Excl10, Excl12 to Excl18, war, intentional self-injury, treatment outside India except Emergency Worldwide Care and any policy-schedule specific time-bound or lifetime exclusions","note":"Code Excl11 is not printed in the cited exclusion list.","quote":"Breach of law: Code –Excl10 ... Hazardous or Adventure sports: Code-Excl09 ... Investigation & Evaluation: Code Excl04 ... Rest Cure, rehabilitation and respite care: Code – Excl05 ... Obesity/Weight control: Code – Excl06 ... Change-of-Gender treatments - Code – Excl07 ... Cosmetic or plastic surgery: Code – Excl08 ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.Code – Excl12 ... Treatments received in health hydros, nature cure clinics, spas or similar establishments ... Dietary supplements and substances that can be purchased without prescription ... Expenses related to the treatment for correction of eye sight due to refractive error less than 7.5 dioptres.Code – Excl15 ... Unproven Treatments– Expenses related to any unproven treatment ... Sterility and Infertility –Code – Excl17 ... Maternity:Code – Excl18 ... War or similar situations: Treatment arising from or consequent upon war or any act of war ... Intentional self injury or attempted suicide while sane or insane. ... Treatment availed outside India, except for claims arising under Emergency Worldwide Care benefit ... Any specific time bound or lifetime exclusion(s) applied by Us and specified in the Schedule and accepted by the insured.","sources":[{"clause":"2","heading":"Standard exclusions","page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-3"},{"clause":"2(ii)","heading":null,"page":23,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-ii"},{"clause":"2(d)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-d"},{"clause":"3","heading":"Specific Exclusions","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#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":"quote-verified","value":"The policyholder may cancel by giving 7 days’ written notice and gets a pro-rata premium refund for the unexpired policy period. No refund is made where any claim has been admitted or any benefit has been availed; for instalment policies, future instalments for the current policy year are adjusted in an admissible claim and no refund applies during that policy year.","display":"7 days’ written notice; pro-rata refund for unexpired period, but no refund if a claim has been admitted or any benefit availed","note":null,"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. ... Note : For Policies where premium is paid by instalment : In case of admissible claim under the Policy, future instalment for the current Policy Year will be adjusted in the claim amount and no refund of any premium will be applicable during the Policy Year. ... Notwithstanding anything contained herein or otherwise, no refunds of premium shall be made in respect of Cancellation where any claim has been admitted or any benefit has been availed by the Insured Person under the Policy.","sources":[{"clause":"1(a)","heading":null,"page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a-8"},{"clause":"1(b)","heading":"Note","page":30,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-b-7"},{"clause":"1(e)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-e-4"}],"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":"quote-verified","value":"The policy covers medical treatment taken within India, with an exception for the Worldwide Emergency Care benefit. Payments under the policy are made only in Indian Rupees within India.","display":"India only, except Worldwide Emergency Care","note":"Worldwide Emergency Care is subject to its stated limits and reimbursement conditions.","quote":"This Policy only covers medical treatment taken within India. All payments under this Policy will only be made in Indian Rupees within India. ... Worldwide Emergency Care Expense on treatment of illness or conditions first manifested during the Policy Period while travelling overseas","sources":[{"clause":"3(ii)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-3-ii"},{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"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":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days","note":"Applies on new individual health insurance policies and not on renewals or at the time of porting/migrating the policy.","quote":"The insured person shall be allowed free look period of 30 days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable.","sources":[{"clause":"1(e)","heading":null,"page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-e-4"}],"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":"quote-verified","value":{"unit":"days","amount":30},"display":"30 days; 15 days for monthly mode","note":"Monthly premium mode has fifteen days; all other cases have thirty days.","quote":"The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases.","sources":[{"clause":"Def. 17","heading":"Grace Period","page":5,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-def-17"}],"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":"quote-verified","value":"Persons aged 91 days to 65 years can be covered. Children between 91 days and 5 years can be insured only if either parent is also insured; adult dependents have minimum entry age 18 years and maximum entry age 65 years.","display":"91 days to 65 years","note":"From the prospectus.","quote":"This policy covers persons in the age group 91 days to 65 years. The maximum entry age is restricted to 65 years. The Minimum entry age for Adult Dependent is 18 years and Maximum entry age is 65 years.