HDFC ERGO Health Insurance Claim Process — Step-by-Step Guide

Call HDFC ERGO helpline or use their app to register your claim. For planned hospitalization, intimate 3-5 days before admission. Emergency cases can be intimated within 24 hours of admission.

Keep your policy number and health card handy. Note down the claim reference number.

Cashless: Visit a network hospital — HDFC ERGO pays directly. Reimbursement: Pay first, submit bills later. Cashless is recommended as you pay zero upfront at network hospitals.

Always check if your hospital is in HDFC ERGO's network before choosing cashless.

The hospital sends a pre-authorization form to HDFC ERGO. The insurer reviews and approves within 2-4 hours. Show your health card and ID at the hospital helpdesk.

If pre-auth is partially approved, you can appeal with additional medical documents.

Collect all documents: Policy copy, ID proof (Aadhaar/PAN), hospital bills with payment receipts, discharge summary, doctor consultation papers, investigation reports, pharmacy bills, and filled claim form.

Take photos of all documents as backup. Get itemized bills instead of consolidated bills.

For cashless: Pay only non-covered amount (deductibles, co-pay). For reimbursement: Submit claim form with all documents within 15-30 days. HDFC ERGO processes claims as per IRDAI guidelines.

IRDAI mandates claim settlement within 30 days. If delayed beyond 30 days, insurer pays interest.

If HDFC ERGO rejects your claim, ask for written rejection reason. File an appeal with the insurer's grievance cell within 15 days. If unresolved, approach Insurance Ombudsman (free service). Call Paliwal Secure for free claim assistance.

Don't accept rejection easily. HDFC ERGO's grievance cell must respond within 15 days. Insurance Ombudsman resolves most cases within 1-3 months.