What is the difference between Silver and Gold?

Both variants have the same sum insured options and the same health cover. In Gold, HDFC ERGO bears the cost of the wellness tests, either at an empanelled centre or as a reimbursement of up to ₹2,000 at an approved centre. In Silver, the cost of the wellness tests is yours. Each variant is available without co-payment or with a 20% co-payment, where you bear 20% of the eligible claim.

How do the restore benefit and cumulative bonus work?

When your sum insured and any cumulative bonus are partly or fully used, 100% of the base sum insured is restored instantly. This happens only once in a policy year and the restored amount does not carry forward. The cumulative bonus adds 10% of the base sum insured after every claim-free year, up to 100%. If you claim after a bonus has built up, the bonus reduces by 10% of the sum insured the next year.

What sum insured options are available?

You can choose ₹2 lakh, ₹3 lakh, ₹5 lakh, ₹10 lakh, ₹15 lakh, ₹20 lakh, ₹25 lakh or ₹50 lakh. You can increase the sum insured only at renewal and only if no claim has been lodged or paid. A one-grid increase needs no fresh medical tests, while a bigger increase does, and the waiting period applies afresh to the added amount.

What is not covered by Energy?

Among others, treatment outside India, outpatient treatment, maternity and infertility treatment, cosmetic surgery, dental treatment that does not need hospitalisation and non-medical expenses are not covered. Pre-existing conditions other than diabetes and hypertension are covered only after 24 months, and the listed conditions carry a 24-month waiting period.

HDFC ERGO my:health Energy: Diabetes Cover

Q: Who can buy Energy and what are the age limits?

Adults aged 18 to 65 years at entry who are currently diagnosed with Type 1 or Type 2 diabetes, pre-diabetes or hypertension can buy the plan. There is no maximum cover-ceasing age, so you can keep renewing. A pre-policy check-up at a network centre is required for every proposal, and the cost is reimbursed once the proposal is accepted.

Q: How does the wellness programme and reward points work?

You get two check-ups in a policy year: a half-yearly one and an annual one. Your results on HbA1c, blood pressure, BMI and cholesterol earn incentive points, and the points decide your discount on the renewal premium and a reimbursement for health care expenses. The discount ranges from 5% to 25% of the renewal premium, based on points. Reports must be submitted within the time windows in the policy, or they are not counted.

my:health Energy Overview

my:health Energy is an HDFC ERGO health insurance plan built for people who are already diagnosed with Type 1 diabetes, Type 2 diabetes, pre-diabetes (Impaired Fasting Glucose or Impaired Glucose Tolerance) or hypertension. Most plans make you wait before treatment for these conditions is covered. Energy pays for hospitalisation arising from diabetes and hypertension from day one. Sum insured options run from ₹2 lakh to ₹50 lakh on an individual basis. The plan comes in Silver and Gold variants, each with or without a 20% co-payment, and includes a wellness programme with check-ups twice a year and reward points that can cut your renewal premium.

Covers hospitalisation arising from diabetes and hypertension from day one, with no waiting period for these conditions. Comes in Silver and Gold variants, with an optional 20% co-payment. The premium can be loaded after the pre-policy check-up.

Expert Review of my:health Energy

The main reason to look at Energy is the day-one cover. Hospitalisation arising from diabetes or hypertension is covered with no waiting period, and there is no general 30-day waiting period either. The plan also adds a restore benefit, a cumulative bonus, a yearly HbA1c check-up reimbursement and a wellness programme that can earn up to 25% off your renewal premium. The trade-offs are about eligibility and cost. Adults can join only between 18 and 65 years, the plan is for individuals only, and a pre-policy check-up is required for every proposal, after which HDFC ERGO can load the premium by up to 100% per condition and 150% overall. Pre-existing conditions other than diabetes and hypertension still carry a 24-month waiting period, and the restore benefit works only once in a policy year. The Gold variant costs more than Silver because HDFC ERGO pays for the wellness check-ups. The optional 20% co-payment lowers the premium but you then share every eligible claim.

