National Super Top Up Mediclaim Policy

এক নজরে

• Available on individual or floater basis. (p.1)
• Claims operate after cumulative medical expenses exceed the scheduled threshold. (p.1)
• PED cover uses a 12-month wait followed by staged claim percentages. (p.9)
• Pre- and post-hospitalisation periods are 30 and 60 days. (p.5)

কারা বিবেচনা করতে পারেন

People comparing additional hospitalisation cover above a chosen annual threshold may review this policy together with their base cover and schedule.

যোগ্যতা

• Family members are the insured's spouse, children and parents or parents-in-law covered under the policy. (p.2)
• Where only children under 18 are covered, the policy continues to expiry and a legal guardian may renew it covering the children. (p.13)

Coverage-এর কাঠামো

• The policy may be issued for one, two or three years as selected and stated in the schedule. (p.8)
• Eligible reasonable and customary medically necessary in-patient expenses above the cumulative threshold are covered, subject to the policy limits. (p.1)
• Eligible expenses for the same admissible condition are covered for up to 30 days immediately before hospitalisation. (p.5)
• Eligible expenses for the same admissible condition are covered for up to 60 days immediately after discharge. (p.5)
• Eligible day-care procedure medical expenses are covered subject to the cumulative threshold and policy terms. (p.2)

মূল সুবিধা

• Actual emergency road-ambulance charges are reimbursed once per illness when an in-patient claim is admitted. (p.8)
• Eligible organ-donor in-patient hospitalisation expenses are covered when the insured person's transplant in-patient claim is admitted. (p.6)
• AYUSH treatment is included among the covered benefits, subject to the policy and sum insured. (p.2)
• Maternity expenses are covered up to the sum insured after a three-year waiting period, without a maternity sub-limit, subject to the cover's conditions and exclusions. (p.18)
• Each claim-free policy year earns 5% of basic sum insured; a claim reduces accrued bonus at the same rate, and bonus is capped at 50% of basic sum insured. (p.8)

Sum insured / deductible

• Threshold and sum-insured combinations are stated in the Table of Benefits (examples include Threshold INR 2 lakh with Sum Insured INR 3/5/7 lakh; Threshold INR 3 lakh with Sum Insured INR 3/5/7/10 lakh; Threshold INR 5 lakh with Sum Insured INR 5/7/10/15 lakh). Confirm the exact pairing on the policy schedule. (p.18)
• A claim becomes admissible when cumulative medical expenses for hospitalisation(s) in a policy year exceed the threshold stated in the schedule; eligible expenses above the threshold and subsequent hospitalisations are considered, subject to the sum insured. (p.1)

Waiting period

• Illness treatment is excluded for the first 30 days from first policy commencement, except covered accident claims; this does not apply after more than 12 months' continuous coverage. (p.10)
• Listed diseases and procedures carry 90-day, one-year or two-year waiting periods, with staged admissible percentages for specified conditions. (p.9)
• PED treatment is excluded for 12 months; declared and accepted PED claims are limited to 50% in months 13-24, 75% in months 25-36 and 100% after 36 months. (p.9)

Co-payment ও sub-limit

• Room rent and ICU charges are included in covered medical expenses, subject to the Table of Benefits and policy limits. (p.5)

গুরুত্বপূর্ণ বর্জন

• Admissions primarily for diagnostics or evaluation are excluded. (p.10)
• Professional hazardous or adventure-sports treatment is excluded. (p.10)
• Alcoholism, drug or substance abuse and their consequences are excluded. (p.10)
• OPD and domiciliary treatment expenses are excluded. (p.11)
• Treatment outside India is excluded. The wording contains additional exclusions. (p.12)

Renewal ও portability

• The policy is renewable unless withdrawn, except for established fraud, non-disclosure or misrepresentation; renewal cannot be denied merely because of prior claims. (p.13)
• After five uninterrupted years, a person covered before age 45 may migrate at renewal to an existing company indemnity product without threshold, subject to underwriting and later-policy terms; standard migration and portability provisions also apply. (p.8)
• The grace period is 30 days; renewal coverage is not available for a period for which premium is not received. (p.3)
• The policyholder may cancel with seven days' written notice, subject to refund conditions; new policies have a 30-day free-look period from receipt. (p.13)