TOP UP POLICY

Frequently Asked Questions

1. WHAT IS A SUPER TOP UP POLICY?

A Super top up policy is a health insurance plan that offers you additional
coverage beyond the coverage limits of your existing health plans. Such a
plan is essentially used to enhance existing health coverage. You can buy a
super top up plan whether you have health insurance from your workplace
or an independent policy.

Once aggregate of all claims crosses Deductible Sum Insured (Existing

corporate Sum Insured) then the Top-up policy will cover expenses till the
Sum Insured opted in Top-up policy. The policy will have same terms and
conditions, exclusions as per the base policy. Even the list of dependents
would remain same.

2. WHAT ARE THE SALIENT FEATURES OF THE POLICY?

This Policy covers In-Patient Hospitalisation Expenses incurred in India.

 This Policy covers aggregate hospitalisation expenses in respect of

covered hospitalisation of members of M/s. Piramal Enterprises
Limited. Coverage would be applicable if treatment is during the policy
period and expenses are exceeding the Sum Insured under Group
Mediclaim policy.

3. WHAT ARE THE SUM INSURED OPTIONS AVAILABLE UNDER THE

POLICY?

Sum Insured is available on family floater basis i.e Single Sum Insured for all
family members covered under the Policy.
Details of Sum Insured is mentioned below –

BASIC SUM
INSURED (ALSO SUPER TOP UP SUM PREMIUM INCL 18%
CALLED AS INSURED GST
DEDUCTIBLE)
INR 4.2 lacs INR 3 lacs INR 3,199/-
INR 4 lacs INR 3,474/-
INR 5 lacs INR 3,839/-

INR 6 lacs INR 5 lacs INR 3,520/-

INR 7 lacs INR 3,839/-
INR 10 lacs INR 4,298/-

INR 9 lacs INR 7.5 lacs INR 3,942/-

INR 10 lacs INR 4,113/-
INR 15 lacs INR 4,754/-

INR 22 lacs INR 5 lacs INR 10,514/-

INR 9 lacs INR 11,199/-
INR 15 lacs INR 12,744/-

4. IS THE LIMIT FOR INDIVIDUAL MEMBER OR FAMILY FLOATER?

It is Family floater. Thus in above case, the topup sum insured is floating on
all family members
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5. BY ADDING TOP-UP SUM INSURED, CAN I OPT FOR HIGHER ROOM

RENT?
Room rent under base policy is 1% of Sum Insured per day for normal room
and 2% of Sum Insured per day for ICU. The limit does not change and room
rent eligibility does not increase.

6. WHO IS ELIGIBLE TO OPT FOR THIS SUPER TOP COVER?

All the employees and their dependents as declared under Group Mediclaim
Policy.

7. WHAT BENEFITS I WILL GET THROUGH SUPER TOP UP MEDICLAIM

POLICY?

 If the claim bills exceed the sum insured under GMC policy provided by
your employer then Super Top Up Policy Sum Insured will be become
available for settlement of claim as per the terms and conditions of the
policy
 All the coverages which are applicable to GMC policy are applicable to this
policy as well

8. WHAT ARE THE GENERAL EXCLUSIONS?

All the exclusions which are applicable to GMC policy are applicable to this
policy as well. Additional exclusions are:
 Joint replacement expenses is not covered
 Maternity expenses are not covered

Any room rent capping, or non payable expenses made under GMC policy
cannot be claimed under Super Top Up policy.

11.ANY MEDICAL TESTS TO AVAIL THIS BENEFIT?

No. Super Top Up policy is not subject to any medical test.

12.DOES THE COVER START FROM DAY 1 OF POLICY?

Yes.

13.WHAT ARE THE EXPENSES THAT CAN BE CLAIMED UNDER THE

POLICY?

All the expenses which stands payable as per GMC policy but are not payable
due to exhaustion of sum insured are payable under the Super Top Up policy
upto the sum insured opted.

14.HOW ARE CLAIMS REJECTED AND FOR WHAT REASONS?

 If the claims are rejected in Basic Mediclaim policy then the same will be
rejected in this policy as well.
 If the claim is below the sum insured of basic policy then it will not be
registered under this policy.

15.DO WE HAVE TO SUBMIT SEPARATE SET OF CLAIM DOCUMENTS TO

TPA?

There is no need to submit separate claims documents to TPA. Edelweiss

Insurance Brokers Ltd. will co-ordinate with TPA for submission. An
authorisation letter/consent letter would be required and the request for
utilisation of Topup should be conveyed in writing by employee.
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16.ARE BOTH POLICIES TPA SAME?

Yes. TPA under ICICI Lombard Topup Policy and GMC policy is their in-house
TPA

17.I HAVE CORPORATE POLICY OF RS. 6 LAKH AND PERSONAL POLICY

OF RS. 5 LAKH. CAN I UTILISE MY RS. 5 LAKH TOPUP TOPUP AFTER
UTILSING BOTH THESE POLICIES

No. The deductible under Topup cannot be increased over the employee
group policy sum insured. Thus topup cannot be utilised after utilising both
these policies

18.CAN I ADD FAMILY NAMES DURING MID TERM OF THE POLICY OR AT

THE RENEWAL OF POLICY?

No. You can’t add name of the family member except for new born baby &
newly married spouse under Super Top up Policy.

19.AM I ELIGIBLE FOR REFUND, IF I CANCEL THE POLICY MID TERM?

No. Refund is only allowed incase of resignation from the organisation,

subject to No claim made by the employee or his family under Topup policy.
Pro-rata premium refund would be allowed.

20.IF I LEAVE THE ORGANISATION DURING MID TERM OF THE POLICY,

AM I STILL COVERED UNDER THE POLICY?

No. HR will intimate insurance co. and the automatically cover would be
terminated. There is no provision of voluntary cover by paying additional
premium.