Oriental Super Health Top-up Policy
A super health top-up plan ensures to cover your medical costs beyond your base health insurance policy or your out-of-pocket expenses (in case you do not have a base health insurance plan). So, it provides the insured an extra coverage to meet the costs of unforeseen circumstances. Super Health Top-up insurance policy from Oriental General Insurance Company Ltd. is one such policy that comes in handy in times of medical emergencies.
What is Oriental Super Health Top-up Policy?
As the name suggests, Oriental Super Health Top-Up Policy is a super top-up plan which means, the insurance provider is liable to pay all expenses that exceed the deductible amount, but up to the limit of the sum insured under the policy.
This policy has a period of one year, and it comes with a lifelong renewal opportunity, subject to certain conditions.
One can insure oneself alone, or with one's family, i.e. you can opt for an individual policy or a family floater option as well.
Features of the Oriental Super Health Top-Up Plan
Some of the unique features of this plan are as follows:
- Free Look Period: Oriental Super Health Top-Up Plan comes with a free look period of 15 days. The policyholder can read the terms and conditions of the policy during this period and can request for the cancellation of the policy provided no claim has been made.
- Income Tax Benefits: One can avail the tax benefits available under section 80D of the Income Tax Act.
- Reimbursement of the Cost of Medical Tests: 50% of the expenses incurred on pre-policy medical check-ups will be reimbursed, provided the proposal has been accepted.
- Pre-existing Conditions: Pre-Existing Conditions are also covered under this policy after 4 continuous years of the renewal of the policy.
Benefits of Oriental Super Health Top-up Plan
The scope of coverage or benefits offered under this policy are as mentioned below:
- Hospitalisation Expenses: The expenses for the treatment where hospitalisation of more than 24 hours is required are covered under this plan. Room rent will be covered up to 1% of the deductible amount and intensive care unit (ICU) charges will be covered up to 2% of the deductible amount, per day. These limits can be removed on payment of additional premium. It also includes expenses relating to the medical practitioner, surgeon, anaesthetist’s fees, operation theatre charges, drugs and medicines, oxygen, diagnostic tests, etc.
- Pre-hospitalisation Expenses: Medical expenses incurred in 30 days immediately preceding the hospitalisation of the insured are covered in this plan.
- Post-hospitalisation Expenses: Medical expenses incurred in 60 days immediately succeeding the hospitalisation of the insured are also covered under this policy.
- Daycare Treatment Expenses: The expenses incurred on treatments which required less than 24 hours of hospitalisation are also covered, provided they are undertaken in the in-patient department of a hospital or a nursing home or a daycare centre. The treatment undergone should be specified in the policy else should be approved by the TPA in writing, prior to the treatment.
- AYUSH Expense Cover: AYUSH stands for Ayurveda, Yoga and Naturopathy, Unani, Siddha, Homeopathy. Any expense related to such treatments is covered provided they are taken as in-patient treatment.
- Organ Donor Expenses: Expenses related to the donor of an organ are also covered under this policy provided the organ is used for the insured and such donation has been made in respect with the provisions of the Transplantation of Human Organs Act.
- Organ Donor Benefit: In case, the insured donates his/her organ, a lumpsum payment of 10% of the sum insured will be made, provided, the policy has been in force for a continuous period of 24 months.
- Maternity Expenses: This policy provides maternity cover for up to 10% of the sum insured. But, the expenses should have been covered as in-patient expenses. This benefit is available only if this policy has been in force for a continuous period of 12 months. Expenses for delivery, including Cesarian deliveries and lawful termination of pregnancy, are covered, subject to certain conditions.
- New Born Baby Cover: This benefit is available only if both insured and his/her spouse are covered under this policy either on an individual basis or a family floater basis. The policy provides automatic cover of 5% of the sum insured to the newborn baby up to 90 days of age. For babies above 90 days, the cover would be provided on payment of requisite premium.
- Coverage to SAARC Countries: The cover would be provided to insured persons travelling to Afghanistan, Bangladesh, Bhutan, Maldives, Nepal, Pakistan, and Sri Lanka. However, the facility of a cashless settlement of claims would not be available. Claims will be settled only on reimbursement basis on the return of the insured to India.
- Saving Benefits: One can save up to 10% of the premium if one or more persons are insured under the policy with an individual sum insured per person. If the applicant to this policy is also insured under a base health insurance from Oriental, at the inception of this policy, he/she can save up to 10% of the premium.
If the policy is purchased from the online portal without any intermediary involved, one can save up to 10% on the premium, subject to a maximum of Rs 2000.
*All savings are provided by the insurer as per the IRDAI approved insurance plan. Standard T&C apply.
Exclusions of the Oriental Super Health Top-Up Plan
Under a certain circumstance, the policy becomes null and void:
- Pre-Existing Conditions: Any pre-existing diseases or illness will not be covered unless the policy has been in force for a period of continuous 48 months. Any complication arising from such pre-existing conditions will not be covered under this policy.
- Dental Treatment: Any corrective, aesthetic or cosmetic procedure undertaken for teeth will not be covered under the policy like root canal treatments, filling of cavity, crown, etc. However, dental treatment necessitated by a disease or illness requiring hospitalisation will be covered under Oriental Super Top-up policy.
- Participation in any Hazardous Activity: Any medical expenditure arising out of participation in any adventurous activity such as ballooning, scuba diving, rock climbing, skydiving, bungee jumping, rafting, diving, etc. are not covered under the policy. Any expenses arising out of involvement in military, air or naval force are also excluded.
- Criminal Activity: Any illness or injury occurring due to involvement in some crime or activity with criminal intent is also excluded from the policy.
