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top up health insurance


Diseases are growing, technology and medical science is advancing. Are you satisfied with your medical insurance plan? Does it provide proper cover in this era of inflation? If your answer is NO then a Top-Up policy is all that you need to buy. It is like the Stepney supporting you after the sum insured limit of your health insurance is exhausted.
Top-up plans are cheaper than the basic health insurance. These can also be taken long with the health cover provided by the employer. Many people get confused considering the riders and top-up as the same. Actually, top-up plans are just the indemnity plans along with regular Health Insurance Policy.
Normally the health Insurance is sometimes found not adequate in covering the medical expenses. So TOP Plan is recommended in which case this policy covers the expenses over and above the basic health Insurance. In the calculation of the premium there are different slabs considering the amount of the basic health Insurance because in TOP UP insurance the sum Insured of the normal health Policy is minimum excess which means that if there is claim over and above the sum Insured of the basic Health Policy then only the TOP UP Policy shall trigger. This policy is offered on an individual or floater basis and can cover up to 6 family members. It can be taken along with another health insurance policy.
The proposer need not be considered as the primary member but in TOP Up Policy the eldest family member will be considered the primary member and the others are considered as additional members and premium will be calculated accordingly.
As health Insurance the tenure of Top Up Policy is 12 months.
Normally health check-ups are conducted for individuals who are more than 50 years old or for those who have declared an adverse claim history. If an individual who is less than 50 years and owns a health insurance policy and had no claims registered in the past 2 years, then normally the pre-acceptance health check-ups are not required.
Insurance company grants TOP UP Health Plan after obtaining the following medical examination: ECG, Fasting BSL, Urine R, Lipid profile, HbA1C, SGPT, CBC, SGOT, Sr. Creatinine, eye check-up, knee check-up etc. Many insurance companies reimburse 50% of the cost of medical reports if the proposal is accepted by the Insurance Company.
Minimum Age of Entry 18 months.
Maximum Age of Entry 65 years.
Minimum age of entry as family member: 3 months
Maximum age of entry as family member: 65 years
Other Conditions: Only the spouse, dependent parents and dependent children are considered as “family” and can be added to the policy cover
Maximum Number of policy that could be covered under top up policy: 6 persons.
The following documents have to be submitted at the inception of the policy:
a.  Duly filled proposal form, which is signed by the insured individual or group of individuals.
b.  Details of previous health insurance policies as well as current health insurance policies are to be provided in the proposal form along with the clam history.
c.  Copy of the expired policy/ the current Health Insurance policy can be attached to the form.
The Policy provides the following benefits
I. Hospitalisation expenses
1.  Room, Boarding and Nursing expenses
2.   ICU
3.   Expenses incurred for Surgeon, Anaesthetist, Medical Practitioner, Consultants, and Specialists Fees.
4.   Expenses incurred on Anaesthetic, blood, oxygen, Operation theatre charges, surgical appliances, Medicines & drugs, dialysis, chemotherapy, radiotherapy, cost of artificial limbs, cost of prosthetic devices implanted during surgical procedure like Pacemaker, orthopaedic implants, infra cardiac valve replacements, vascular stents, relevant laboratory/diagnostic tests, x-ray and similar expenses that are medically necessary and hospitalization expenses (excluding cost of organ) incurred for donor in respect of organ transplant to the insured.
If the insured person opts for a room with rent higher than the entitled category, the charges payable above shall be limited to the charges applicable to the entitled category only. However, this will not apply for Medicines & drugs and implants.

Pre-hospitalisation expenses incurred up to 30 days prior to date of admission and Post-hospitalisation expenses incurred up to 60 days from the date of discharge – actual expenses or 10% of the Sum Insured whichever is less.
Expenses for the following illness restricted to –
a.   Cataract, Hernia, Hysterectomy – Actual expenses or 25% of SI whichever is less.
b.   Major illness/surgeries – Actual expenses or 70% of S.I. whichever is less.
c.   Policy holder need to bear amount of expenses as mentioned in policy as Co Pay. For list of major illness/surgeries, please see the prospectus or policy document.

II. Day Care Treatment Certain specified Day Care procedures which require less than 24 hours hospitalization.
III. Free Look period of 15 days shall be applicable at the inception of the first policy.
V. Premium paid for self, spouse, dependent children and dependent parents are exempt from Income Tax under Section 80-D of the IT act as per rules in force. For detailed terms and conditions, please see our Prospectus and Policy in our website.
1.  All Pre-existing diseases up to 48 months of continuous coverage.
2.  Any disease contracted during the first 30 days of inception of policy.
3.  Waiting period of 2/4 years for certain specified illness/treatment.
4.  Vaccination and Inoculation of any kind unless it is post-animal bite
5.  General debility and Run down conditions
6.  Circumcision, Cosmetic surgery, Plastic surgery.
7.  HIV/AIDS and Sexually transmitted diseases
8.  Psychiatric and psychosomatic disorders
9.  Injury arising out of drug/alcohol abuse or self-injuries
10.  Pregnancy, ailments related thereto and child birth
11.  War, act of foreign enemy, ionizing radiation and nuclear weapon.
12.  Naturopathy
13.  Experimental or unproven treatment
14.  All external equipment
15.  Dental treatments
16.  Expenses related to naturopathic treatment, acupuncture, acupressure, magnetic therapy, etc
17.  Injury due to participation in a criminal act.
18.  Stem Cell surgery or genetic disorders
19.  All non-medical expenses
20.  Treatment availed outside India, etc.

a)  If the insured individual does not have continuous coverage in excess of 24 months of the policy,
then following medical conditions are not covered:
1.  Benign ENT (Ear, Nose and/or Throat) disorders.
2.  External or internal benign cysts, tumours, polyps, breast lumps, etc.
3.  Benign hypertrophy
4.  Congenital Internal Disease
5.  Cataract and age related eye ailments
6.  Diabetes Mellitus
7.  Gout and Rheumatism
8.  Gastric/ Duodenal Ulcer
9.  Hernia of all types
10.  Hypertension
11.  Hydrocele
12.  Non Infective Arthritis
13.  Pilonidal sinus, Sinusitis and related disorders
14.  Piles, Fissures and Fistula in anus
15.  Prolapsed Inter Vertebral Disc and Spinal Diseases that are not caused by an accident
16.  Stone in Gallbladder and Bile duct, excluding malignancy
17.  Skin Disorder
18.  Stones in Urinary system
19.  Varicose Veins and Varicose Ulcers
20.  Treatment for Menorrhagia/ Fibromyoma, Myoma and Prolapsed uterus.
b)  If the insured individual does not have continuous coverage in excess of 48 months of the policy,
the following medical conditions are not covered:
1.  Degenerative condition causing joint replacement
2.  Osteoporosis and Osteoarthritis caused by old age.
Tax deduction under Income Tax Act section 80-D is available.

Reg. Office : B-711, Mondeal Heights, Next to Hotel Novotel, S.G. Highway, Satellite, Ahmedabad 380015 Gujarat -India
IRDAI Direct Insurance Registration No. 639 - Valid till 06th March, 2024
Contact No. +91 9727227797 ; E mail: info@arron.in
Tollfree : 1800123000044
Principal Officer : Mr. Ramesh K. Patel ; E mail : rameshpatel@arron.in

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