Super Top-Up Insurance Policy

A Health Insurance Policy is a type of insurance that takes care of your medical expenses that arise due to a illness. This insurance also ensures that you can avail cashless treatment at a network hospital without having to pay for them. Health insurance is a must have policy keeping in mind the high cost of treatments in current era.

Introduction

Who can take this Policy?

Coverage

Add on Covers

Basis of Sum lnsured

Exclusions

Top Up Insurance
Top-up health insurance plans are policies that offer an additional coverage, beyond the threshold limit of the existing health insurance policy.

Super Top Up Insurance
Super top-up health insurance plans are similar to top-up plans, except that top-up plan covers a single claim above the threshold limit, while the super top-up plan covers the total of all hospitalization bills above the threshold limit.

Deductible
Deductible is a fixed amount paid out-of-pocket by an insured for the medical expenses before an insurance company pays the balance cost.

Any individual can take this policy provided there age is 18 years for adults and 91 days for dependent children. The cover can be taken for self or family members.

In patient hospitalization expenses
Pre-post hospitalization
Pre-existing diseases
Daycare procedures
Organ donor cover

Add on covers are not available for this policy.

Age, Medical requirements of family, cost of medical treatment on your city, Medical history, sum insured of base policy.

General exclusions under this policy are:

Adventure sport injuries
Self-Inflicted injuries
War and unlawful activities
Venereal or sexually transmitted diseases
Dental treatment
Cosmetic surgery
Any pre-existing ailment/injury that was diagnosed /acquired within 48 months prior to issuance of the first policy.
Any diseases contracted during first 30 days of the policy start date except those arising out of accidents
Non-allopathic treatment
Expenses attributable to self-inflicted injury (resulting from suicide, attempted suicide)
Expenses arising out of or attributable to alcohol or drug use/misuse/abuse
Cost of spectacles/contact lenses, dental treatment
Medical expenses incurred for treatment of AIDS
Treatment arising from or traceable to pregnancy and childbirth, miscarriage, abortion and its consequences
Congenital disease
Tests and treatment relating to infertility and in vitro fertilizations

IMPORTANT POINTS TO REMEMBER WHILE BUYING THE POLICY

Deductible always be equal or less than base policy's sum insured

Deductible always be equal or less than base policy's sum insured to get the maximum benefit of Top Up/Super top up policy.

Always go for higher sum insured

Always go for higher sum insured as premium is very economical for Top Up/Super Top up policy.

Never miss the renewal to avail the continuity benefit

Never miss the renewal to avail the continuity benefit as pre existing disease would have few years of waiting period in new policy.

Key Documents at The Time Of Claims

General Claim
Intimation Format

Immediate Action Client
Should Take

Indicative General Documents
for Settlement of Claims

Why Choose Us?

Professional & Experienced Team

Customized Solutions

Strong Relationship With Insurance Companies

Service Commitment ONTIME EVERYTIME

Technological Edge

Additional Services Offered

Competitive Premium

Single Window Solution

Downloads

Proposal Form

Policy Wordings

Claim Form

FAQ's

PREMIUM

COVERAGES

CLAIMS

OTHERS

Do we have any loading of premium on pre-existing ailments?

Yes, there were will be loading of premium on pre-existing ailments which will be arrived at after health check-up of the customer. Acceptance of the proposal will be subject to medical underwriting.
Why is premium for Top up and Super Top up policy less than basic Health insurance policy?

This is so because of deductible. The claim in these policies is paid only in excess of deductible. Therefore, insurance companies can give higher coverage at less premiums as compared to basic health policies.
What are the different premium payment frequency option available?

You can make one time single premium payment or choose Monthly, Quarterly, Half yearly or Yearly premium payment mode. In case of premium payment mode other than Single and Yearly, a loading will be applied on the premium.
Do I get refund of premium on cancellation of policy?

Request for cancellation shall be intimated to the insurance company by giving 15 days notice. The insurer will refund the premium for the unexpired term. Premium shall be refunded only if no claims has been made under the policy. Please refer the terms and conditions specified in the policy for further clarity.

After how many months will pre-existing diseases be covered?

This depends on insurer to insurer. Pre-existing Diseases will be covered only after certain months (specified in the product) of continuous coverage.
Chemo & dialysis covered under day care since it does not require local or general anesthesia?

Yes, since chemo & dialysis are recurring procedures and does not require local or general anaesthesia, it will be covered under day care procedures.
A person undergoes Dialysis 4 times in a week will it be covered if the basic deductible is exhausted?

Yes, it will be paid.
Can I also include my parents and parents in law in this policy?

Yes, you can include your parents and parents in-law in the same Policy on an Individual Sum Insured basis and in a separate Policy on floater Sum Insured basis.

Can I apply for cashless like regular health policy?

Yes, Cashless can be applied through hospital.
Do Threshold/ deductible limit consist of single claim or multiple claims?

Threshold/ deductable limit is an aggregate deductable which the customer has to pay either from his pocket or through other Mediclaim, beyond aggregate deductable (crossed in single claim or in multiple claims in a policy year) full claim amount will be paid.
If the deductible is 2 lakhs & reimbursement is 3.5 lakhs, the other insurance company approved 1.5 lakhs, so how much will my insurance company pay?

Irrespective of what the previous insurer paid, insurance will pay whatever are the medical expenses over and above the threshold limit.
What are the claim documents required?

Please refer Policy wordings for exhaustive list of claims documents required.

Is continuity benefit extended to top up and Super top up plans?

Continuity benefit will not be available to top up and super top up plans as portability benefits are not available in this product.
Can I cover my family members in this policy?

You can cover your family members in a single Policy on Individual Sum Insured basis.
Will I get tax benefit if I cover my family on individual sum insured basis?

Yes, you will get Tax benefit under section 80D.
What is the entry & exit age for this policy?

This Policy, one can be a proposer under the Policy from the age of 18 years to 65 years. You can insure your children from the age of 91 days to the age of 23 years.

Claim Case Study - 1

Situation

Room Rent Capping/Restriction.

Challenge

Customer will have to pay a sizeable amount at the time of discharge because of room rent capping.

Solution

Customer should select the room according to the policy’s room rent limit to avoid payment of difference from their own funds.

Advisory/Conclusion

Always go for a policy with no room rent capping to avoid such situations.

Claim Case Study - 2

Situation

Generally insured does not get the original reports (MRI/X-Rays/USG Report) returned from TPA/Insurance Company after the settlement of claim.

Challenge

Limited knowledge how to get these reports (MRI/X-Rays/USG Report) returned from TPA/Insurance Company.

Solution

As a right you can claim the original reports (MRI/X-Rays/USG Report) from the TPA / Insurance Company after 15 days subsequent to settlement of claim. It is the responsibility of your insurance broker to get it done on your behalf.

Advisory/Conclusion

You should always intimate to the TPA / Insurance Company well in advance that you need these original reports returned after the claim settlement.

INSUROLOGY

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