HDFC Ergo was founded in 2002 as a joint venture between India’s HDFC and Germany’s ERGO International AG. Over the last couple of decades, this general insurance brand has built its credibility with its long list of financial products. As a health insurance provider, HDFC Ergo is one of the most popular picks in the industry, considering its list of value-worthy comprehensive policies. The only caveat for the brand is that health insurance plans from this brand tend to be a bit expensive as compared to the others in its class.
| Pros | Cons |
|---|---|
| Comprehensive health insurance plans | Plans are expensive. |
| Excellent Claim Settlement ratio | |
| Great Incurred Claim Ratio | |
| Low complaint volume |
Metrics of HDFC Ergo Health Insurance
HDFC Ergo has an excellent insurance track record with feature-rich policies, valuable add-ons, and excellent claim settlement history. This robust track history has earned them a vast client pool nationwide. While this proves its credibility by word-of-the-mouth in the industry, determining its reputation and sustainability depends on a few metrics.
Please note: Across the following metrics, we have considered 3-year data. This helps you gauge the consistency of the insurer.
Claim Settlement Ratio of HDFC Ergo Health Insurance
Claim Settlement Ratio, or CSR, is one of the primary metrics used to determine the insurer's credibility. It is calculated by -
(Total number of claims settled by an insurer in a year/Total number of claims raised to the insurer in the year) * 100
In calculating the annual total of settled claims, outstanding claims from the previous year are combined with those resolved in the current year, while unresolved claims are disregarded.
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If the CSR is less than 80 - Steer clear of this insurer. With such a low CSR, the insurer most likely doesn’t settle claims adequately. As potential policyholders, this exposes you to high risks of rejecting valid claims.
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If the CSR is more than 90 but less than 100 - This is the ideal range in CSR. You have made a solid pick if your insurer lies in this range.
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If the CSR is more than 100 - While this CSR score is more than perfect, this is not a good sign. During CSR calculation, outstanding claims of the last year are considered. Hence, any insurer with a CSR above 100 has delayed claim settlements. And as a health insurance policyholder, delayed claim settlement is the last thing you want.
| Years | HDFC Ergo Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 97 | 91.484 |
| 2021 - 2022 | 100 | 89.967 |
| 2022 - 2023 | 95.49 | 91.460 | Average (2020 - 2023) | 97.50 | 90.970 |
Insight: HDFC Ergo has one of the best CSRs in the industry, and its numbers have been consistently above the industry average over the years. This is an excellent sign for potential policyholders. Although CSR is only one of the metrics used to determine an insurer’s credibility, HDFC Ergo is already proving to be a good pick.
Incurred Claim Ratio of HDFC Ergo Health Insurance
While CSR reveals the number of claims settled by an insurer across a year, you need deeper insights. You need to know how much of the claim is being settled by the insurer if the insurer is paying claims partially or wholly. The Incurred Claim Ratio of an insurer, which is given by -
(The amount of claim settled by an insurer in a year/ The total amount collected by the insurer via premiums in the year) * 100
-helps reveal the total amount settled via claims.
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If the ICR is less than 50 - The insurer is most likely focused on its business interests, ignoring the complete settlement of claims. This is not a good sign for policyholders, who might face rejection of their valid claims or partial settlement of claims.
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If the ICR is between 50 and 70 - This is considered the ideal range for health insurance providers. Insurers within this range of ICR (may go a bit higher) reveal that the health insurance provider pays equal attention to settling claims from policyholders and ensuring its business stability.
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If the ICR is more than 100 - Such insurers are paying off excess claims to their policyholders. While this might be a good sign for policyholders, initially, in the long run, this isn’t promising. Paying off many claims indicates that the insurer may soon face a financial crunch and develop sustainability issues for the brand.
| Years | HDFC Ergo Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 79.3 | 78.27 |
| 2021 - 2022 | 97.47 | 91.79 |
| 2022 - 2023 | 79.04 | 78.82 | Average (2020 - 2023) | 85.27 | 82.96 |
Insight: While the ICR for HDFC Ergo may not be in the ideal range, the numbers are a positive sign for policyholders. This indicates that while the insurers may pay higher claims, they prioritise client requirements over their business profits. Also, since these numbers haven’t crossed 100 once over the last 3 years, the consistency is much appreciated.