\nb) Children between 91 days and 5 years can be insured provided either parent is getting insured under this Policy.","sources":[{"clause":"1","heading":"Suitability","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6948#c-1"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"The documents state payment facilities and grace periods for monthly versus other modes, but do not state the premium payment frequencies offered.","quote":null,"sources":[],"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":"quote-verified","value":["Deductible (Optional)","lndividual Personal Accident Rider","Protector Rider","Hospital daily cash rider","Critical Advantage rider","Unlimited Restore (Add on)","Optima Wellbeing (Add on)"],"display":"Optional deductible and add-ons: lndividual Personal Accident Rider, Protector Rider, Hospital daily cash rider, Critical Advantage rider, Unlimited Restore and Optima Wellbeing","note":"Add-ons/riders are listed in the prospectus and are not treated as base policy benefits.","quote":"6) Deductible (Optional) per Insured Person per Policy Year ( Rs in Lakh) | 2.00; 3.00; 5.00 & *10.00 *10.00 deductible available for SI of 20 lacs and above ... Add – On Covers: ‘Health wallet’ offers following Add on Covers:\n• lndividual Personal Accident Rider: Provides Lumpsum pay out in case of Accidental Death, Permanent Total Disablement and Permanent Partial Disablement. Sum Insured shall be 5 (five) times the Sum Insured of Base Plan up to a maximum of Rs. 1 Crore\n• Protector Rider: Covers expenses which are not payable under the Base Plan as per the List of Excluded items released by IRDA along with benefits such as Sum Insured protector\n• Hospital daily cash rider: Daily cash benefit upto 1K/2K/3K\n• Critical Advantage rider: covers planned treatment abroad for listed 8 major illness\n• Unlimited Restore (Add on): Provides unlimited restoration in a Policy Year.\n• Optima Wellbeing (Add on): Covers expenses for various outpatient benefits.","sources":[{"clause":null,"heading":"Schedule of benefits - Health Wallet Individual","page":44,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-schedule-of-benefits-health-wallet-individual"},{"clause":null,"heading":"Schedule of benefits Health Wallet - Family Floater","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6948#c-schedule-of-benefits-health-wallet-family-floate"}],"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":"quote-verified","value":"Coverage need not be available during the period for which no premium is received. If premium is paid in instalments during the policy period, the insurer shall offer coverage during the grace period; for non-instalment premium payment, coverage is not available for the period for which no premium is received.","display":"Instalment premium: coverage during grace period; non-instalment: no coverage for period with no premium received","note":null,"quote":"Coverage need not be available during the period for which no premium is received. The grace period for payment of the premium for all types of insurance policies shall be: fifteen days where premium payment mode is monthly and thirty days in all other cases. Provided the insurers shall offer coverage during the grace period, if the premium is paid in instalments during the policy period (Note: In case of non-instalment premium payment, coverage shall not be available for the period for which no premium is received).","sources":[{"clause":"Def. 17","heading":"Grace Period","page":5,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-def-17"}],"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":"quote-verified","value":"Hospital room rent or boarding is covered as part of in-patient treatment, subject to the Sum Insured.","display":"Covered up to Sum Insured","note":"No separate per-day room rent amount or room category cap is printed in the cited wording.","quote":"HDFC ERGO General Insurance Ltd. will cover all the Insured Persons under this Policy upto the Sum Insured. ... In-patient Treatment This includes\n• Hospital room rent or boarding;","sources":[{"clause":null,"heading":"Preamble","page":3,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-preamble"},{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"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":"The wording covers hospital room rent or boarding but does not state an allowed room category.","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":"quote-verified","value":"Intensive Care Unit expenses are covered as part of in-patient treatment, subject to the Sum Insured.","display":"Covered up to Sum Insured","note":"No separate per-day ICU cap is printed in the cited wording.","quote":"HDFC ERGO General Insurance Ltd. will cover all the Insured Persons under this Policy upto the Sum Insured. ... In-patient Treatment This includes\n• Hospital room rent or