Pros

Hospitalisation arising from diabetes and hypertension is covered from day one, with no waiting period.
No general 30-day waiting period.
Restore benefit and a cumulative bonus of 10% per claim-free year, up to 100%.
A wellness programme with two check-ups a year, an HbA1c reimbursement and reward points that can earn up to 25% off the renewal premium.
No cover-ceasing age, and no loading on renewal because of claims.
All day care procedures are covered, and sum insured goes up to ₹50 lakh.
A 20% co-payment option lowers the premium for those willing to share claims.

Cons

Adults can join only between 18 and 65 years, and the plan is for individuals only.
Pre-existing conditions other than diabetes and hypertension are covered only after 24 months, as are the listed conditions.
A pre-policy check-up is required for every proposal and the premium can be loaded by up to 100% per condition and 150% overall.
The restore benefit works only once in a policy year, and a single claim cannot exceed the base sum insured plus any cumulative bonus.
Premium bands in the prospectus rise steeply with age, and Gold costs more than Silver.

About HDFC ERGO (Insurer Profile)

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.

my:health Energy Features and Benefits

Day-one cover for diabetes and hypertension

Hospitalisation arising out of diabetes and hypertension is covered from the first day of the policy, along with the complications connected to these conditions. There is no waiting period for them, and no general 30-day waiting period applies to the plan.

Other pre-existing conditions are covered only after 24 months of continuous coverage.

Who can be covered

The plan is for adults aged 18 to 65 years at entry who are currently diagnosed with Type 1 diabetes, Type 2 diabetes, pre-diabetes (Impaired Fasting Glucose or Impaired Glucose Tolerance) or hypertension. There is no maximum cover-ceasing age on renewal.

The plan is issued to an individual only, on an individual sum insured basis.

Sum insured options

You can choose a sum insured of ₹2 lakh, ₹3 lakh, ₹5 lakh, ₹10 lakh, ₹15 lakh, ₹20 lakh, ₹25 lakh or ₹50 lakh.

You can raise the sum insured only at renewal, and only if no claim has been lodged or paid under the policy. A one-grid increase needs no fresh medical tests, while a larger increase does, and the waiting period applies afresh to the added amount.

Silver and Gold variants, with or without co-payment

Silver and Gold have the same sum insured options and the same health cover. The difference is the wellness programme: in Gold, HDFC ERGO bears the cost of the wellness tests, and in Silver the cost of the tests is yours. Each variant is available without co-payment or with a 20% co-payment.

With co-payment, you bear 20% of the eligible claim amount under in-patient treatment, pre and post hospitalisation, day care, organ donor, shared accommodation and ambulance cover. The co-payment does not reduce the sum insured.

In-patient hospitalisation

Covers treatment where you stay in a hospital for more than 24 hours: room rent or boarding, nursing, ICU, medical practitioner fees, anaesthesia, blood, oxygen, operation theatre, surgical appliances, medicines, consumables, diagnostic procedures and internally implanted prosthetics or devices.

Treatment outside India and treatment at a facility that is not a hospital are not covered.

Pre and post hospitalisation

Consultations, investigations and medicines are covered for up to 30 days before hospitalisation and up to 60 days after discharge.

The expenses must relate to the same condition as the admission, and the in-patient or day care claim must be admitted.

Day care procedures

Medical treatment or surgery under general or local anaesthesia in a hospital or day care centre for less than 24 hours is covered, where technology means it would otherwise have needed a stay of more than 24 hours.

Outpatient treatment and admissions only to give a drug or medication, other than cancer chemotherapy, are not covered.

Organ donor expenses

Covers the medical treatment of the organ donor for harvesting the organ, including surgery to remove the organ, when the recipient's in-patient claim is admitted.

The donor's pre and post hospitalisation expenses are not covered, and the admission must comply with the Transplantation of Human Organs Act.

Emergency ambulance

Expenses on an ambulance in an emergency are covered up to ₹2,000 per hospitalisation.

The ambulance service must be from a registered provider.

Shared accommodation benefit

If you are hospitalised in shared accommodation in a network hospital, a specified condition in the policy wording is waived.

The prospectus refers to Section 3 B (xxxi) of the policy wording for this waiver, so check the wording for the exact effect.

Restore benefit

When your sum insured and any cumulative bonus are partly or fully used, 100% of the base sum insured is added instantly. The total is available for in-patient claims for the rest of the policy year.

