Overview
The HDFC ERGO Energy Gold plan is a specialized health insurance policy tailored for individuals managing diabetes (Type 1 and Type 2), pre-diabetes, or hypertension. It offers coverage from Day 1 for complications arising from these chronic conditions, eliminating the waiting period for related hospitalizations. Key features include comprehensive wellness benefits, such as two free medical check-ups per year, a personalized wellness portal, and rewards like premium discounts of up to 25% based on health parameters.
Experts Review
Written by Nikhil Nair
Senior Writer
The HDFC ERGO Energy Gold plan is an excellent choice for individuals with diabetes or hypertension seeking immediate coverage and proactive health management. Its standout feature is the inclusion of free wellness tests twice a year, covering key health parameters such as HbA1c, cholesterol levels, BMI, and blood pressure. This proactive approach incentivizes healthy living through reward points that translate into premium discounts or reimbursements, making it a cost-effective option for long-term policyholders.
The plan also provides robust coverage for hospitalization expenses, including pre- and post-hospitalization (30 and 60 days), daycare procedures, and organ donor costs. The absence of room rent restrictions enhances flexibility during hospitalization. Additionally, the Restore benefit reinstates the sum insured once annually if exhausted during claims, ensuring continuous financial protection.
While the Gold variant offers added perks like free wellness check-ups and higher wellness rewards, it comes at a higher cost compared to the Silver plan. The plan also lacks domiciliary hospitalization benefits, which may limit its utility.
Pros
Feature set is satisfactory.
Insurer has a solid track record with great claim and service metrics.
Cons
Premiums are relatively high.
No coverage if you are forced to hospitalize at home, which is a notable gap.
Maternity benefits not offered, which could be a drawback for some.
Doctor consultations are not covered, which is a key feature.
HDFC Ergo
Key Insights
Founded
2002
HDFC Ergo was established 23 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
98% claims settled in 30 Days
HDFC Ergo settles 98% of all claims it receives demonstrating strong credibility.
Network Hospitals
13,000+
HDFC Ergo has a strong network with over 13,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Complaints
7 complaints per 10,000 claims registered
HDFC Ergo maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Pre existing diseases waiting
STANDOUT
If you are already dealing with diabetes or hypertension, then the insurer will cover you from day 1. However, if you are dealing with other pre-existing diseases including thyroid and cardiovascular problems, then you’ll have to wait 2 years before they start covering these complications.
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Customisable
Choose a co-payment of 20% to reduce premiums.
Room Rent
Shared room, single room, deluxe room or any room that’s available. The insurer won’t nitpick on your choice of room since the policy has no restrictions on room rent.
Disease sub-limit
No funny business here. If your insurer hasn’t explicitly stated they won’t cover a certain illness, you can claim the full amount up to the sum insured, irrespective of the disease you’re dealing with. Meaning this policy doesn't impose the dreaded disease wise sub-limits.
Pre/Post hospitalization
No worries if the doctor had to run a host of diagnostic tests before or after hospitalizing you. The insurer has your back. They will cover this amount in full for a pretty reasonable duration - 30 days before you are hospitalized and 60 days after discharge. This includes the cost of medication by the way.
Add-ons
Voluntary Co-Payment
Choose a co-payment of 20% to reduce premiums.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Expense related to pancreatic islet transplantation.
Admission for administration of Intraarticular or Intra-lesional injections, Supplementary medications like Zolendronic acid (Trade name Zometa, Reclast, etc.) or IV immunoglobulin infusion.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 2 years.
Cataract
Benign prostatic hypertrophy (BPH)
Myomectomy
Hysterectomy
All types of hernia
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
2 years Pre-existing disease waiting period
Ditto's Take
◦ Excellent ◦
After a close look at the waiting periods, we can say that the waiting periods on this policy are excellent. Especially the PED waiting period which is better than usual.
What's missing in the policy
No coverage if you are forced to hospitalize at home.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
P
Pragya Mishra
Coverage from Day 1 for diabetes/hypertension complications is a lifesaver for those with these conditions!
P
Pratima Menon
Personalized wellness portal helps manage health effectively.
P
Priya Jain
Eliminates waiting period for related hospitalizations, which is a huge relief.
R
Raghava Bose
Need to consistently meet health parameters to get the full 25% discount.
B
Bhanu H.
Two free medical check-ups per year (HbA1c, cholesterol etc.) is an excellent wellness benefit!
D
Deepak J.
Day 1 coverage for diabetes/hypertension complications is the main draw. Very reassuring.
G
Garima M.
Better than Silver variant due to free check-ups and higher rewards. Good for proactive health management.
J
Jatin P.
Premiums are on the higher side, even for the Gold variant.
M
Mohan Menon
Day 1 coverage for diabetes complications! Unbelievable! Finally a plan for us.
R
Rishi Bhatnagar
Two free medical check-ups per year, helps keep track of health. Very good benefit.
M
Meera Aggarwal
Tailored for diabetes and hypertension, isko bolte hain specialized care!
R
Rohan Dutta
The wellness portal requires regular engagement to get full benefits.
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Frequently Asked Questions
Does Energy Gold have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There’s a 2-year waiting period for a list of diseases which is a mandate before you can start claiming.
- Pre-Existing Disease Waiting Period: There's a 2-year waiting period for any pre-existing disease you may have while buying the policy.
- No waiting period for illnesses and conditions arising out of Diabetes and Hypertension like Type 1 and 2 Diabetes Mellitus, Impaired Fasting Glucose, and Impaired Glucose Tolerance.
Does Energy Gold have room rent restrictions?
Does Energy Gold offer a restoration benefit?
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