boarding;\n• Nursing;\n• Intensive Care Unit","sources":[{"clause":null,"heading":"Preamble","page":3,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-preamble"},{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"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 do not state a proportionate deduction rule for occupying a room above a limit.","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":"not-stated","value":null,"display":null,"note":"The documents define co-payment and mention that Reserve Benefit can pay co-payment for any health insurance claim, but do not state a base policy co-payment percentage.","quote":null,"sources":[],"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":"quote-verified","value":"An optional aggregate deductible can be chosen. Claims are payable only if the aggregate covered eligible medical expenses for hospitalisations in a policy year exceed the deductible stated in the schedule; options are Rs. 2 lakh, 3 lakh, 5 lakh and 10 lakh, with the 10 lakh deductible available for sum insured of 20 lakh and above.","display":"Optional aggregate deductible: Rs. 2 lakh, 3 lakh, 5 lakh or 10 lakh; 10 lakh only for SI of 20 lakh and above","note":"Applies on individual basis for individual sum insured policies and family floater basis for family floater policies if opted.","quote":"Where optional Deductible is chosen, then all claims made for benefits listed Section B of the Policy will be payable only if the aggregate of covered eligible Medical Expenses, in respect to Hospitalisation (s) in a Policy Year is in excess of the Deductible as stated in the Schedule. ... 6) Deductible (Optional) per Insured Person per Policy Year ( Rs in Lakh) | 2.00; 3.00; 5.00 & *10.00 *10.00 deductible available for SI of 20 lacs and above","sources":[{"clause":"5","heading":"Deductible","page":19,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-5"},{"clause":null,"heading":"Schedule of benefits - Health Wallet Individual","page":44,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-schedule-of-benefits-health-wallet-individual"}],"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":"not-stated","value":null,"display":null,"note":"The documents do not state caps for named diseases or procedures such as cataract or knee replacement.","quote":null,"sources":[],"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":"quote-verified","value":{"unit":"days","amount":60},"display":"60 days","note":"Applies where the related inpatient, day care or domiciliary claim is admissible.","quote":"Pre-Hospitalisation expense for consultations, investigations and medicines incurred upto 60 days before the date of admission to the hospital (In-patient, Day Care or Domiciliary Treatment).","sources":[{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"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":"quote-verified","value":{"unit":"days","amount":90},"display":"90 days","note":"Applies where the related inpatient, day care or domiciliary claim is admissible.","quote":"Post-Hospitalisation expenses | i) Claims which have NOT been admitted under 1 a), 1d), and 1e).\nfor consultations, investigations and medicines incurred upto 90 days after discharge from the Hospital.","sources":[{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"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":"quote-verified","value":"All day care procedures are covered.","display":"All Day Care Procedures Covered","note":null,"quote":"1d) Day Care Procedures | All Day Care Procedures Covered","sources":[{"clause":null,"heading":"Schedule of benefits - Health Wallet Individual","page":44,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-schedule-of-benefits-health-wallet-individual"}],"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":"quote-verified","value":"Domiciliary treatment is covered when treatment for an illness, disease or injury that would normally require hospital care is taken at home because the patient cannot be moved to a hospital or because a hospital room is not available.","display":"Covered when patient cannot be moved to hospital or no room is available","note":"Treatment of less than 3 days is excluded, except the first three days are covered only if treatment period is greater than three days.","quote":"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: i. The condition of the patient is such that he/she is not in a condition to be removed to a Hospital or, ii. The patient takes treatment at home on account of non availability of room in a Hospital.","sources":[{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"law":[]},{"key":"ayush","label":"AYUSH treatment","section":"Cover","meaning":"Ayurveda, Yoga, Unani, Siddha and Homeopathy treatment in a recognised hospital, and any limit.","status":"quote-verified","value":"AYUSH inpatient care expenses in an AYUSH Hospital are covered up to the Sum Insured for Ayurveda, Unani, Sidha, Homeopathy, Yoga and Naturopathy.","display":"Covered up to Sum Insured for inpatient AYUSH treatment","note":"Treatment availed outside India is not covered under this benefit.","quote":"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","sources":[{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"law":[{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 