[Resolved]  HDFC Bank Ergo — Why my policy is not covered for Pregnancy.

Name:- Nanda Kishore Bhosle Policy number :[protected] Phone Number:- [protected] I have been using the Health Card from 2009(With BajajAllianz) before its was migrated to HDFC ERGO. I have taken this policy from the HDFC Credit Card. Few days back I called the customer care execute for the claim. He said that I am eligible only if I have the policy for 4 years continuously. When I told them that I am using the card before it was migrated to HDFC ERGO, then they said that they don’t have the detail’s and asked for the policy papers of the Bajaj Allianz. When I got the policy number of that they started saying that it is covered only to the Health Suraksha Policy with Gold and Silver. They never told me before what kind of card I have. Along with the renewal document they have sent me a set of documents which say that Maternity Expenses will be covered. This wordings are mentioned in the Policy Wording under Section 2. In the document they no where mentioned that it was for Gold or Silver card holders.Even when we purchase the policy online it never asks for which kind of Suraksha policy we are purchasing. Please do justice for me in this regards. Its costing me more than 50 thousand now. The case with my wife is not a normal pregnancy. Its a highly complicated and Risk Pregnancy. She is carrying a 37 weeks of pregnancy with GDM, with Hypothyroidism, with Rh negative pregnancy with previous cesarean section with breech presentation with corrected anemia which is considered as a very high risk pregnancy and the concerned doctor is expecting delivery at 38 completed weeks by C-Section. Please do Justice for me .
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Aug 14, 2020
Complaint marked as Resolved 
 
2 Comments

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Dear Mr.Nandakishore,

Thank you for sharing the required details.
We will look into the matter and get back to you shortly.

For any queries please feel free to call our Toll-Free:

[protected]from any Landline & Mobile)
[protected]from MTNL or BSNL Phone)


Regards,

HDFC ERGO General Insurance
Dear Mr. Bhosle,

As informed to you earlier through e-mail dated 20th September 2013, we wish to inform you that the benefits pertaining to maternity expenses are optional and it is only effective if shown in the policy schedule.

Please find the coverage details mentioned below with regards to your query of pre and post hospitalization.

Pre Hospitalization: Pays for medical expenses incurred due to an illness 60 Days prior to Hospitalization provided that:

Such Medical Expenses were in fact incurred for the same condition for which the Insured Person’s subsequent Hospitalisation was required, and we have accepted an inpatient Hospitalisation claim under Benefit of In Patient Treatment.
Post Hospitalization: Pays for medical expenses incurred due to an illness 90 Days post discharge from the Hospital provided that:

Such costs are incurred in respect of the same condition for which the Insured Person’s earlier Hospitalisation was required.

We have accepted an inpatient Hospitalisation claim under Benefit of In Patient Treatment.

For any further queries please feel free to contact us on:

Toll- Free Helpline :
[protected] from any Landline & Mobile
[protected] from MTNL or BSNL Phone

E-mail address : [protected]@hdfcergo.com

Regards,
Team HDFC ERGO

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