Objective

A top-up policy that becomes active only with medical expenses above a certain limit. It is meant to be bought as an additional policy to take care of hefty claims.

Suited for

This policy is more effective for those who already have a basic health insurance cover and wish to increase the protection further. Those who do not hold any health insurance policy may also go in for this policy if they can pay small medical bills that are not covered by the top-up policy. This policy is available for both individual and family on a floater basis.

What does it do?

It is a top up plan that gets activated only when the claim crosses the deductible limit. A deductible is that portion of claim which has to be borne either by an existing policy or by the policyholder himself. In this plan, deductible limit applies afresh each time insured person is hospitalized during the policy term. For instance, an insured accesses hospitalisation services twice during a policy term. For the first time the total medical expenses amounted to Rs 2 lakh and Rs 2.5 lakh during second hospitalisation. If the deductible limit on his policy was Rs 3 lakh, the policyholder will not receive insurance benefit of this policy as the admissible claim expenses were below the deductible limit each time. This policy offers a wide range of deductible starting from as low as Rs 30,000 up to Rs 5 lakh.
It covers hospitalisation expenses including doctor's fee, nursing, room charges up to the daily limit stated in the policy document, ICU charges, oxygen, OT charges, anesthesia and other expenses incurred as an inpatient. This plan can be bought as an individual or as a family floater policy.

Pros

Premiums paid under this plan qualify for deduction under Section 80D of Income Tax Act.
Policyholder can escape from hassle of paying premiums annually by selecting a higher policy term of 2 or 3 years.
It provides for lifelong renewals as there is no policy ceasing age.
There is no need to undertake pre-policy medical check up upto 55 years of entry age.

Cons

There is capping on room rent expenses.
Deductible applies afresh on each claim.

Our View

Add-on plans are not intended to duplicate the existing cover, these plans are rather meant to pay for higher claims which are beyond the reach of basic insurance plans. Instead of buying another insurance policy, a top up is recommended if your current insurance cover seems inadequate. The only constraint to this product is that threshold limit applies to every single treatment undertaken as an inpatient in a hospital. In contrast, there are certain policies in the market that cover each hospitalisation after the expenses of previous hospitalisation(s) put together exceed threshold. Such top-up policies have an edge over the policies where deductible applies on each claim.

Eligibility

Entry Age (years)

Minimum

18, 3 months for children

Maximum

65; 35 for dependent girl child and 25 for dependent male child

Maximum Policy Renewal Age (years)

Life long

Coverage Type

Individual/ Family floater

Policy Term (years)

1 or 2 or 3

Sum Insured (Rs)

Maximum

15 lakhs over and above deductible

Minimum

50000 over and above deductible

Pre Policy Medical Check Up

Mandatory beyond 55 years of age. 50% of medical cost will be reimbursed

Grace Period for Policy Renewal

15 days

Policy Termination

Policy may be terminated by giving a 15 days written notice by either parties. In case no claim has been made under the policy, a pre defined percentage of premium will be refunded. Insurance company will retain a part of premium for coverage provided.

Customer Service

Address

Cholamandalam MS General Insurance Company Limited
Dare House 2nd floor, No 2 N.S.C. Bose Road, Chennai 600 001

Mail to

customercare@cholams.murugappa.com

Call to

1800 200 5544

SMS

CHOLA to 56677

Network Hospitals

Http://www.cholainsurance.com/nwhosp/

Scope of Cover

Cahless facility

available if treatment availed in a cashless hospital

Reimbursement facility

available if treatment taken in any other non-empanelled hospital

Pre and post hospitalisation

covers pre hospitalisation for 60 days before hospitalisation upto 5% of admissible claim and post hospitalisation for 90 days upto 10% of admissible claim upto maximum of Rs 50000

Inpatient hospitalisation

covered

Room Rent

covered with sub-limits

Emegency ambulance

covered upto Rs 3000 per hospitalisation

Exclusions and Waiting Period

Pre existing diseases

will be covered after a period of 4 years of continuous renewal.

No claim period

30 days starting from the inception of the policy

Waiting Period

certain diseases such as cataract, hernia piles etc will be covered after first policy year has elapsed. Other diseases such as hypertension, diabetes, varicose veins etc. will be covered after a waiting period of 2 years.

General Exclusions

Expenses towards out patient treatmentCost of organ transplantDomiciliary treatmentPlastic Surgery, slimming or any other beauty related treatments.All diseases or conditions caused by or related to HIV or AIDS.Naturopathy and non allopathic treatment.Any condition arising due to involvement in any illegal or criminal activity