1","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Guidelines on providing AYUSH coverage in Health Insurance policies, 2024","section":"Para 2","url":"https://indiainsurances.com/law/irdai-ayush-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 1","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II A.I(1)","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"modern_treatments","label":"Modern treatments","section":"Cover","meaning":"Robotic surgery, immunotherapy, oral chemotherapy, stem cell therapy and the like, and any cap on them.","status":"not-stated","value":null,"display":null,"note":"The documents do not state coverage or caps for modern treatments such as robotic surgery, immunotherapy, oral chemotherapy or stem cell therapy; stem cell harvesting is listed as an exclusion.","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":"quote-verified","value":"Medical and surgical expenses of an organ donor for harvesting the organ are covered where an insured person is the recipient. Expenses incurred by an insured person while donating an organ, and the donor’s pre- and post-hospitalisation expenses, are not covered.","display":"Covered for donor harvesting expenses when insured person is recipient","note":null,"quote":"Organ Donor Medical and surgical Expenses of the organ donor for harvesting the organ where an Insured Person is the recipient. IMPORTANT: Expenses incurred by an insured person while donating an organ is not covered. | 1. Claims which have NOT been admitted under 1a) for insured member. 2. Admission not compliant under the Transplantation of Human Organs Act, 1994 (as amended). 3. The organ donor’s Pre and Post- Hospitalisation expenses.","sources":[{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"law":[]},{"key":"ambulance","label":"Ambulance cover","section":"Cover","meaning":"Road (and air) ambulance cover and its limit.","status":"quote-verified","value":"Ambulance expenses for transporting the insured person to a hospital for treatment in an emergency are covered up to Rs. 2,000 per hospitalisation.","display":"Road ambulance up to Rs. 2,000 per hospitalisation","note":"The wording does not state an air ambulance cover.","quote":"Ambulance Cover Expenses incurred on transportation of Insured Person to a Hospital for treatment in case of an Emergency, subject to Rs. 2000 per Hospitalisation","sources":[{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"}],"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":"quote-verified","value":"If the Basic Sum Insured and Multiplier Benefit are exhausted due to paid and accepted claims during the policy year, a Restore Sum Insured equal to 100% of the Basic Sum Insured becomes automatically available for future claims in that policy year. It applies once for an insured person in a policy year, is not carried forward, and cannot be used for the same illness or disease for which a claim has already been paid to that insured person in that year.","display":"100% of Basic Sum Insured, once per policy year, for future claims after exhaustion","note":"In family floater policies, the illness or disease is covered if the claim is by another insured person other than the one who already claimed for that illness or disease.","quote":"If the Basic Sum Insured and Multiplier Benefit (if any) is exhausted due to claims made and paid during the Policy Year and accepted as payable, then it is agreed that a Restore Sum Insured (equal to 100% of the Basic Sum Insured) will be automatically available for the particular Policy Year ... The Restore Sum Insured can be used for only future claims made by the Insured Person. | Illness/Disease (including its complication) for which a claim has already been paid to the Insured Person in the current Policy Year ... The Restore Sum Insured will only be applied once for the Insured Person during a Policy Year; ... If the Restore Sum Insured is not utilised in a Policy Year, it shall not be carried forward to any subsequent Policy Year.","sources":[{"clause":"1(d)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-d"},{"clause":"1(e)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-e"},{"clause":"1(f)","heading":null,"page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-f"}],"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":"quote-verified","value":"On renewal without a break, 50% of the Base Sum Insured of the expiring policy is added as Multiplier Benefit irrespective of claims, up to a maximum of 100% of the Basic Sum Insured.","display":"50% of Base Sum Insured each renewal, maximum 100%, irrespective of claims","note":"This is a Multiplier Benefit and does not apply to Reserve Benefit.","quote":"On Renewal of this Policy with the Company without a break, a sum equal to 50% of the Base Sum Insured of the expiring Policy shall be provided as multiplier benefit irrespective of any claims ... The maximum multiplier bonus will not exceed 100% of the Basic Sum Insured in any Policy Year.","sources":[{"clause":"3","heading":"Multiplier Benefit","page":16,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-3"}],"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":"quote-verified","value":"Medicines, drugs and consumables are covered