FAQs
FAQs

my:Health Medisure Super Top Up FAQs

Do Threshold/deductable 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 by HDFC Ergo General Insurance.

Example-1: Single Claim in a policy year

Dedcutible Sum Insured in HDFC Ergo General Insurance Insured Super Top up Policy Claim amt assessed Dedcutible Exhaustion balance Dedcutible Claim amt payable by other policy / saving Claim amt payable by HDFC Ergo General Insurance Insured Super Top up Policy
At inception 200,000 800,000 0 0 200,000 0 0
Claim 1 200,000 800,000 10,000,00 2,00,000 0 2,00,000 8,00,000

Example-2: Multiple Claims in a policy year

Dedcutible Sum Insured in HDFC Ergo General Insurance Insured Super Top up Policy Claim amt assessed Dedcutible Exhaustion balance Dedcutible Claim amt payable by other policy / saving Claim amt payable by HDFC Ergo General Insurance Insured Super Top up Policy
At inception 200,000 800,000 0 0 200,000 0 0
Claim 1 200,000 800,000 150,000 150,000 50,000 150,000 0
Claim 2 200,000 800,000 300,000 50,000 0 50,000 250,000
Claim 3 200,000 800,000 550,000 0 0 0 550,000

I have completed 4 years in ‘xyz’ company Mediclaim and my diabetes/BP is now covered, will Super Top Up cover my PED?

In Super Top Up policy waiting periods will start afresh.

Will the continuity benefit (2years) be given on Super Top Up plan as well?

Continuity benefit will not be available in Super Top Up plan as portability benefits are not available in this product.

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.

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.

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.

A person undergoes for dialysis 4 times in a week will it be covered if the basic deductable is exhausted?

Yes, any illness payable under the Policy for which threshold gets exhausted, will be paid under Super top up.

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.

  • Brother, Sister, Grand Son, Grand Daughter, Daughter in Law, Son in Law, Nephew, Niece, Grand Mother and Grand Father.

Will I get tax benefit if I cover my family on individual Sum Insured basis?

Yes, you will get Tax benefit under section 80D.

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.

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.

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.

What is the minimum and maximum deductible in this plan?

You can choose minimum of Rs. 2,00,000 and maximum of Rs. 5,00,000 aggregate deductible in this policy.

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.

Can I also include my parent and parent 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.

Is it mandatory to inform change in health condition in writing while renewing 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.

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.

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.

In case of self financing, can the client apply for cashless?

Yes, Cashless can be applied through hospital.

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.

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