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The super top-up health insurance policy helps you to enhance your base health plan’s coverage. If the base plan is not sufficient enough to meet the actual medical expenses in a single claim or your sum insured is exhausted because of multiple claims in a year, then you can count on a super top-up plan. A super top-up insurance plan becomes necessary when a single claim does not traverse the threshold limit of the regular plan, but multiple claims do. It offers an additional benefit to the base plan which helps the insured if the medical expenses exceed the threshold value either due to a single claim or multiple claims in a year. A policyholder can make multiple claims in a year till the sum insured gets exhausted. A super top-up policy will consider the total claim amount in a year. Therefore any claim amount below the threshold limit will be payable under his regular health policy and the remaining amount by the super top-up health insurance policy.

For instance, Siddharth has an existing health insurance plan of Rs.3 lakhs and has bought a super top-up health cover of Rs.9 lakhs with a deductible of Rs.3 lakhs.

Suppose, he gets hospitalized and if the medical expenditure is Rs.8 lakh, his regular policy would pay Rs.3 lakhs and the super top-up insurance plan would pay Rs.5 lakhs. If another claim of Rs.4 lakhs is made in the latter part of the year by him, the entire amount is paid by the super top-up plan since the regular policy cover is exhausted. The claim is settled if the overall bill amount exceeds the deductible limit.

For instance Siddharth has an existing health insurance plan of Rs.5 lakhs and has bought a super top-up health cover of Rs.10 lakhs with a deductible of Rs.5 lakhs.

Suppose, Siddharth makes 3 claims in a year, say of Rs.5 lakhs, Rs.2 lakhs and Rs.3 lakhs, i.e. a total of Rs.10 lakhs. His regular policy would pay Rs.5 lakhs and you then stand exhausted. The remaining 2 claims will be paid by the super top-up health insurance policy.

Note: Your base plan cover should be equal to the declared deductible in the super top-up plan.

Both these policies differ on account of their structure. Top-up plans consider each hospitalization as a single incident and a new one. So if you anticipate multiple hospitalizations, each of them will have to exceed the deductible. This is one of the major and most cost-effective differentiators of a super top-up policy. A super top-up policy covers multiple treatments in a year. For the purpose of claims, it considers the total treatment expenses in a year. In other words, super top-up policies are similar to top-up policies, except that a top-up policy covers a single claim above the threshold limit, while a super top-up plan covers the total of all hospitalization bills above the threshold limit.

Deductible means a cost sharing requirement under a health insurance policy where the insurance company will not be liable for eligible medical expenses up to a specified amount, that incur in a policy period. It does not reduce the sum insured. It is the amount up to which the insurer will not pay for claims incurred in a policy year under the policy. The deductible will apply on individual basis in case of an individual policy and on family floater basis in case of a family floater policy.

Though it is not compulsory to have a health reimbursement policy to buy a super top-up policy, it is futile to take a super top-up policy unless you have a reimbursement cover equal to at least the threshold limit of the super top-up plan.

You may want a super health insurance policy if –

  • You have not yet taken any health-insurance policy.
  • You do have a basic/regular health-insurance policy with an insurer who does not provide a top-up cover/super top-up cover.
  • You have a health-insurance policy but the sum assured is not significant to cover huge hospitalization costs.
  • You want to minimize the premium amount

  • In-patient Treatment
  • Pre-Hospitalization
  • Post-hospitalization
  • Day Care Treatment
  • Non-medical expenses cover
  • Road ambulance cover
  • Donor expenses
  • Cumulative bonus

Yes, the plan offers option of providing cover on individual as well as family floater basis

Family includes self, spouse, dependent children and dependent parents. An insurer may allow you to cover dependent parents under the single policy or under a separate family floater policy.

Note: Parents shall include your (i.e. policyholder’s) dependent parents.

No, sisters and brothers cannot be covered as dependents.

Policy period could be 1 year, 2 years or 3 years.

Generally, for a 1-year policy term, premium can be paid on an annual basis, whereas for a 2 and 3 years policy term, premium can be paid on half-yearly/quarterly/monthly basis.

The minimum cover that you opt for is Rs.1 lakh. The maximum sum insured availability could vary from insurer to insurer.

Entry age under a top-up health insurance plan is 18 years. Generally there will be no exit-age for ceasing of the cover.

Yes, pre-insurance medical examination will be conducted on the basis of adverse medical declarations in the proposal form, age of member, sum insured and deductible opted. Most insurers do not ask for medical check-ups up to the age of 55 years.

Yes, pre hospitalization expenses incurred up to 30 days prior to the hospitalization and post hospitalization expenses incurred up to 60 days from the date of discharge from the hospital are covered under the plan.

Expenses incurred for inpatient care treatment under Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homoeopathy systems of medicines shall be covered under the policy up to sum insured. However there might be a waiting period applicable that could differ from insurer to insurer.

Claims are paid on indemnity basis – cashless or reimbursement

Though it is not compulsory to have a health reimbursement policy to buy a top-up policy, it is futile to take a top-up policy unless you have a reimbursement cover equal to at least the threshold limit of the top-up plan. This way you will be able to take care of your bills even before the top-up plan kicks in. This applies even if you have a group heath cover from your employer. If the employer's cover has a sum insured of Rs.2 lakhs, you could buy a top-up plan with a threshold of not more than Rs.2 lakhs.

No, you can buy regular health insurance from one insurance company and top up plans from another.

Yes, a top-up health insurance plan covers any medical expenses that arise for your family due to an illness or an accident.

No, a top-up health insurance plan covers treatment and/or services rendered only in India.

Yes the policy can be renewed on expiry. Insurers generally allow Lifelong Renewability.