Complaint Volume of HDFC Ergo Health Insurance
You should examine a health insurance provider's complaint numbers to determine its credibility. The higher the complaint numbers, the worse it is for the insurer. And since most complaints are related to claim settlement, insurers with high complaint volume should be avoided.
| Years | HDFC Ergo Health Insurance | Industry Average |
|---|---|---|
| 2020 - 2021 | 6.21 | 13.212 |
| 2021 - 2022 | 7.95 | 35.969 |
| 2022 - 2023 | 6.23 | 19.578 | Average (2020 - 2023) | 6.80 | 24.029 |
Insight: HDFC Ergo has one of the lowest complaint volumes in the health insurance industry, which is no surprise considering its market reputation of streamlined claim settlement. This reflects why HDFC Ergo remains a top recommendation for individuals seeking health insurance plans.
Top Health Insurance Plans Offered by HDFC Ergo Health Insurance
Over the decades, HDFC Ergo has developed diverse, industry-first feature-loaded, comprehensive health insurance policies. Such policies cater to the policyholders' health and financial goals, owing to customisation over multiple affordable add-ons.
As the 2.0 versions of Optima Restore (HDFC Ergo’s flagship program), Optima Secure and Optima Super Secure are worthy of purchase. The plan offers 2 times and 3 times (based on the chosen variant) the cover amount you have selected right after the commencement of the policy. The plan has no room rent restrictions, co-payment, or disease-wise sub-limits. The Optima Super Secure / Secure policy includes a host of add-ons:
- Unlimited Restoration,
- Critical Illness Cover,
- Hospital Daily Cash,
- Individual Personal Accidents and
- Aggregate Deductible.
Drawbacks: Like any policy from HDFC Ergo, the plan is a tad bit pricey. Moreover, the policy requests a pre-existing waiting period of 3 years.
This is the flagship health insurance product from the stable of HDFC Ergo, and despite being followed up with multiple updated policies, it remains a popular choice among policyholders. The plan is comprehensive, affordable, and without many restrictions. The policy covers all the bases - no room rent restrictions, copayment, disease-wise sub-limits, domiciliary and daycare coverage, and an attractive No-Claim Bonus.
Drawbacks: While the plan is relatively affordable (compared to similar plans from HDFC stable), it misses out on its coverage for alternative treatments, i.e., AYUSH treatments. Additionally, the policy has a 3-year pre-existing waiting period. Since this is a solid pick from the health insurance plan lineup from HDFC, a 2-year waiting period would have been much better!
This is an excellent policy from HDFC Ergo. The plan offers extensive coverage (₹7.5 lakhs to ₹15 lakhs), has no unreasonable terms and conditions, and is affordable. This comprehensive plan also provides you with an optional co-payment feature (that you should never avail of) and several add-ons, namely -
- Preventive Health Check-Up Booster,
- Parent and Child Care Cover,
- Parent and Child Care Cover – Booster,
- Air Ambulance Cover,
- Recovery Benefit,
- Sum Insured Rebound,
- Outpatient Dental Treatment,
- External Medical Aids,
- Major Illness Hospitalization Expenses,
- Non-Medical Expenses Cover, and
- Waiting period Modification Option.
Drawbacks: The plan rarely has a drawback. However, there are a couple of scopes for improvement - the waiting period for pre-existing conditions is 3 years, and the No-Claim Bonus starts from a bare 10% (to a maximum of 100%).
Conclusion
If you are looking for a credible health insurance provider with a host of comprehensive policies and don’t mind the slightly increased premiums, HDFC Ergo is your sweet spot. While we have been mentioning its pricier premiums, you should also remember that against such raised premiums, you get guaranteed assurances about HDFC’s timely settlement of claims.