HDFC ERGO General Maxima Health Plan

What is the Plan all About?

HDFC ERGO General Maxima health plan offers unique out-patient cover apart from the wide in-patient cover. It provides cover against in-patient hospitalization expenses plus other small day-to-day health problems that usually don’t require hospitalization. In a real sense, this health plan provides you a complete health cover.

There are 3 plan options you can chose under this plan:

1 member
2 members
2 adults+ up to 2 children

Key Features

Wide in-patient & out-patient cover
No sub-limits are applicable
Enjoy cashless hospitalization across 4000+ network hospitals
Add-on cover for critical illness
Lifelong Renewability

Policy Benefits

In-patient hospitalization such as room rent, boarding, ICU charges, Operation Theater Charges, Medicines, Diagnostic Procedures, etc. are covered.
Pre-hospitalization expenses incurred before hospitalization are covered up to 30 days.
Post-hospitalization expenses incurred after hospitalization are covered up to 60 days.
140 enlisted day care procedures that require the insured person to get hospitalization for less than 24 hours are covered.
Organ donor medical expenses are covered for harvesting of the organ.
Domiciliary treatment is covered, when hospitalization goes beyond 3 continuous days.
Daily Cash Benefit is payable for choosing shared accommodation & accompanying an insured child.
Maternity expenses, including pre & post natal are covered up to the limits specified in the policy.
Newborn baby cover is available as an add-on and it covers newborn from day 1-90.
Optional benefit to get coverage against listed critical illnesses. It provides a lump sum benefit to all family members on Individual Sum Insured Basis equivalent to Rs.3 Lacs.
Outpatient benefits such as doctor consultations, diagnostic tests, pharmacy, dental treatment, spectacles & contact lenses, and annual health check-up. Pre-existing illnesses are covered under OPD benefits.

Value Added Benefits

For in-patient treatment, get a cumulative bonus of 10% on every claim-free year, to a maximum of 50% of the sum insured. For out-patient, 50% of any un-utilized entitlement certificates can be carried forward to the next policy year. This benefit does not include annual health check-up.
Emergency ambulance services are payable.
Annual health check ups for every insured person above 18 years.
Maternity expenses for normal delivery- Rs 15,000 and Caesarean delivery- Rs 25,000 are payable.
Opt ‘Stay Healthy’ package to get an online health assessment, offers & discounts on health products, customized diet plan, and many more.
Avail tax benefits u/s 80D as per IT Act, 1961 for premium paid for this plan.

Sub Limits

No room rent limit is applicable under the plan.
Daily cash benefit (shared accommodation) of Rs 500 per day, to a maximum of Rs 3000 is payable. Daily cash benefit (accompanying the insured child) of Rs 300 per day, maximum of Rs 9000 is payable.
Expenses incurred for Emergency Ambulance are covered up to Rs 2000 per hospitalization.
Doctor consultations are restricted up to 4/6/8 consultations for policies opted for 1 member, 2 members and 2 adults+ up to 2 children respectively.
Diagnostic tests, pharmacy, dental treatment, spectacles & contact lenses are covered up to Rs 5000/5500/7000 under 1 member, 2 members and 2 adults+ up to 2 children respectively.
Annual health check-up is provided with 12/3 entitlement certificate for for 1 member, 2 members and 2 adults+ up to 2 children policies respectively.

Waiting Period Clause

Initial Waiting Period: A waiting period of 30 days from the inception date for all hospitalization claims except in case of accidents.
Specific Waiting Period: Specific illnesses such as ENT Disorders, Joint Replacement, hemorrhoids,etc.are covered after 24 months of policy coverage.
Pre existing Disease Waiting Period: Any pre-existing ailment/injury is covered after a continuous policy coverage for 36 months.
Maternity Waiting Period: Maternity expenses incurred are covered after a waiting period of 4 years.

Who can Buy the Plan?

Factor	Minimum	Maximum
Age (as on last birthday)	Adult: 18 Years, Children: 91 Days	65 Years
Sum Assured	3 Lacs	3 Lacs
Cover Type	Individual/Family Floater	-
Policy Tenure	1 Year	1 Year
Grace Period	30 Days	-
Free Look Period	15 Days	-
Riders	Newborn Baby Cover, Critical Illness Cover	-