under in-patient treatment. Standard non-payable items and other medical expenses not covered under any medical insurance are covered under the Reserve Benefit, while specified non-medical expenses such as food charges, laundry charges, attendant charges, ambulance collar, ambulance equipment, baby food and baby utility charges are excluded from the base cover.","display":"In-patient medicines, drugs and consumables covered; non-medical items are excluded from base cover but Reserve Benefit covers standard non-payable items","note":"Reserve Benefit is separate from the in-patient benefit sum insured.","quote":"In-patient Treatment This includes ... • Medicines, drugs & consumables; ... Medical expenses incurred on inpatient and/or outpatient treatment. This includes\n- Co-payment and / or Deductible for any health insurance claim\n- Standard non-payable items under any health insurance claim\n- Other Medical Expenses not covered under any medical insurance ... Non-Medical expenses such as Food charges (other than patient’s diet provided by hospital), laundry charges, attendant charges, ambulance collar, ambulance equipment, baby food, baby utility charges and other such items.","sources":[{"clause":"1(a)","heading":null,"page":11,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-a"},{"clause":"4(ii)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-4-ii"},{"clause":"3","heading":"Specific Exclusions","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-3-2"}],"law":[]},{"key":"maternity","label":"Maternity cover","section":"Cover","meaning":"Whether childbirth costs are covered, the limit and the waiting period.","status":"quote-verified","value":"Maternity is excluded, except ectopic pregnancy; miscarriage is excluded unless due to an accident and lawful medical termination of pregnancy is excluded during the policy period.","display":"Excluded, except ectopic pregnancy; miscarriage only if due to accident","note":null,"quote":"Maternity:Code – Excl18 ... Medical treatment expenses traceable to childbirth (including complicated deliveries and caesarean sections incurred during hospitalization) except ectopic pregnancy; ... Expenses towards miscarriage (unless due to an accident) and lawful medical termination of pregnancy during the Policy period.","sources":[{"clause":"2(d)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-d"},{"clause":"2(a)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-a-2"},{"clause":"2(b)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-b-2"}],"law":[]},{"key":"newborn","label":"Newborn baby cover","section":"Cover","meaning":"Whether a newborn is covered from birth and for what.","status":"not-stated","value":null,"display":null,"note":"The documents state entry age for children from 91 days, but do not state newborn cover from birth.","quote":null,"sources":[],"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 state inpatient treatment cover for 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":"quote-verified","value":"At each renewal, preventive health check-up expenses are reimbursed for insured persons who were insured in the previous policy year, up to limits based on Reserve Benefit sum insured and plan type.","display":"At each renewal; up to Rs. 1,500 to Rs. 7,000 depending on plan and Reserve Benefit","note":"Benefit does not carry forward if not claimed and is not provided if Health Wallet is not renewed further.","quote":"At each renewal, We will reimburse expenses incurred on preventive health check-up by an Insured Person upto the amount mentioned in the table below. This benefit is available ONLY to those Insured Persons who were insured in the previous Policy Year. ... For Non Deductible plans | Individual | Not Offered | Upto Rs 1500, per individual | Upto Rs 2500, per individual | Upto Rs 3000, per individual | Upto Rs 3500, per individual\nFamily Floater | Not Offered | Upto Rs 3000, per policy | Upto Rs 5000, per policy | Upto Rs 6000, per policy | Upto Rs 7000, per policy\nFor Deductible plans | Individual | Not Offered | Upto Rs 1000, per individual | Upto Rs 2000 per individual | Upto Rs 2500 per individual | Upto Rs 3000 per individual","sources":[{"clause":"2","heading":"Preventive Health Check-up","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-2"}],"law":[]},{"key":"opd","label":"Out-patient (OPD) cover","section":"Cover","meaning":"Doctor consultations, tests and medicines without admission, and the limit.","status":"quote-verified","value":"Reserve Benefit covers out-patient expenses including diagnostic tests, vaccinations, pharmacy, consultations with specified practitioners, dental expenses and special health foods and supplements.","display":"Reserve Benefit covers OPD expenses including tests, vaccinations, pharmacy, consultations, dental and special foods/supplements","note":"Reserve Benefit sum insured options are separate from the basic in-patient benefit.","quote":"Out-patient expenses: This includes\n- Diagnostic Tests\n- Vaccinations\n- Pharmacy\n- Consultations with a Medical Practitioner, Physiotherapist ,Dietician, Speech therapist, Psychologist\n- Dental expenses\n- Special health foods and supplements )","sources":[{"clause":"4(i)","heading":"Out-patient