Because We Care

Your health is our concern and

uncomplicating it is our promise.

HDFC ERGO Group Health Insurance

A comprehensive health plan for Small and Medium Enterprises (SME)
At HDFC ERGO General Insurance Company Limited, we appreciate how unique each SME is.

And yet each outfit, irrespective of size, strength or turnover, faces the same need to safeguard the health and well-being
of its employees.

To address the unique requirements of SME customers, we at HDFC ERGO General Insurance Company Limited.
have products which are comprehensive, simple to understand, with a set of benefits relevant to the employees of SME
organisations.

Choices are made available to the different SME segments through the plan options Plan 1 to Plan 6.

USP OF THE PRODUCT

No sublimit on Maternity
Medical Expenses Cover^
hospital room rent covered*

Pre & Post Hospitalization Coverage for employee,

Medical Expenses Cover All Day Care procedures
spouse & children
30 & 60 days

No pre policy check up Wide range of

Road Ambulance Cover
Sum Insured

Cashless claim settlement

across nearly 10,000 Organ Donor expenses
network hospitals^^

*For more details please refer to the plan details

 GENERAL INFORMATION

AGE
LIMITS Relationship Minimum age of entry Maximum age of entry

Employee 18 years 60 years*

Spouse 18 years 60 years
Dependent Child Day 1 25 years
- Employees above 60 years can be insured on case to case basis post UW approval
- Renewability age maximum till age 70 years

FAMILY Employee (Primary member) would mean any person working, on

DEFINITION permanent basis and is on the rolls of the company & the ones, working on
contractual basis for whom a separate attendance record, is maintained.

Spouse would mean the primary insured member’s legally married spouse as long
as they continue to be married

Dependent children would mean primary insured member’s child, aged

between 1 to 25 years, unmarried and financially dependent on the primary insured.

FAMILY SIZE Individual sum insured

Maximum of 6 members per family with a maximum number of 4 children.

Family floater sum insured

Maximum of 6 members per family with a maximum number of 2 adults and up to a
maximum of 4 children per family.

SUM INSURED 6 sum insured options to choose from

OPTIONS (`)
1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000

- Option of `7.50 & 10 Lac sum insured is offered only for senior management/ promoters.
- In case all members require these sum insured a prior approval from group underwriter
will be required

PREMIUM Each of the above sum insured are available in two options
OPTIONS
a. Individual Sum Insured basis
b. Family Floater Sum Insured basis

PREMIUM TIER - MMR (PIN codes starting from (400, 401, 402, 410 or 421) & NCR (110,201,203,
120,121,122 0r 123)
- Rest of India

EMPLOYEE SIZE - Minimum - 25

- Maximum - 300

POLICY TENURE - 1 Year

BENEFIT STRUCTURE

Plan Name Plan 1 Plan 2 Plan 3 Plan 4 Plan 5 Plan 6

SI Type Individual Basis Family Floater Basis

Employee Size 25-300 50-300 100-300 25-300 50-300 100-300

Medical Covered Covered Covered Covered Covered Covered

Expenses Cover^ upto SI upto SI upto SI upto SI upto SI upto SI

Pre
30 days 30 days 30 days 30 days 30 days 30 days
Hospitalization

Post
60 days 60 days 60 days 60 days 60 days 60 days
Hospitalization

Organ Donor Covered Covered Covered Covered Covered Covered

expense upto SI upto SI upto SI upto SI upto SI upto SI

Domiciliary Covered Covered Covered Covered Covered Covered

Treatment upto SI upto SI upto SI upto SI upto SI upto SI

All Day Care All Day Care All Day Care All Day Care All Day Care All Day Care
Day Care
covered upto covered upto covered upto covered upto covered upto covered upto
procedures
SI SI SI SI SI SI

Road Ambulance `2,000 per `2,000 per `2,000 per `2,000 per `2,000 per `2,000 per
Cover hospitalisation hospitalisation hospitalisation hospitalisation hospitalisation hospitalisation

30 days waiting
Waived Waived Waived Waived Waived Waived
period

1st year disease

Applicable Applicable Applicable Applicable Applicable Applicable
waiting period

Pre-existing
disease waiting 36 Months 36 Months 36 Months 36 Months 36 Months 36 Months
period

9 Months No waiting 9 Months No waiting

Maternity Cover Not covered Not covered
waiting period period waiting period period

Pre and
Not covered Covered Covered Not covered Covered Covered
Post-natal cover

Baby Covered
Not covered Covered Covered Not covered Covered Covered
from Day 1
MATERNITY COVER (OPTIONAL)

Employee Size < 50 Maternity cover not offered

Employee Size >50 9 months waiting period

Employee Size > 100 Maternity cover offered from day 1

Base Sum Insured Maternity cover - SI

1,00,000 20,000

2,00,000 25,000

3,00,000 25,000

5,00,000 30,000

7,50,000 30,000

10,00,000 50,000
 PLAN

A
INDIVIDUAL SUM INSURED PREMIUM
(Applicable Per Person premium table exclusive of Goods & Services Tax & Cess).