Yes.

The insurer may allow for an increase in the sum insured at the time of renewal. The insurer is not obliged to allow an increase, if you are not in good health. Any such request for enhancement must be accompanied by a declaration that you or any other insured person in respect of whom such enhancement is sought is not aware of any symptoms or other indications that may give rise to a claim under the policy. The insurer may require you or such insured person to undergo a medical examination in order to take a decision on accepting the request for enhancement in the sum insured. The enhancement is subject to underwriting guidelines and policy terms & conditions.

Cumulative Bonus means any increase or addition in the sum insured granted by the insurer without an associated increase in premium. Cumulative Bonus will be increased by 5% in respect of each claim free policy year (where no claims are reported), provided the policy is renewed with the company without a break subject to maximum of 50% of the sum insured under the current policy year. If a claim is made in any particular year, the cumulative bonus accrued shall be reduced at the same rate at which it has accrued. However, sum insured will be maintained and will not be reduced in the policy year.

Yes, in case policy premium is paid on an annual basis, then a grace period of 30 days will be given to pay the premium due under the policy. If the policy premium is paid on an instalment basis, i.e. half yearly, quarterly or monthly, then a grace period of 15 days would be given to pay the instalment premium due under the policy.

If the insured fails to remit premium for renewal before expiry of the period of insurance, but within 30 days thereafter, admissibility of any claim during the period of subsequent policy shall be considered in the same manner as under a policy renewed without break. The insurer however shall not be liable for any claim arising out of ailment suffered or hospitalisation commencing in the interim period after expiry of the earlier policy and prior to date of commencement of subsequent policy.

The time limit for notification of a claim upon the happening of any event which may give rise to a claim under the policy, a notice with full particulars shall be sent to the insurer or its will differ from insurer to insurer. The time limit could vary from 24 hours or 7 days depending on the treatment, consultation or procedure.

  • Planned Hospitalisation - Insured Person should intimate admission at least 3 days prior to the planned date of admission.
  • Emergency Hospitalisation - Insured Person should intimate within 48 hours but not later than discharge from the hospital.

Insurance Company can settle or reject the claim within 30 days from the date of receipt of last necessary document in accordance with the provisions of Regulation 27 of IRDAI (Health Insurance) Regulations, 2016.

You have 15 days from the date of receipt of the policy to review the policy terms and conditions. Post such review if you feel that the terms of the policy are unacceptable, you have an option to cancel the policy provided you have not made any claim under the policy. This 15 days’ time frame is called the free look period. In such a case, premium paid for the policy will be refunded in your account within 15 days from your request of policy cancellation. Your premium refund will be subject to deduction of amount spent by the insurer on medical examination, stamp duty charges and proportionate risk premium. Where the risk has already commenced a deduction towards the proportionate risk premium for period on cover shall be made or where only a part of the risk has commenced, such proportionate risk premium commensurate with the risk covered during such period shall be deducted.

You may cancel your plan by giving the insurer a 15 days written notice. The insurer shall refund the premium for the unexpired term as per short term period scale and certain conditions. Certain insurers may not process a refund for cancellation of policies with Premium Payment Mode as Half-yearly, Quarterly or Monthly

The insurer may at any time cancel the policy on grounds of misrepresentation, fraud, non-disclosure of material fact or non-cooperation by you by sending a 15 days written notice in which case the insurer shall return to the insured a proportion of the premium corresponding to the unexpired period of insurance if no claim has been paid/admitted under the policy.

Expenses incurred in connection with or in respect of

  • Domiciliary hospitalization expenses
  • Ambulance charges
  • Dental treatment or surgery of any kind unless necessitated due to an accident and requiring minimum 24 hours Hospitalization or treatment of irreversible bone disease involving the jaw which cannot be treated in any other way, but not if it is related to gum disease or tooth disease or damage.
  • Any cosmetic surgery unless forming part of treatment for cancer or burns, surgery for sex change or treatment of obesity/morbid obesity or 35.
  • Any treatment arising from or traceable to pregnancy, childbirth including caesarean section. However, this exclusion will not apply to Ectopic Pregnancy proved by diagnostic means.
  • Any pre-existing condition(s) as defined in the policy.

Note: This is a partial list of the policy exclusions. Please refer to the policy document for the complete list of exclusions.

a) Initial Waiting – 30 days

  • Expenses related to the treatment of any illness within 30 days from the first policy commencement date shall be excluded except claims arising due to an accident, provided the same are covered.
  • This exclusion shall not apply if the insured has been covered continuously by the concerned insurer and without any break in the previous policy year, or if the insured renews and increases the sum insured or changes his deductible, then this exclusion shall only apply in relation to the amount by which the sum insured has been increased or deductible has been changed.

b) Specific Waiting – Depending on the illness

c) Pre Existing Diseases – 48 months

  • Expenses related to the treatment of a pre-existing Disease (PED) and its direct complications shall be excluded until the expiry of 48 months of continuous coverage after the date of inception of the first policy with the insurer. If the insured is continuously covered without any break as mandated by IRDAI, then the waiting period for the same would be reduced to the extent of prior coverage.
  • Coverage under the policy after the expiry of 48 months for any pre-existing disease is subject to the same being declared at the time of application and accepted by the insurer.

Yes, you can take more than one policy from the same insurer.

Portability means the right accorded to an individual health insurance policyholder (including all members under a family floater cover), to transfer the credit gained for pre-existing conditions and time bound exclusions, from one insurer to another insurer. Yes, portability is available under the policy.

Yes, the premium paid for top-up health insurance plan is exempted under the current tax laws u/s 80D of the Indian Income Tax Act.