HDFC ERGO Medisure Super Top Up Insurance Plan

1. What is a Super Top up?

It is a health insurance plan that strengthens your existing plan to give you a higher sum insured and a wider cover to meet your medical expenses. You can take it as an independent policy or as a top up to your existing plan

2. What is the need of buying a Super Top Up?

In cases where your existing medical cover is not sufficient enough to cover your medical expenses, Super Top Up helps increase the sum insured and provider wider coverage at an affordable premium.

3. What is deductible & how does it operate?

Deductible is the amount you pay towards your health care expenses before your insurance plan starts to pay. The amount of deductible varies as per the plan and can be crossed in single claim or in multiple claims in a policy year

4. What are the minimum and maximum deductible in the plan?

You can opt for a minimum of Rs. 4,00,000 and maximum of Rs. 5,00,000 aggregate deductible in this policy

5. What do you mean by Pre-Existing Diseases?

Pre-existing diseases refers to any condition, ailment, injury or illness that you have been diagnosed with or had symptoms of 36 months before taking your policy.

6. Will my Pre-existing diseases be covered in Super Top Up?

Pre-existing diseases will be covered in Super Top Up only after 36 months of continuous coverage.

7. Is there any waiting period?

Yes, there is a waiting period of 36 months (or 3 years) for before Super Top Up starts covering the pre-existing diseases.

8. Do I need to undergo a medical test for buying this policy?

No pre-policy medical check-up is required for individuals’ up to 55 years* of age, subject to no health adversity. However, beyond that age you may need to go through some routine check-ups.

9. Are there any special discounts available under the policy?

You get a 5% discount on opting for two-year policy and a 10% Family Discount when three or more family members are covered under individual sum insured basis

10. I have completed 4 years in ‘xyz’ company Mediclaim and my diabetes/BP is now covered, will my:health Super Top Up cover my PED?
In my:health Super Top Up policy waiting periods will start afresh.

11. Will the continuity benefit (2 years) be given on my:health Super Top Up plan as well?
Continuity benefit will not be available in my:health Super Top Up plan as portability benefits are not available in this product.

12. Does pre-existing cover starts after 4 years?
The policy covers expenses incurred for the treatment of diseases that you have before taking the policy. Such will be covered only after 36 months of continuous coverage.

13. Chemo & dialysis does not required local or general anesthesia will it be cover under day care?
Yes, since chemo & dialysis are recurring procedures and does not require local or general anesthesia, in this context all such procedures will be covered & paid under day care procedures.

14. Do we have any loading on pre-existing ailments?
Yes, there were will be loading 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.

15. A person undergoes for dialysis 4 times in a week will it be covered if the basic deductible is exhausted?
Yes, any illness payable under the policy for which threshold gets exhausted, will be paid under my:health Super top up.

16. Can I cover my family member in this policy?
You can cover your family members as given below in a single Policy on Individual Sum Insured basis.
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Brother, Sister, Grand Son, Grand Daughter, Daughter in Law, Son in Law, Nephew, Niece, Grand Mother and Grand Father.

17. Will I get tax benefit if I cover my family on individual Sum Insured basis?
Yes, you will get Tax benefit under section 80D.

18. Is there any co-payment applied on this policy?
All person(s) named in the Schedule to this Policy above the age of 80 years (age last birthday) shall bear a co-pay of 10% for each and every claim.

19. Do I need to undergo medical test for buying this policy?
You are not required to undergo any medical tests up to the age of 55 years, except if you have declared any pre-existing diseases or ailments at the time of applying for the policy. In such cases and for applicants above age 55 years, one has to undergo the specified medical tests.

20. What are the Medical test charges?
Pre agreed charges for health check up with our network provider are Rs 1000/- and Rs.1200/- per person for SET1 & SET2 respectively. On acceptance of proposals, we will reimburse 50% of the expenses.

21. What is the minimum and maximum deductible in this plan?
You can choose minimum of Rs. 2lacs and maximum of Rs. 5lacs aggregate deductible in this policy.

22. 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.

23. 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.

24. Is it mandatory to inform change in health condition in writing while renewing my:health Super Top Up plan?
No. There is no such obligation under the policy. Once we have accepted the proposal, member will be eligible for life time renewal.

25. If the claim amount is 6 lakhs, how much will be paid by HDFC ERGO General Insurance?
Whatever is over and above the threshold limit will be paid.

26. What are the documents required?
Please refer Policy wordings for exhaustive list of claims documents required. We will not ask for anything over and above the list given in Policy.

27. In case of self financing, can the client apply for cashless?
Yes, Cashless can be applied through hospital.

28. If the deductible is 2 lakh & reimbursement is 3.5 lakh, the other insurance company approved 1.5 lakh, so how much will HDFC ERGO General Insurance pay?
Irrespective of what the previous insurer paid, HDFC ERGO General Insurance will pay whatever are the medical expenses over and above the threshold limit.

29. Do Threshold/deductible limit consist of single claim or multiple claims?
Threshold/ deductible limit is an aggregate deductible which the customer has to pay either from his pocket or through other Mediclaim, beyond aggregate deductible (crossed in single claim or in multiple claims in a policy year) full claim amount will be paid by HDFC Ergo General Insurance.

Example-1: Single Claim in a policy year

Example-2: Multiple Claims in a policy year