Mumbai MMR + Delhi NCR

Plan 1 - Without Maternity Cover - MMR & NCR
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 2,610 2,958 3,303 3,829 4,432 5,455
18-35 3,578 4,057 4,533 5,253 6,080 7,483
36-45 4,308 4,881 5,454 6,323 7,317 9,007
46-55 7,145 8,098 9,048 10,489 12,136 14,937
56-65 10,192 11,552 12,906 14,963 17,313 21,309
66-70 18,172 20,597 23,013 26,676 30,868 37,992

Rest of India
Plan 1 - Without Maternity Cover - ROI
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 1,711 1,940 2,166 3,278 4,095 4,681
18-35 2,346 2,660 2,972 4,498 5,618 6,421
36-45 2,825 3,200 3,576 5,413 6,762 7,729
46-55 4,685 5,310 5,933 8,980 11,215 12,817
56-65 6,683 7,574 8,462 12,810 15,999 18,285
66-70 11,915 13,505 15,089 22,838 28,526 32,601

Mumbai MMR + Delhi NCR

Plan 2 - Maternity Cover with 9 months waiting period - MMR & NCR
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 2,901 3,353 3,664 4,417 5,008 5,882
18-35 3,773 4,343 4,772 5,805 6,638 7,723
36-45 4,432 5,086 5,602 6,846 7,863 9,106
46-55 6,988 7,985 8,841 10,904 12,632 14,490
56-65 9,734 11,098 12,317 15,263 17,756 20,275
66-70 16,926 19,249 21,426 26,673 31,172 35,420

Rest of India
Plan 2 - Maternity Cover with 9 months waiting period - ROI
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 2,023 2,338 2,555 3,841 4,532 5,302
18-35 2,631 3,028 3,327 5,047 6,008 6,962
36-45 3,090 3,546 3,906 5,953 7,117 8,209
46-55 4,873 5,568 6,165 9,482 11,433 13,062
56-65 6,788 7,739 8,589 13,272 16,070 18,277
66-70 11,803 13,423 14,941 23,194 28,212 31,931
 Mumbai MMR + Delhi NCR
Plan 3 - Maternity Cover with no waiting period - MMR & NCR
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 3,067 3,560 3,871 4,626 5,197 6,162
18-35 3,940 4,550 4,979 6,014 6,827 8,003
36-45 4,598 5,293 5,809 7,055 8,052 9,386
46-55 7,154 8,192 9,048 11,113 12,821 14,770
56-65 9,900 11,305 12,525 15,472 17,945 20,555
66-70 17,092 19,457 21,634 26,882 31,361 35,700

Rest of India
Plan 3 - Maternity Cover with no waiting period - ROI
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 2,139 2,483 2,699 4,023 4,703 5,555
18-35 2,747 3,173 3,472 5,229 6,179 7,214
36-45 3,206 3,691 4,051 6,135 7,288 8,461
46-55 4,989 5,713 6,310 9,664 11,604 13,315
56-65 6,904 7,883 8,734 13,454 16,241 18,530
66-70 11,919 13,568 15,086 23,376 28,383 32,183

FAMILY FLOATER SUM INSURED PREMIUM

(Applicable Per Person premium table exclusive of Goods & Services Tax & Cess).
Mumbai MMR + Delhi NCR
Plan 4 - Without Maternity Cover - MMR & NCR
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 2,084 2,362 2,638 3,058 3,539 4,356
18-35 2,857 3,240 3,620 4,195 4,855 5,975
36-45 3,440 3,898 4,355 5,049 5,843 7,192
46-55 5,705 6,466 7,225 8,375 9,690 11,927
56-65 8,138 9,224 10,305 11,948 13,824 17,015
66-70 14,510 16,447 18,376 21,301 24,648 30,337