The sum insured is restored only once in a policy year, an unused restored amount does not carry forward, and a single claim cannot exceed the base sum insured plus any cumulative bonus.

Cumulative bonus

After every claim-free policy year, a 10% cumulative bonus on the base sum insured is added for the next year if you renew without a break, up to a maximum of 100%.

If you claim after a bonus has built up, the accrued bonus reduces by 10% of the sum insured the next year. The in-patient sum insured is not affected.

HbA1c check-up benefit

HDFC ERGO reimburses up to ₹750 per claim for an HbA1c check-up on submission of the original payment receipt.

A maximum of two claims in a policy year, with at least 3 months between the two tests. On Gold, HbA1c tests done under the wellness programme are not counted for this benefit.

Wellness programme with two check-ups a year

You get two medical check-ups in a policy year. The half-yearly check-up covers HbA1c, blood pressure, BMI and a specialist consultation. The annual check-up adds a wider panel including fasting blood sugar, lipid profile, kidney and liver tests, an ECG and a doctor consultation.

On Gold, the check-ups are done by an empanelled centre at HDFC ERGO's cost, or HDFC ERGO reimburses up to ₹2,000 against the bill at an approved centre. Reports must be submitted within the stated windows. You also get a personalised wellness web portal, newsletters and a helpline.

Reward points and renewal discount

Your check-up results on HbA1c, blood pressure, BMI and cholesterol earn incentive points. Based on points, you can get a 5%, 10%, 20% or 25% discount on the renewal premium, and a reimbursement of up to the same percentage of the renewal premium for health care expenses such as consultations, medicines, diagnostics and dental.

The discount and reimbursement apply from the next policy year and are reassessed each year. A reimbursement can be claimed once in the policy period, and unclaimed amounts do not carry forward.

Waiting periods reduce on renewal

The waiting periods mentioned in the policy wording reduce by 1 year on every continuous renewal of the Energy policy.

Pre-policy check-up

A pre-policy check-up at a network centre is required for all proposals, and 100% of the cost is reimbursed once the proposal is accepted. HDFC ERGO can accept the proposal, add an exclusion or load the premium based on the results.

The maximum loading is 100% per diagnosis or medical condition and 150% overall for an individual. If the proposal is declined, the cost of the check-up is deducted from the refundable premium.

Renewal terms

Renewal cannot be denied because you made a claim, and no loading applies on renewal based on your claims. You can renew within a 30-day grace period to keep continuity, although there is no coverage during the grace period.

Premium on renewal can change because of your age or a change in tax rates, and premium rates need IRDAI approval to change.

Tax benefit

The premium qualifies for a deduction under Section 80D of the Income Tax Act, subject to changes in tax laws.

What my:health Energy Does Not Cover (Exclusions)

Conditions or treatments that the policy clearly says it will not cover.

Treatment availed outside India.
Treatment at a healthcare facility that is not a hospital.
Treatment for which hospitalisation is not necessary.
Pre-existing diseases other than diabetes and hypertension, and their direct complications, until 24 months of continuous coverage are complete.
Admissions primarily for diagnostics and evaluation, and diagnostic expenses unrelated to the current treatment.
Admissions primarily for enforced bed rest, custodial care, rehabilitation or respite care.
Surgical treatment of obesity unless it meets the clinical, age and BMI conditions in the policy.
Change-of-gender treatments.
Cosmetic or plastic surgery, unless it is reconstruction after an accident, burns or cancer, or is medically necessary and certified by the treating doctor.
Treatment arising from professional participation in hazardous or adventure sports.
Treatment arising from committing or attempting to commit a breach of law with criminal intent.
Treatment at hospitals or by providers specifically excluded by the insurer.
Treatment for alcoholism, drug or substance abuse or any addictive condition.
Treatment in health hydros, nature cure clinics, spas or similar establishments.
Dietary supplements and substances that can be bought without a prescription, unless prescribed as part of a hospitalisation or day care claim.
Correction of eyesight for refractive error below 7.5 dioptres.
Unproven treatments that lack significant medical documentation of effectiveness.
Sterility and infertility treatment, including contraception, sterilisation, IVF and other assisted reproduction, and surrogacy.
Maternity expenses, including childbirth and caesarean sections, except ectopic pregnancy, and miscarriage or medical termination of pregnancy unless due to an accident.
War, invasion, nuclear, chemical or biological weapons and radiation of any kind.
Intentional self-injury, attempted suicide or suicide.
Participation in naval, military or air force operations.
Investigative treatment for sleep apnoea, general debility or exhaustion.
Congenital external diseases, defects or anomalies.
Stem cell harvesting and growth hormone therapy.
Dental treatment and surgery of any kind, unless it requires hospitalisation.
Circumcision, unless necessitated by illness or injury.
Convalescence, sanatorium treatment, private duty nursing or long-term nursing care.
Vaccination and inoculation, except after an animal bite.
Non-medical expenses such as food charges, laundry and attendant charges.
Treatment taken on an outpatient basis.
Hearing aids, spectacles and contact lenses.
Treatment for hair loss and baldness, including wigs and hair replacement.
Artificial limbs, external devices, wheelchairs, crutches and cochlear implants, unless necessitated by an accident.
Any claim arising from non-disclosure of a pre-existing illness or material fact.