expenses","page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-4-i"}],"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":"quote-verified","value":"Premium is computed based on the city of residence, with Tier 1, Tier 2, Tier 3 and Tier 4 zones. Premium is modified pro rata for a midterm address change involving migration from one zone to another.","display":"Yes, premium depends on residence city zone: Tier 1, Tier 2, Tier 3, Tier 4","note":null,"quote":"For the purpose of policy issuance, the premium will be computed basis the city of residence provided by the insured person in the proposal form. The premium that would be applicable zone wise and the cities defined in each zone are as under:\n• Tier 1: Delhi, Gurgaon, Ghaziabad, Gautam Buddha Nagar, Faridabad, and Noida\n• Tier 2: Mumbai, and MMR\n• Tier 3: Gujarat, West Bengal, Rajasthan, Madhya Pradesh, Andra Pradesh, Assam, Dehradun, Rest of Haryana, Rest of Uttar Pradesh\n• Tier 4: Rest of India\nThe premium will be modified in case of midterm address change involving migration from one zone to another and would be calculated on pro-rata basis.","sources":[{"clause":"3(ii)","heading":null,"page":32,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-3-ii"}],"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":"quote-verified","value":"Cashless service is available at network hospitals, subject to pre-authorization, with payment made directly to the network provider to the authorised amount.","display":"Available at Company’s Network Provider, subject to pre-authorization","note":null,"quote":"Cashless facility can be availed only at Company’s Network Provider. The complete list of Network Providers and empanelled service providers is available on Company’s website and can also be obtained by contacting the Company. ... The Company shall make payment for the Cashless facility to the authorized amount, directly to the Network Provider.","sources":[{"clause":"1","heading":"Claim Procedure","page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-5"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"quote-verified","value":"Claims are to be sent to and processed by the Company, HDFC ERGO General Insurance Co. Ltd.","display":"HDFC ERGO General Insurance Co. Ltd. / the Company","note":"The policy definitions mention a TPA in general definitions, but the claim procedure uses the Company.","quote":"Notice with full particulars shall be sent to the Company as under: ... The Company upon getting cashless request form and related medical information from the Insured Person/ Network Provider shall issue pre-authorization letter to the Network Provider after verification. ... HDFC ERGO General Insurance Co. Ltd. A 36, A Block Rd, B Block, Sector 64, Noida, Uttar Pradesh 201309","sources":[{"clause":"1","heading":"Claim Procedure","page":36,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-1-5"},{"clause":"2","heading":"Contact us","page":38,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946#c-2-5"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"quote-verified","value":true,"display":"Yes, family floater basis available","note":null,"quote":"The policy offers option of covering on individual sum insured basis and on family floater basis.","sources":[{"clause":"1","heading":"Suitability","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6948#c-1"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Wallet","pages":45,"fetched_at":"2026-10-16 04:06:47+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/health-wallet-combined-pw-cis-hegi-373014324919.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6398"},{"kind":"wording","label":"Health Wallet","pages":48,"fetched_at":"2026-10-17 19:40:50+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/PolicyWordings_HealthWallet-486034103328.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6946"},{"kind":"wording","label":"Health Wallet (IRDAI copy)","pages":35,"fetched_at":"2026-10-20 01:52:43+00","source_url":"https://irdai.gov.in/documents/37343/931203/HDHHLIP21337V022021_2020-2021.pdf/a99058ad-0ecd-e28a-9bd5-77ee65593df1?version=1.1&t=1668582958771&download=true","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/27592"},{"kind":"prospectus","label":"Health Wallet","pages":71,"fetched_at":"2026-10-16 04:06:37+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/prospectus/health/health-wallet-651343788429.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6394"},{"kind":"prospectus","label":"Health Wallet","pages":115,"fetched_at":"2026-10-17 19:40:40+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/Prospectus_HealthWallet-526638094240.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6948"},{"kind":"cis","label":"Health Wallet","pages":14,"fetched_at":"2026-10-16 04:05:00+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/cis---health-wallet/pdf181-540262150725.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6336"},{"kind":"cis","label":"Health Wallet","pages":14,"fetched_at":"2026-10-17 19:39:03+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/CIS_HealthWallet_Website-459431630214.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6938"},{"kind":"brochure","label":"Health Wallet","pages":12,"fetched_at":"2026-10-17 19:38:04+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/hehi/health-wallet-brochure-new-354210974071.