Top Up Mediclaim Insurance Policy
- This Policy covers In–Patient Hospitalisation Expenses incurred in India.
- This policy will respond only when the aggregate of all Hospitalisation expenses (except Pre / Post hospitalization expenses) of one or all members of the policy, exceeds the “Threshold” stated in the policy.
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This Policy will respond for each and every Hospitalisation after the Threshold has been exceeded by previous Hospitalisation expenses subject only to the Sum Insured stated in the Policy.
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The Sum Insured is the maximum liability of the company for all members of the policy. Thus, this Policy offers protection in excess of any Primary Health Policy/Benefit scheme that the Insured may have.
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Expense in excess of Threshold, receivable from any other entity, the Insured Person has an option to recover it from either that entity or this policy, but not both.
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However, the Sum Insured under the policy will be available over and above any reimbursement received from any other entity if such amounts exceed the Threshold.
Salient Features
- Yearly Renewal of Policies, some insurers offer renewals every 2 or 3 years
- Policy can be opted for Individual or Family Floater
- Policy cover individual between the age of 91 days to 65 years and can be renewed for Lifetime
- Covered pre-existing medical conditions after a waiting period of 2-4 years
- Sum insured opted can be as much as Rs. 1 Cr
- Portability of Policy Renewal to different insurer at the time of renewal
- Tax Benefits under section 80(D)
Exclusions
The most important exclusion relates to pre-existing illness. If the insuring person had a health condition, existing prior to taking the policy, which required medical treatment, the same gets automatically excluded in the policy. To ensure that in subsequent renewals medical conditions incepting since the policy was taken do not get excluded, the insuring person must renew the policy without break.
The other exclusions are :-
- Exclusion of certain named diseases in the first year of the policy.
- Congenital external disease, sterility, venereal disease, intentional self-injury, use of drugs,
alcohol, rest cure etc.
- AIDS
- Charges primarily for diagnostic, laboratory examinations, and not related to any treatment in
hospital. So also for vitamins and tonics unless prescribed for treatment.
- Dental treatment not requiring hospitaiisation.
- Treatment arising from or traceable to pregnancy, childbirth, including caesarean.
- Naturopathy treatment.
