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HDFC ERGO Individual Personal Accident is a benefit-based accident policy that pays a lump sum if an accident causes death or permanent disability, along with a library of smaller benefits for situations that follow an accident, such as ambulance, hospital cash, burns, fractures and children's education. It comes in three plan options, Essential, Advanced and Elite, with accidental death sum insured ranging from ₹20 lakh up to ₹10 crore. You can cover yourself, your spouse, dependent children and dependent parents in one policy, and there is no waiting period.
HDFC ERGO's own personal accident plan (not the IRDAI-standard Saral version) — three options, Essential, Advanced and Elite, with accidental death cover from ₹20 lakh to ₹10 crore. Pays a lump sum on accidental death or disability. Premium depends on your occupation class.
This policy is useful as income protection. The payout does not depend on medical bills, and the sum insured is linked to your income, 20 times annual income for salaried people and 25 times for self-employed people, so the cover tracks what your family would lose. The plan you pick decides how many extras you get. Essential covers the core benefits plus ambulance, hospital cash, outpatient expenses and prosthetics. Advanced and Elite add benefits such as broken bones, burns, adventure sports, air ambulance and head and spinal injury tests, and Elite adds coma, elderly care and marriage expenses for children. Temporary total disablement, accidental in-patient hospitalisation and loan secure are optional in every plan. Only accidents are covered. Illness and natural death are outside the policy, premium depends on your occupation class, and income proof is needed depending on the sum insured.
HDFC ERGO Health Insurance
Key Insights
Founded
2002
HDFC ERGO Health Insurance was established 24 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
97.9% CSR, calculated as a 3-year average
HDFC ERGO Health Insurance settles 97.9% of all claims it receives, demonstrating strong credibility.
Network Hospitals
12,000–14,000
HDFC ERGO Health Insurance has a network of 12,000–14,000 hospitals, ensuring wide accessibility and convenience for policyholders.
Essential has an accidental death sum insured from ₹20 lakh to ₹1 crore, Advanced from ₹1 crore to ₹2.5 crore and Elite from ₹2.5 crore to ₹10 crore. Higher plans carry larger limits on the smaller benefits and add more benefits.
HDFC ERGO's library of benefits also includes other packaged variants, such as Trekker, Trip and Backpacker. This page covers Essential, Advanced and Elite.
The sum insured is paid to the nominee if an accidental bodily injury during the policy period is the sole and direct cause of death within 365 days of the accident.
A set percentage of the sum insured is paid for permanent total disablement and permanent partial disablement caused by an accident, as per the scale in the policy. These benefits can go up to the accidental death sum insured.
The disablement must be the sole and direct result of the accident and occur within 365 days of it.
For the policyholder, the sum insured can be up to 20 times annual income if salaried and 25 times if self-employed or a business owner. An earning spouse gets the same multiples, capped at the policyholder's sum insured.
A non-earning spouse or dependent parents can have up to 50% of the policyholder's sum insured, with a maximum of ₹1 crore. A dependent child can have up to 25% of the policyholder's sum insured, with a maximum of ₹25 lakh. Income proof is needed depending on the sum insured.
The sum insured increases by 5% each year, up to 50% of the accidental death sum insured, irrespective of claims. The bonus applies to the accidental death, permanent total disablement and permanent partial disablement sums insured only.
Cumulative bonus cannot be transferred from another insurer.
Optional. Pays a weekly benefit equal to 1% of the sum insured for up to 100 weeks while an accident stops you from working. The cap is ₹5 lakh on Essential, ₹25 lakh on Advanced and ₹50 lakh on Elite.
Available only to earning members. It is not available to non-earning members and children.
Optional. Reimburses medical expenses for accidental hospitalisation, including 30 days of pre-hospitalisation, 60 days of post-hospitalisation and day care procedures. The sum insured is ₹1 lakh on Essential, ₹3 lakh on Advanced and ₹5 lakh on Elite. 100% of it is added again when it is partly or fully used.
Conditions or treatments that the policy clearly says it will not cover.
Insurer
HDFC ERGO Health Insurance plans and claim process
It is an accident-only insurance policy that pays a lump sum on accidental death, permanent total disablement and permanent partial disablement, along with a library of extra benefits for events that follow an accident. Examples include emergency ambulance, hospital cash, burns, fractures, an education fund and loan secure. It can cover you, your spouse, dependent children and dependent parents in one policy.
They are three plan options. Essential offers an accidental death sum insured from ₹20 lakh to ₹1 crore, Advanced from ₹1 crore to ₹2.5 crore and Elite from ₹2.5 crore to ₹10 crore. All three include core benefits such as ambulance, hospital cash, out-patient expenses and prosthetics. Advanced and Elite add benefits like broken bones, burns, adventure sports and air ambulance, and Elite also adds coma, elderly care and marriage expenses for children.
Disclaimer: Premium amounts are indicative and may vary based on age, health, and plan selected. Claim settlement ratios are from IRDAI Annual Reports. Finzony is not an insurance broker or agent. Verify all details on the official HDFC ERGO Health Insurance website before purchasing.
Contact Details
1800-2700-700
Headquarters: 6th Floor, Leela Business Park, Andheri-Kurla Road, Andheri (East), Mumbai – 400 059, Maharashtra, India
The aforementioned ratios have been averaged over three years (FY24-FY26)
In-patient care under AYUSH systems is covered only when taken in an AYUSH hospital.
Optional. Pays the outstanding principal loan amount on accidental death or permanent total disablement, up to the accidental death sum insured.
Arrears and penalties charged by the bank or lender are not included. Available only to earning members.
For the policyholder, it can be up to 20 times annual income if salaried and 25 times if self-employed or a business owner. An earning spouse gets the same multiples, capped at the policyholder's sum insured. A non-earning spouse or dependent parents can have up to 50% of the policyholder's sum insured, with a maximum of ₹1 crore, and a dependent child up to 25% with a maximum of ₹25 lakh. Income proof is needed depending on the sum insured.
The policyholder and adult dependents can join from 18 to 69 years, and dependent children from 91 days to 25 years. A child aged 91 days to 5 years can be covered only if a parent is also covered under the same policy. There is no maximum cover-ceasing age on renewal. A child covered as a dependent is offered a separate individual policy at renewal after completing 25 years.
Three are optional in every plan. Temporary total disablement pays a weekly benefit of 1% of the sum insured for up to 100 weeks while an accident stops you from working. Accidental in-patient hospitalisation with restore reimburses hospital costs and restores the sum insured once used. Loan secure pays your outstanding principal loan on accidental death or permanent total disablement. Temporary total disablement and loan secure are available only to earning members.
There is no waiting period in the policy. The cumulative bonus adds 5% of the accidental death sum insured each year, up to 50%, irrespective of claims, and applies to the accidental death, permanent total disablement and permanent partial disablement sums insured. The bonus cannot be transferred from another insurer.
Illness and natural death are not covered, and neither are intentional self-injury, suicide, abuse of intoxicants, breach of law, war and nuclear events, maternity, external congenital conditions and sexually transmitted diseases other than HIV and AIDS. Adventure sports are excluded unless you opt for the Adventure Sports benefit, and professional participation in hazardous sports is excluded.
You can buy a 1, 2 or 3 year policy. A 2-year policy earns a 7.5% discount and a 3-year policy earns 10%. Covering two or more members under one policy earns a 10% family discount. Premium depends on the sum insured, your occupation class and your health, so riskier occupations pay more.