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627/document/6303"}],"versions":[{"uin":"HDHHLIP21337V022021","version":null,"approved_on":null},{"uin":"HDFHLIP27065V032627","version":null,"approved_on":null}],"where_to_buy":[{"purpose":"buy","kind":"insurer","name":"HDFC ERGO General Insurance official website","url":"https://www.hdfcergo.com/","note":"Buy directly from the insurer."},{"purpose":"buy","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."}],"claims_and_complaints":[{"purpose":"claim","kind":"insurer","name":"Claim intimation and process","url":"https://www.hdfcergo.com/claim/register-bike-insurance-claim/cashless-claims","note":null},{"purpose":"claim","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"grievance","kind":"insurer","name":"Grievance redressal","url":"https://www.hdfcergo.com/customer-voice/grievances","note":null},{"purpose":"grievance","kind":"official","name":"Bima Bharosa (IRDAI grievance portal)","url":"https://bimabharosa.irdai.gov.in/","note":"Register and track a complaint against any insurer with IRDAI. Complain to the insurer first; escalate here if the reply is late or unsatisfactory."},{"purpose":"grievance","kind":"official","name":"e-Daakhil (consumer commission e-filing)","url":"https://edaakhil.nic.in/","note":"Not reachable from our crawler on 2026-10-19; use e-Jagriti if this link does not open."},{"purpose":"grievance","kind":"official","name":"e-Jagriti (consumer commission filing)","url":"https://e-jagriti.gov.in/","note":"Ministry of Consumer Affairs platform for consumer commission cases, a route for insurance disputes that the Ombudsman does not settle."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Ahmedabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Gujarat, Dadra & Nagar Haveli, Daman and Diu. Email: oio.ahmedabad@cioins.co.in. Phone: 079 - 25501201/02. Address: Office of the Insurance Ombudsman, Jeevan Prakash Building, 6th floor, Tilak Marg, Relief Road, AHMEDABAD – 380 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bengaluru","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Karnataka. Email: oio.bengaluru@cioins.co.in. Phone: 080 - 26652048 / 26652049. Address: Office of the Insurance Ombudsman, Jeevan Soudha Building,PID No. 57-27-N-19 Ground Floor, 19/19, 24th Main Road, JP Nagar, Ist Phase, Bengaluru – 560 078."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhopal","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Madhya Pradesh, Chhattisgarh. Email: oio.bhopal@cioins.co.in. Phone: 0755 - 2769201 / 2769202 / 2769203. Address: Office of the Insurance Ombudsman, 1st floor,\"Jeevan Shikha\", 60-B,Hoshangabad Road, Opp. Gayatri Mandir,Arera Hills Bhopal – 462 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Bhubaneswar","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Odisha. Email: oio.bhubaneswar@cioins.co.in. Phone: 0674 - 2596461 /2596455/2596429/2596003. Address: Office of the Insurance Ombudsman, 62, Forest park, Bhubaneswar – 751 009."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chandigarh","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Punjab, Haryana (excluding Gurugram, Faridabad, Sonepat and Bahadurgarh), Himachal Pradesh, Union Territories of Jammu & Kashmir,Ladakh & Chandigarh. Email: oio.chandigarh@cioins.co.in. Phone: 0172-2706468. Address: Office Of The Insurance Ombudsman, Jeevan Deep Building SCO 20-27, Ground Floor Sector- 17 A, Chandigarh – 160 017."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Chennai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Tamil Nadu, PuducherryTown and Karaikal (which are part of Puducherry). Email: oio.chennai@cioins.co.in. Phone: 044 - 24333668 / 24333678. Address: Office of the Insurance Ombudsman, Fatima Akhtar Court, 4th Floor, 453, Anna Salai, Teynampet, CHENNAI – 600 018."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Delhi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Delhi & following Districts of Haryana - Gurugram, Faridabad, Sonepat & Bahadurgarh. Email: oio.delhi@cioins.co.in. Phone: 011 - 46013992/23213504/23232481. Address: Office of the Insurance Ombudsman, 2/2 A, Universal Insurance Building, Asaf Ali Road, New Delhi – 110 002."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Guwahati","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Assam, Meghalaya, Manipur, Mizoram, Arunachal Pradesh, Nagaland and Tripura. Email: oio.guwahati@cioins.co.in. Phone: 0361 - 2632204 / 2602205 / 2631307. Address: Office of the Insurance Ombudsman, Jeevan Nivesh, 5th Floor, Near Pan Bazar , S.S. Road, Guwahati – 781001(ASSAM)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Hyderabad","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Andhra Pradesh, Telangana, Yanam and part of Union Territory of Puducherry. Email: oio.hyderabad@cioins.co.in. Phone: 040 - 23312122 / 23376991 / 23376599 / 23328709 / 23325325. Address: Office of the Insurance Ombudsman, 6-2-46, 1st floor, \"Moin Court\", Lane Opp.Hyundai Showroom , A. C. Guards, Lakdi-Ka-Pool, Hyderabad - 500 004."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Jaipur","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Rajasthan. Email: oio.jaipur@cioins.co.in. Phone: 0141- 2740363. Address: Office of the Insurance Ombudsman, Jeevan Nidhi – II Bldg., Gr. Floor, Bhawani Singh Marg, Jaipur - 302 005."