banner-logo

Types of Super Top-up (Health) Insurance

img

More About Super Top-up (Health) Insurance

A Super Top-Up Health Insurance Plan enhances your existing coverage by offering a higher sum insured and broader benefits. It helps manage large medical expenses and can be purchased as an independent policy or an add-on to your current plan.

A Super Top-Up Health Insurance Plan is designed to enhance your financial security by covering medical expenses beyond a set deductible. Here are key features that make it a smart choice:

Deductible Benefit

Initial medical costs can be covered by your existing policy or paid out-of-pocket. Once the deductible is met, the Super Top-Up plan takes care of the excess expenses.

Affordable & Hassle-Free

No medical tests required up to 55 years of age (if no pre-existing conditions). Premium remains fixed from 61 years onwards, ensuring stability.

Flexible Coverage

Available as a floater policy for families, covering the proposer, spouse, dependent children, and parents under one plan.

Higher Sum Insured Options

Choose from coverage amounts ranging from ₹3 lakh to ₹50 lakh to suit your needs.

Pre-Existing Disease Cover

Covered after 12 months from the first policy, ensuring long-term protection.

Lifetime Renewability

Continue your coverage for life with renewal options.

Cashless Treatment

Avail treatment at 6,000+ empanelled hospitals across India for a seamless experience.

Additional Benefits

Free health check-ups, a 15-day free-look period, and tax benefits under Section 80D of the Income Tax Act.

A Super Top-Up Health Insurance Plan provides extensive coverage beyond your base health insurance. Here are common benefits you may get in a Super top-up plan:

In-Patient Hospitalisation

Covers medical expenses when you or an insured family member is hospitalized for treatment.

Pre & Post-Hospitalisation Expenses

Medical costs incurred 60 days before hospitalisation and 90 days after discharge are reimbursed.

Hospital Accommodation

Covers the cost of a single private room (for sum insured of ₹5 lakh & above) without capping on room rent.

Day Care Treatments

Covers all day care procedures that require hospitalisation for less than 24 hours.

Domiciliary Treatment

Covers medical expenses for home treatment if hospitalisation is not possible due to medical advice or unavailability of hospital beds. Treatment must continue for at least 3 consecutive days.

Organ Transplant

Covers the medical expenses of the organ donor’s hospitalisation for organ harvesting if the organ is for the insured person.

AYUSH Treatment

Covers alternative treatments (Ayurveda, Unani, Siddha, Homeopathy) up to the sum insured.

Emergency Ambulance Cover

Pays ambulance charges per hospitalisation if the in-patient claim is accepted.

Pharmacy & Diagnostic Services

Purchase medicines and diagnostic services through empanelled providers via the insurer’s website or app.

E-Consultation

Avail online doctor consultations for illness diagnosis or planned surgeries during the policy period.

While a Super Top-Up Health Insurance Plan offers extensive coverage, certain exclusions apply. Here are some aspects that may not be covered:

Medical Treatment Outside India

Expenses incurred for treatments abroad are not covered.

Newborn Baby Expenses

Medical costs related to a newborn baby are not included under this policy.

Unapproved Medical Claims

Claims that are not admitted under the medical expenses section of the policy will not be covered.

Non-Compliance with Organ Transplant Laws

Claims that do not adhere to The Transplantation of Human Organs (Amendment) Bill, 2011 will not be accepted.

Organ Donor’s Pre & Post-Hospitalisation Expenses

While the cost of organ harvesting is covered, the donor’s pre and post-hospitalisation expenses are not included.

For a complete list of exclusions, consider referring to your product brochure and policy terms & conditions.

The eligibility criteria for a Super Top-Up Health Insurance policy may vary based on the specific plan and insurer. Here are the key factors to consider:

Entry Age

Individuals aged 91 days to 80 years can apply for coverage.

No Pre-Policy Medical Tests

If you are 55 years or younger and have no pre-existing conditions, you can get coverage without medical tests (subject to a clean proposal form).

For detailed terms and conditions, refer to the policy brochure of your chosen plan.

Filing a claim under a Super Top-Up Health Insurance Plan depends on the process of your insurer. Here are two common ways that you may need to follow for claim process.

Cashless Claim Process

  • Step 1: Get admitted to a network hospital and inform the insurer.
  • Step 2: Submit the pre-authorisation form at the hospital’s insurance desk.  
  • Step 3: The insurer reviews the request and approves eligible expenses.
  • Step 4: After approval, the insurer directly settles the bill with the hospital.

Reimbursement Claim Process

  • Step 1: Get treated at any hospital and pay the medical bills upfront.
  • Step 2: Submit the claim form, medical bills, discharge summary, prescriptions and reports to the insurer.
  • Step 3: The insurer reviews the documents and reimburses eligible expenses.

Make sure to file the claim within the specified time and keep all necessary documents for smooth processing. For detailed terms, refer to your policy brochure.

A Super Top-Up Mediclaim Policy helps you enhance your health coverage, but choosing the right plan requires careful consideration. Here are key factors to keep in mind:

Deductible Amount

Choose a deductible that aligns with your existing health insurance or the amount you can afford to pay before the policy kicks in.

Sum Insured

Opt for an adequate coverage amount to handle rising medical costs, with options ranging from ₹3 lakh to ₹50 lakh.

Network Hospitals

Ensure the insurer has a wide network of cashless hospitals for hassle-free treatment.

Pre-Existing Disease Coverage

Check the waiting period for pre-existing conditions, which typically ranges from 12 months onward.

Entry Age & Renewability

Confirm if the plan allows lifelong renewability and check the age limits for eligibility.

Medical Tests Requirement

Some plans waive off pre-policy medical tests up to 55 years if no pre-existing illness is present.

Additional Benefits

Look for features like free health check-ups, AYUSH treatment, domiciliary care, and emergency ambulance cover.

Frequently Asked Questions

You can claim tax benefits on the premium paid for a Super Top-Up Health Insurance Policy under Section 80D of the Income Tax Act, 1961. The deduction limit is:

  • Up to ₹25,000 for individuals below 60 years.
  • Up to ₹50,000 for senior citizens (60 years & above).
  • Additional ₹50,000 if paying for senior citizen parents.

The key difference between a Super Top-Up Plan and a Regular Top-Up Plan lies in how the deductible is applied:

  • Regular Top-Up Plan: The deductible applies per claim, meaning each hospitalisation must exceed the deductible amount for the policy to activate.
  • Super Top-Up Plan: The deductible applies to total medical expenses in a policy year, allowing multiple smaller claims to be covered once the cumulative amount crosses the deductible.

A base health insurance policy is not mandatory to buy a Super Top-Up Plan. You can purchase it as a standalone policy and cover the deductible amount yourself in case of a claim. However, having a base health insurance policy can be beneficial, as it helps cover smaller medical expenses, while the Super Top-Up Plan takes care of higher costs once the deductible limit is crossed.

A deductible is the predefined amount you must pay for medical expenses before the Super Top-Up plan starts covering costs.

  • The deductible amount varies based on the plan you choose.
  • It can be met in a single claim or multiple claims within the policy year.
  • Once the total medical expenses exceed the deductible, the Super Top-Up plan covers the remaining costs.

A Super Top-Up Plan activates once your total medical expenses exceed the deductible in a policy year. If your base health insurance gets exhausted, the Super Top-Up Plan will cover additional medical costs beyond the deductible limit.