- Other Exclusions: Any expenses incurred on sex-change procedures, obesity programmes, all non-medical expenses, unproven treatments, hospitalisation charges for diagnostic and evaluative purposes, sexually transmitted diseases, war-related disease or injury are some of the other exclusions from this policy.
Who is Eligible to Buy the Oriental Super Health Top-Up Policy?
Any person aged 18 years and above but not more than 65 years of age is eligible to buy Oriental Super Health Top-Up plan. One can insure himself/herself and even include eligible family members.
The maximum age for entry into this policy is 65 years. However, persons over 65 and up to 70 years of age can also buy this policy on the payment of requisite additional premium. 10% loading charges are applicable on premiums in this case.
Such loading charges are not applicable if the person enters the policy at the age of 65 years or less.
Claim Process of Oriental Super Health Top-up Policy
The claim procedure under Oriental health insurance includes the following steps:
- Notification of Claim: The insured or someone on his/her behalf should inform the provider about the hospitalisation within 48 hours of admission to the hospital but, before discharge. This provision is applicable in both planned and emergency hospitalisation.
- Cashless Facility for Claims Settlement: If the insured undergoes treatment in any network hospital or nursing home of the provider, he/she can avail cashless settlement of claims. This can be done only on a pre-authorisation basis, where the insured must ask for approval to the provider, and the provider can approve/disapprove the same within 48 hours.
- Process: The insured or the policyholder is required to submit the necessary documents to the insurance provider within the stipulated time, after the scrutiny of documents and assessment of the claim, the provider will settle the claims within 30 days from the receipt of such documents.
For making a claim under this policy the following documents are required:
- Original Bills, doctor’s consultation reports, medical history of the patient recorded by the hospital, pathological and other test reports, surgeon’s original certificate, FIR and post mortem report (in the event of death), and other necessary documents as demanded by the provider.
Documents Required for Buying Oriental Super Health Top-Up Policy
In order to complete the buying process, the applicant will have to produce the following documents:
- The applicant needs to fill the proposal form to apply for this policy with all relevant details.
- The applicant is required to undergo pre-insurance medical tests.
- If the provider accepts the proposal, 50% of the cost of such tests will be reimbursed in case of fresh proposals.
How to Buy the Oriental Super Health Top-Up Plan?
The buying steps are very easy. One will have to visit the official website of paisawiki.com and follow the steps as mentioned:
- Step 1: Visit the paisawiki.com website.
- Step 2: From the drop-down menu, select 'Buy Online' and choose the name of your policy 'Super Health Top-Up Policy.'
- Step 3: Fill up the insurance details column, choose the type of plan, i.e. individual or family floater and fill in other necessary details.
- Step 4: After filling in the insurance details, you will be directed to ‘Calculate Premium’ section.
- Step 5: The next section involves filling in your personal details.
- Step 6: The last step involves making the payment.
Renewal of Oriental Super Health Top-Up Plan
The policy also can be renewed through paisawiki.com. the renewal steps usually include:
- Step 1: Visit the official website and go to the ‘health’ option.
- Step 2: Click on ‘Renew Online’.
- Step 3: Enter the number of the policy you wish to renew.
- Step 4: After filing in the number, ‘Policy Details’ ‘Premium Calculated’, and ‘Customer personal information for OICL policy renewal will get activated.
- Step 5: Click on Renew Now.
This policy comes with a lifelong renewal option. One needs to furnish the requisite premium before or at the renewal date of the policy.
A grace period of 30 days is available for the renewal of the policy, failure to pay the premium within the stipulated time will lead to cancellation of the policy. No coverage will be available during the grace period.
Ans: No, one does not require a base health insurance policy for this top-up plan. However, in such an event, the insured or the policyholder will be liable to pay the medical expenses from his/her pocket until the same exceeds the deductible amount.
Ans: A person above 55 years of age or with an adverse medical history is required to undergo General Physical Examination, CBC with ESR, Lipid Profile, HbA1c, S. Creatinine, Urine-Routine & Molecular, ECG, TSH, X-Ray Chest, USG, Eye Examination – Fundus & Glaucoma.
Ans: The deductible amount can not be lowered at any time during the policy period. However, one may request an increase in the deductible at the time of renewal of the policy. Sum insured under this policy can be revised but only at the time of renewal.
Ans: This policy comes with a free look period of 15 days so, the policyholder holds the right to cancel the policy within this period provided no claims are made under this policy. The premium would be refunded after deduction of the expenses and risk premium (in case the policy has already started).
This look period is not available in case of renewals of the policy.
Ans: Treatments underwent in SAARC countries, i.e. Afghanistan, Bangladesh, Nepal, Pakistan, Bhutan, Maldives and Sri Lanka, are covered. For the purpose of claim settlement, the currency conversion rate prevailing at the date of admission of the insured to the hospital would be applicable.
Ans: No, dental treatments are excluded from this policy. However, in the event, such treatment is necessitated by a disease or illness and requiring hospitalisation will be covered.
Ans: No, income proofs are not required to avail the policy. One can opt for any plan, the sum insured, and any deductible amount from the available options.
Ans: AYUSH treatments, i.e. Ayurveda, Yoga and Naturopathy, Unani, Siddha and Homeopathy treatments, are covered under this plan. Such treatment must have been undertaken as an in-patient treatment in the hospitals/nursing homes specified in the policy wordings.
Ans: Yes, two options are available i.e. Individual Policy and Family floater option. One can choose as per one's requirements.
Written By: Paisawiki - Updated: 12 February 2021