Disclaimer: For illustration purposes only - exact terms are in the policy wording.

Specific Illness Waiting Period in my:health Energy

The conditions and procedures below are covered only after 24 months of continuous coverage with HDFC ERGO. The waiting period does not apply to claims that arise from an accident. Any condition or complication arising out of or connected to Type 1 or Type 2 diabetes, Impaired Fasting Glucose, Impaired Glucose Tolerance or hypertension is not part of this waiting period. If a listed condition is also a pre-existing disease, the longer waiting period applies.

Sinusitis
Rhinitis
Tonsillitis
Adenoidectomy
Mastoidectomy
Tonsillectomy
Tympanoplasty
Surgery for nasal septum deviation
Surgery for turbinate hypertrophy
Nasal concha resection
Nasal polypectomy
Cysts and polyps, including breast lumps
Polycystic ovarian disease
Fibromyoma
Adenomyosis
Endometriosis
Prolapsed uterus
Hysterectomy
Non-infective arthritis
Gout and rheumatism
Osteoarthritis
Ligament, tendon and meniscal tear
Prolapsed intervertebral disc
Joint replacement surgeries
Cholelithiasis
Cholecystitis
Pancreatitis
Fissure, fistula in anus, haemorrhoids and pilonidal sinus
GERD, and ulcer and erosion of the stomach and duodenum
Cirrhosis (alcoholic cirrhosis is permanently excluded)
Perineal and perianal abscess
Rectal prolapse
Cholecystectomy
Hernia surgery
Calculus diseases of the urogenital system, including kidney, ureter and bladder stones
Benign hyperplasia of the prostate
Varicocele
Surgery on the prostate
Surgery for hydrocele and rectocele
Cataract
Retinal detachment
Glaucoma
Surgery of varicose veins and varicose ulcers
Benign tumours of non-infectious cause, such as cysts, nodules, polyps, lumps and growths

What's missing in my:health Energy

No outpatient cover. Treatment taken on an outpatient basis is excluded.

No cover for treatment outside India.

No maternity cover. Maternity, infertility and IVF expenses are excluded.

Dental treatment is covered only when it requires hospitalisation.

Non-medical expenses such as food charges, laundry and attendant charges are not covered.

my:health Energy FAQs

What is HDFC ERGO my:health Energy?

my:health Energy is a health insurance plan for adults who are already diagnosed with Type 1 diabetes, Type 2 diabetes, pre-diabetes (Impaired Fasting Glucose or Impaired Glucose Tolerance) or hypertension. It covers hospitalisation arising from these conditions from day one and adds a wellness programme with reward points. It is issued to an individual only, on an individual sum insured basis.

Is there a waiting period for diabetes and hypertension?

No. Hospitalisation arising out of diabetes and hypertension is covered from day one, and no general 30-day waiting period applies to this plan. Other pre-existing conditions are covered after 24 months of continuous coverage, as are listed conditions such as cataract, hernia and joint replacement. These waiting periods reduce by 1 year on every continuous renewal.

Who can buy Energy and what are the age limits?