What You Should Know Before Choosing a Super Top-Up Health Insurance Policy

A super top-up health insurance policy provides additional medical coverage after the total eligible expenses cross a chosen threshold. It may cover individuals or families under separate or shared sum insured options, with or without a base health policy.

Key Benefits

- Sum insured options up to ₹80 lakh.

- Available on individual and family floater basis.

- Coverage for in-patient treatment, day-care procedures, and maternity, subject to policy terms.

- Newborn baby cover from Day 1, subject to limits.

- AYUSH treatment cover up to the sum insured.

- Post-hospitalisation doctor visits, nursing, attendant, and hospital cash benefits may be available.

- Pre-existing diseases covered after a 12-month waiting period.

- 5% early-entry discount for eligible policyholders.

- Two- or three-year policy options with discounts up to 5%.

- Lifelong renewability.

What Is Not Covered

- During the first 30 days, only eligible accidental claims are covered.

- Specific illnesses may have waiting periods of 90 days, one year, two years, or three years.

- Gender-change treatment and non-medically required cosmetic surgery.

- Treatment from excluded healthcare providers.

- Drug or alcohol abuse and self-inflicted injuries.

- Non-prescription medicines, massages, and steam baths.

- Alternative treatments other than covered AYUSH treatments.

- Dental treatment, unless caused by an accident and requiring hospitalisation.

- Outpatient treatment.

Claim Notification

- Planned hospitalisation: Inform the insurer or TPA at least 72 hours before admission.

- Emergency hospitalisation: Inform them within 24 hours of admission.

- Notification must include the policy number, treatment plan, and relevant claim information.

- Notify the insurer immediately when cumulative medical expenses are expected to cross the selected threshold.

Cashless Claims

- Cashless treatment is available at eligible network hospitals, subject to pre-authorisation.

- For the first claim, documents must prove that cumulative expxpenses have crossed the threshold.

- Non-medical and inadmissible expenses must be paid by the insured.

- If cashless approval is denied, the claim may still be submitted for reimbursement.

Documents Required

- Completed claim form.

- Admission prescription and medical reports.

- Hospital, pharmacy, investigation, and treatment bills.

- Diagnosis and surgery certificates.

- Implant bills and stickers, where applicable.

- Discharge summary, medical history, and final bill breakdown.

- Previous hospitalisation and claim settlement records.

- Any additional documents required for claim assessment.

Submission Time

- Hospitalisation, pre-hospitalisation, and road ambulance claims: Within 15 days of discharge.

- Post-hospitalisation claims: Within 15 days after treatment is completed.

Disclaimer

This is a general summary for awareness. Coverage, waiting periods, thresholds, limits, and claim requirements may vary. Always review the complete policy wording before purchasing or making a claim.