Rest of India
Plan 4 - Without Maternity Cover - ROI
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 1,366 1,549 1,729 2,618 3,270 3,738
18-35 1,873 2,124 2,373 3,591 4,486 5,127
36-45 2,256 2,556 2,856 4,322 5,399 6,171
46-55 3,741 4,240 4,737 7,170 8,955 10,235
56-65 5,336 6,048 6,757 10,229 12,775 14,601
66-70 9,514 10,784 12,048 18,236 22,778 26,032
 Mumbai MMR + Delhi NCR
Plan 5 - Maternity Cover with 9 months waiting period - MMR & NCR
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 2,418 2,792 3,054 3,688 4,188 4,910
18-35 3,152 3,626 3,986 4,856 5,560 6,460
36-45 3,706 4,251 4,685 5,733 6,591 7,624
46-55 5,858 6,691 7,411 9,148 10,605 12,155
56-65 8,169 9,311 10,337 12,816 14,918 17,024
66-70 14,222 16,172 18,004 22,420 26,209 29,772

Rest of India
Plan 5 - Maternity Cover with 9 months waiting period - ROI
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 1,686 1,947 2,130 3,207 3,790 4,426
18-35 2,198 2,528 2,780 4,222 5,033 5,823
36-45 2,585 2,964 3,267 4,985 5,966 6,873
46-55 4,085 4,666 5,168 7,955 9,598 10,958
56-65 5,697 6,493 7,209 11,145 13,501 15,347
66-70 9,917 11,277 12,555 19,496 23,721 26,839

Mumbai MMR + Delhi NCR

Plan 6 - Maternity Cover with no waiting period - MMR & NCR
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 2,551 2,958 3,219 3,855 4,339 5,134
18-35 3,285 3,791 4,152 5,023 5,711 6,683
36-45 3,839 4,416 4,851 5,899 6,742 7,847
46-55 5,991 6,856 7,577 9,315 10,756 12,379
56-65 8,302 9,476 10,503 12,983 15,069 17,248
66-70 14,355 16,337 18,170 22,587 26,360 29,995

Rest of India
Plan 6 - Maternity Cover with no waiting period - ROI
Age / SI 1,00,000 2,00,000 3,00,000 5,00,000 7,50,000 10,00,000
0-17 1,779 2,063 2,245 3,352 3,927 4,628
18-35 2,291 2,644 2,895 4,368 5,169 6,025
36-45 2,677 3,080 3,383 5,130 6,102 7,074
46-55 4,177 4,781 5,284 8,100 9,735 11,159
56-65 5,789 6,608 7,324 11,290 13,638 15,549
66-70 10,010 11,393 12,670 19,641 23,858 27,040
Exclusions
• War or any act of war, invasion, act of foreign enemy
• Expenses for treatment directly arising from committing or attempting to commit a breach of law with
• criminal intent
• Committing or attempting to commit intentional self-injury or attempted suicide or suicide
• Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.
• Treatment taken on Outpatient basis
• Expenses related to any unproven treatment, services and supplies
Please refer to the Policy Wording for the complete list of exclusions.

Migration
All insured members will have the opportunity to opt for HDFC Ergo General Insurance Ltd.
Health’s Individual or Family Floater Insurance Plan at the time of renewal or while opting out of the
group, without loosing any benefits. (Subject to Underwriting guidelines and applicable conditions.)

This is only a summary of the product features. The actual benefits available are as described in the policy, and
will be subject to the policy terms, conditions and exclusions. Please seek the advice of your insurance advisor
if you require any further information or clarification.

Statutory Warning ›
Section 41 of Insurance Act 1938 as amended by Insurance Laws Amendment Act, 2015 (Prohibition of
Rebates): No person shall allow or offer to allow, either directly or indirectly, as an inducement to any person to
take out or renew or continue an insurance in respect of any kind of risk relating to lives or property in India, any
rebate of the whole or part of the commission payable or any rebate of the premium shown on the policy, nor
shall any person taking out or renewing or continuing a Policy accept any rebate, except such rebate as may
be allowed in accordance with the published prospectuses or tables of the insurers. Any person making default
in complying with the provision of this section shall be liable for a penalty which may extend to 10 lakh rupee.

Terms & Conditions Apply. ^^Available in select cities only in India. ^Under hospitalization cover. #Premium mentioned
above is inclusive of these optional covers. *For more details please refer to the product details. HDFC ERGO General
Insurance Company Limited. IRDAI Reg. No. 146. CIN: U66030MH2007PLC177117. Registered & Corporate Office:
1st Floor, HDFC House, 165-166 Backbay Reclamation, H. T. Parekh Marg, Churchgate, Mumbai – 400 020. For more
details on the risk factors, terms and conditions, please read the policy document carefully before concluding a sale.
Trade Logo displayed above belongs to HDFC Ltd and ERGO International AG and used by the Company under license.
UIN: HDFC ERGO Group Health Insurance - HDHHGP21544V012021. UID: 9235.