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kochi","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Kerala, Lakshadweep, Mahe-a part of Union Territory of Puducherry. Email: oio.ernakulam@cioins.co.in. Phone: 0484 - 2358759. Address: Office of the Insurance Ombudsman, 10th Floor, Jeevan Prakash,LIC Building, Opp to Maharaja's College Ground,M.G.Road, Kochi - 682 011."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Kolkata","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: West Bengal, Sikkim, Andaman & Nicobar Islands. Email: oio.kolkata@cioins.co.in. Phone: 033 - 22124339 / 22124341. Address: Office of the Insurance Ombudsman, Hindustan Bldg. Annexe, 7th Floor, 4, C.R. Avenue, KOLKATA - 700 072."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Lucknow","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Districts of Uttar Pradesh : Lalitpur, Jhansi, Mahoba, Hamirpur, Banda, Chitrakoot, Allahabad, Mirzapur, Sonbhabdra, Fatehpur, Pratapgarh, Jaunpur,Varanasi, Gazipur, Jalaun, Kanpur, Lucknow, Unnao, Sitapur, Lakhimpur, Bahraich, Barabanki, Raebareli, Sravasti, Gonda, Faizabad, Amethi, Kaushambi, Balrampur, Basti, Ambedkarnagar, Sultanpur, Maharajgang, Santkabirnagar, Azamgarh, Kushinagar, Gorkhpur, Deoria, Mau, Ghazipur, Chandauli, Ballia, Sidharathnagar. Email: oio.lucknow@cioins.co.in. Phone: 0522 - 4002082 / 3500613. Address: Office of the Insurance Ombudsman, 6th Floor, Jeevan Bhawan, Phase-II, Nawal Kishore Road, Hazratganj, Lucknow - 226 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Mumbai","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: List of wards under Mumbai Metropolitan Region excluding wards in Mumbai – i.e M/E, M/W, N , S and T covered under Office of Insurance Ombudsman Thane and excluding areas of Navi Mumbai. Email: oio.mumbai@cioins.co.in. Phone: 022 - 69038800/27/29/31/32/33. Address: Office of the Insurance Ombudsman, 3rd Floor, Jeevan Seva Annexe, S. V. Road, Santacruz (W), Mumbai - 400 054."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Noida","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Uttarakhand and the following Districts of Uttar Pradesh: Agra, Aligarh, Bagpat, Bareilly, Bijnor, Budaun, Bulandshehar, Etah, Kannauj, Mainpuri, Mathura, Meerut, Moradabad, Muzaffarnagar, Oraiyya, Pilibhit, Etawah, Farrukhabad, Firozbad, Gautam Buddh nagar, Ghaziabad, Hardoi, Shahjahanpur, Hapur, Shamli, Rampur, Kashganj, Sambhal, Amroha, Hathras, Kanshiramnagar, Saharanpur. Email: oio.noida@cioins.co.in. Phone: 0120-4027589. Address: Office of the Insurance Ombudsman, Bhagwan Sahai Palace 4th Floor, Main Road, Naya Bans, Sector 15, Distt: Gautam Buddh Nagar, U.P-201301."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: offices and jurisdiction","url":"https://www.cioins.co.in/Ombudsman","note":"Addresses, phone numbers, e-mail and the states or districts each Ombudsman office covers."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Patna","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Bihar, Jharkhand. Email: oio.patna@cioins.co.in. Phone: 0612-2547068. Address: Office of the Insurance Ombudsman, 2nd Floor, Lalit Bhawan, Bailey Road, Patna 800 001."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Pune","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: State of Goa and State of Maharashtra excluding areas of Navi Mumbai, Thane district,Palghar District, Raigad district & Mumbai Metropolitan Region. Email: oio.pune@cioins.co.in. Phone: 020-24471175. Address: Office of the Insurance Ombudsman, Jeevan Darshan Bldg., 3rd Floor, C.T.S. No.s. 195 to 198, N.C. Kelkar Road, Narayan Peth, Pune – 411 030."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman: register a complaint online","url":"https://cioins.co.in/Complaint/Online","note":"Council for Insurance Ombudsmen. Free. For disputes with an insurer after its own grievance process; the office is chosen by where you live (see the offices list)."},{"purpose":"grievance","kind":"official","name":"Insurance Ombudsman, Thane","url":"https://www.cioins.co.in/Ombudsman","note":"Covers: Area of Navi Mumbai, Thane District, Raigad District, Palghar District and wards of Mumbai , M/East, M/West, N, S and T. Email: oio.thane@cioins.co.in. Phone: 022-20812868/69. Address: Office of the Insurance Ombudsman, Jeevan Chintamani Building, 2nd Floor,Near New RTO Office, Louis Wadi,Vasantrao Naik Mahamarg, Thane (West)- 400604."},{"purpose":"grievance","kind":"official","name":"National Consumer Helpline","url":"https://consumerhelpline.gov.in/public/","note":"Government consumer helpline; can take up a complaint before you go to a consumer commission."},{"purpose":"port","kind":"ours","name":"Get free help from IndiaInsurances","url":"/help","note":"Free. We do not sell insurance and earn no commission; your request is not passed to anyone."},{"purpose":"renew","kind":"insurer","name":"Renew car insurance","url":"https://www.hdfcergo.com/renew-car-insurance","note":null}],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Health Wallet (UIN HDFHLIP27065V032627), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-wallet-hdfhlip27065v032627"}