Overview
The HDFC ERGO my:Health Koti Suraksha plan is a comprehensive health insurance policy offering coverage of 50L & 1CR. Divided into two sections—hospitalization cover and personal accident cover, the plan provides robust protection against medical expenses and accidental injuries. While the former covers pre- and post-hospitalization expenses, daycare treatments, domiciliary hospitalization, organ donor costs, and home healthcare services, the latter includes coverage for accidental death, permanent disablement, broken bones, and temporary total disablement. The plan also offers optional add-ons such as medical evacuation, waiver of co-payment, waiver of room rent capping, and non-medical expense cover.
Experts Review
Written by Nikhil Nair
Senior Writer
The HDFC ERGO my:Health Koti Suraksha plan excels in providing extensive coverage for both medical and accidental emergencies, making it a versatile choice for individuals and families. Its standout feature is the flexibility to customize coverage through add-ons like Sum Insured Rebound (restoration benefit), cumulative bonus booster (up to 100% increment in sum insured), and last rites expenses.
The plan’s coverage for pre- and post-hospitalization expenses is generous—60 days before admission and 180 days after discharge. Additionally, annual preventive health check-ups promote proactive health management. The personal accident section provides unique benefits such as chauffeur allowances for temporary disabilities and broken bone coverage, further broadening its utility.
However, the plan has certain limitations. Sub-limits apply to specific conditions like cataract and benign tumors, etc., capping payouts at ₹75,000 despite the high sum insured. Another drawback is the premium pricing, which is competitive but may be high for those opting for extensive add-ons.
Pros
Great pick if you're looking for something affordable.
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, 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
Bad
Co-payment
If you bought this policy after you turned 61 or made a claim for PED while you are serving the PED waiting period, you have to pay 20% of the bill every time you make a claim. Otherwise, you are good to go. The insurer will pay all costs up to the sum insured.
Room Rent
You can share a room or you could have a single room for yourself. But if you are looking for anything slightly fancy, be ready to foot a part of the bill.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for Cataract, Benign – Tumours/Cysts/Nodule/Polyp, Stone in Urinary System, Hernia Related, Appendectomy, Hysterectomy and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
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 - 60 days before you are hospitalized and 180 days after discharge. This includes the cost of medication by the way.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Any Convalescence, sanatorium treatment, private duty nursing, or long-term nursing care.
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.
Custodial care at home or in a facility for help with daily activities is 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.
Internal congenital diseases
Non-infective arthritis
Pilonidal sinus
Gallbladder diseases (including cholecystitis)
Kidney, ureter, bladder stones
Waiting Period
30 days Initial waiting period
2 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
Maternity benefits not offered.
Doctor consultations are not covered.
Customer Reviews
V
Varun B.
Coverage up to ₹1 crore is massive! Plus optional personal accident cover included. Very comprehensive.
X
Xavier D.
Generous pre- (60 days) and post-hospitalization (180 days) coverage. Excellent for recovery.
D
Divya J.
Premiums can be high, especially if you opt for many add-ons.
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Frequently Asked Questions
Does myHealth Koti Suraksha 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 3-year waiting period for any pre-existing disease you may have while buying the policy.
Does myHealth Koti Suraksha have room rent restrictions?
Does myHealth Koti Suraksha offer a restoration benefit?
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