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HDFC ERGO Health Suraksha Top Up Plan

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HDFC ERGO General Insurance Company Ltd. is a joint venture between the private banking service provider HDFC Bank and the Germany based company ERGO International AG. It has a strong presence all over India, in 101 cities with 117 branches. A general insurance joint venture company headquartered in Mumbai, the firm offers a wide range of insurance products ranging from general insurance, vehicle insurance, health insurance, and travel insurance to personal accident insurance and home insurance. The my:health Medisure Super Top Up Insurance plan is one of the products in the health insurance category that is offered by HDFC ERGO.

Plan Overview

The my:health Medisure Super Top Up Insurance plan can be taken as a new policy or to support an already existing one. The already existing policy could be from any other insurance company or from HDFC ERGO. This plan can also be added to the employee health cover in order to increase coverage. It offers much more comprehensive coverage that protects the insured from any major unexpected financial expenses due to medical reasons. The premium, however, remains affordable so that it can be accessible to a large section of the population. This plan can be bought and renewed online which makes the process even easier.

Medisure Super Top Up Insurance plan’s features and benefits

These are the features and benefits of the plan:

  • Coverage for pre-hospitalization and post-hospitalization expenses without sub-limits
  • Coverage for daycare procedures without sub-limits
  • Quick response time of 6 hours for cashless claims or the company pays a penalty to the insured
  • Lower premiums but with higher sum insured
  • A wide range of deductibles to choose from
  • Tax benefits under Section 80D
  • Discount of 5% on the total premium if taken for a continuous period of 2 years
  • Cancellation of the policy can be done within 15 days from date of receipt of the policy’s documents. The premium will be refunded after adjusting the cost of stamp duty charges, proportionate premium, and medical examination (wherever applicable). However, please note that if any claim has been made within this 15-day period, refund will not be applicable.
  • You can renew the policy throughout your lifetime, if the renewal premium (in full) and application is received before the due date or within 30 days of the due date.
  • There is no increase in premium at the time of renewal if a claim has been made during the policy year
  • Spouse, two dependent children, parents, and parent in-laws can be covered in the same policy on an individual sum insured basis and in a separate policy on a floater sum insured basis

Eligibility Criteria

The following is the eligibility criteria for this plan:

  • The insured must be between 18 years and 65 years of age
  • Children can be insured if they are between the age of 91 days to 23 years
  • No medical examination up to the age of 55 years except in the case of pre-existing diseases at the time of application for the policy

Exclusions

These are some of the exclusions of the policy:

  • Pre-existing diseases, injuries, or illnesses as defined in the policy, until 36 months of continuous coverage has elapsed. Some of the pre-existing diseases are the following:
    • Diabetes and related complications (diabetic nephropathy, diabetic retinopathy, diabetic neuropathy, diabetic angiopathy, hyperglycemic or hypoglycemic shocks, diabetic foot or diabetic wounds)
    • Hypertension and related complications (cerebrovascular accident, internal bleeds or hemorrhages, coronary artery disease, hypertensive nephropathy)
  • The following ailments or diseases are covered (expenses along with complications for treatment) only after the first two years of continuous coverage of the policy:
    • Hysterectomy (other than for malignancy)
    • Uterine prolapse including any condition that requires hysterectomy
    • Cataract
    • Polycystic ovarian disease
    • Myomectomy for fibroids
    • Osteoarthritis
    • Osteoporosis
    • Knee replacement surgery (other than caused by accidents)
    • Joint replacement surgery (other than caused by accidents)
    • Prolapse of intervertebral discs (other than caused by accidents)
    • Arthroscopic surgery
    • Arthritis
    • Rheumatism
    • Congenital internal anomaly
    • Fistula in anus, piles, or fissures
    • Varicose veins and varicose ulcers
    • Stones in the urinary, uro-genital, and binary systems
    • Hypertension and diabetes related complications
    • Surgery on tonsils or adenoids
    • Fibroids
    • Dilatation and curettage for treatment purposes
    • Pilonidal sinus
    • Chronic Suppurative Otitis Media (CSOM)
    • Deviated nasal septum, sinusitis, and related disorders
  • Domiciliary hospitalization expenses
  • Ambulance charges
  • Dental treatment or surgery of any kind other than due to an accident and necessitating 24 hours of hospitalization
  • Routine medical eye, and ear examinations
  • Cost of spectacles or contact lenses
  • Hearing aids
  • Laser surgery for cosmetic purposes or corrective surgeries for eyes
  • Genetic disorder and stem cell implantation/surgeries
  • Birth control procedures
  • Hormone replacement therapy
  • Voluntary termination of pregnancy within 12 weeks of conception
  • Any treatment that arises from or is traceable to pregnancy or childbirth including Caesarean section.
  • Aggregate deductibles
  • Co-payment: For people named in the schedule above the age of 80, a co-pay of 10% for each and every claim has to be borne.

Please refer the company brochure for a more extensive list of the exclusions.

FAQs

  1. What is the claim process for cashless hospitalization?
  2. For cashless hospitalization, the claims process is simple with just a few steps. All you need to do is contact HDFC ERGO and submit a cashless request form with the required documents. The decision will be made within 6 hours.

  3. What is the claim process for reimbursement of expenses?
  4. For reimbursement of expenses, all you need to do is collate the original bills with the other required documents and submit it to HDFC ERGO. The response is made by the company within 6 working days.

  5. Which family members can be covered in a single policy under individual sum insured basis?
  6. The following family members can be covered: Grandmother, grandfather, grandson, granddaughter, brother, sister, nephew, niece, son-in-law, and daughter-in-law.

  7. How do I renew my policy?
  8. A request should be made to HDFC ERGO before the expiry date. If there has been a change in a health condition, it should be communicated in writing during the policy renewal.

  9. How do I cancel my policy?
  10. Intimation for cancellation should be given to HDFC ERGO in writing with 15 days of notice.

  11. Is portability an option?
  12. Yes, portability is an option in accordance with IRDAI guidelines.

Read terms, conditions and exclusions mentioned in the policy document.

Find cashless network hospitals nearby: HDFC ERGO Cashless Network Hospitals

Other Health Insurance Plans from HDFC ERGO Health Insurance:

GST rate of 18% applicable for all financial services effective July 1, 2017.

Disclaimer: Premiums may vary depending upon factors like age, location and prevailing taxes/GST.

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