Royal Sundaram Advanced Top-Up Health Insurance Plan
Royal Sundaram General Insurance Co. Limited offers an Advanced Top Up Health Insurance Plan that offers a deductible on an annual aggregate basis, offering a wide range of deductible and sum insured options. It is relatively inexpensive and aids in expanding your health insurance coverage. Once your base health coverage has been used up completely, you can make multiple claims with the Royal Sundaram Advanced Top-Up Plan each year.
The major highlight of the plan is that it comes without any room rent capping or sub-limits and has all the basic features such as inpatient treatment, ICU, Ayush treatment, pre-post hospitalization, donor expenses, etc. The plan also offers many sum insured options that range up to one crore. Additionally, you can get the Advanced Top-up plan by responding to 2 health questions without having to undergo any medical exams. You have the assurance that you will never have to worry about the insured amount when using the top healthcare facility in India or preserving a loved one’s or friend’s dear life.
Here are the eligibility criteria for the Royal Sundaram Advanced Top-Up Health insurance plan.
Minimum- 18 Years
Maximum- 65 Years
|Sum Insured||Wide options of top-up sum insured options such as 95 / 90 / 85 / 80/ 75 / 45 / 40 Lakhs so that you can reach a cover of 50 Lakhs / 1 Crore along with your base policy.|
Here are the coverage details for the Royal Sundaram Advanced Top-Up Health plan.
|Life protect benefit||Provides you 10% additional sum insured at no extra cost|
|Members Covered||Legally wedded spouse, Parents and parents-in-law, Children / Dependent children (i.e., natural or legally adopted) between 3 months to 25 years of age.|
|Waiting Period||30 Days|
|Pre-existing Disease||Option to reduce pre-existing Disease waiting period from 36 months to 24 months|
Key Features and Benefits of Advanced Top-Up Health Insurance Plan
Here are the key features and benefits of considering the Royal Sundaram Advanced Top-Up health insurance plan.
A defined period of 60 days before the date of the hospitalisation covered by the insurance policy, the company shall pay all types of Pre-hospitalization medical expenses that are primarily connected to an eligible hospitalisation needing inpatient care.
For a set period of 90 days, the plan will cover any post-hospitalization medical costs associated with an approved hospitalisation that requires inpatient care. It begins on the date of hospital discharge following a hospitalisation that qualifies for policy coverage and is admissible.
- Daycare Treatment
If an insured individual needs a medically necessary nursery procedure or surgery that necessitates less than a 24-hour hospital stay, the company will pay the insured’s medical expenses up to the amount of insurance.
- Domiciliary Hospitalisation
If medical care is received at home for a continuous period of three days, the company will pay for those costs up to the amount insured.
- Ayush Treatment
Medical costs for inpatient care under the Ayurvedic, Yoga and Naturopathic, Unani, Siddha, and Homoeopathic (AYUSH) systems of medicine throughout each insurance year, up to the sum insured, shall be reimbursed by the firm.
- Home Care Treatment
In the event of a pandemic, an endemic disease, or any other exceptional condition, the plan shall pay the treatment costs for the covered person’s care at home.
Home care services are only covered up to Rs. 50,000 per occurrence and Rs. 1 lakh per insured person and policy year.
- Life Protect Benefit
In the event of a life-threatening condition, the plan will provide an additional amount for any claim that is acceptable up to the limits outlined in the policy if the sum insured becomes insufficient.
- Second Opinion for Critical Illness
If an insured person is identified as having a critical illness within the insurance period, the plan will offer you a second medical opinion. The insured person would receive the expert advice directly.
Exclusions Under the Royal Sundaram Advanced Top-Up Health Insurance Plan
Until the end of the waiting time outlined below, the Company shall not be obligated to make any payments under the policy in connection with or in respect of the following expenses:
- Pre-Existing Diseases
Treatment costs for pre-existing conditions (PED) and their immediate consequences are excluded from coverage for the first 36 months following the start of the first policy with us. Ailments or illnesses that a person has before the commencement date of new health coverage under the terms of the policy are referred to as pre-existing diseases.
- 30 Days Waiting Period
Except for claims arising from an accident, which are covered, expenses linked to the treatment of any sickness within 30 days of the initial policy commencement date shall be excluded.
- Specific Waiting Period
As possible after the start date of the initial policy with the insurer, costs associated with the treatment of the conditions specified below, surgeries, and treatments, shall be excluded until the end of 24 months of continuous coverage. For claims brought about by accidents, the exclusion shall not apply.
- Rehabilitation for addiction-related conditions like alcoholism, drug addiction, or substance misuse, as well as their effects.
- Treatments are administered in health hydros, nature cure clinics, spas, or other similar facilities, or in private rooms attached to these facilities that are recognised as nursing homes, or in rooms where admission is organised entirely or partially for domestic purposes.
- Dietary supplements and substances that are available over the counter, such as vitamins, minerals, and organic compounds, unless a doctor has prescribed them as part of a hospitalisation claim or nursery procedure.
Take Mr. Puneet Kumar as an illustration. He works for a well-known manufacturer of goods in Okhla, New Delhi, as a young professional. He wanted to sign up for a specific health plan that would guard him against life-threatening illnesses. Additionally, because he did not want to take any chances, he was looking for a dedicated health insurance plan. Before deciding on the Royal Sundaram Advanced Top-Up Health Insurance Policy, he thoroughly studied his options.
|Age||Members Covered||Policy Tenure||Deductible||Sum Insured||Premium Amount|
|30 Years||1||1 Year||Rs. 10 Lakhs||Rs. 40 Lakhs||Rs. 1689.12|
How To Claim the Royal Sundaram Advanced Top-Up Health Insurance Plan?
The following are the steps to be followed for the cashless claim.
- The insured party must contact the TPA helpline within 72 hours of admission for scheduled hospitalisation and 48 hours of access for emergency hospitalisation and provide the membership number, policy number, and patient’s name.
- The insured must also submit the required form, which is accessible at the insurance help desk at the hospital, along with information on the hospitalisation, including diagnosis, name of the hospital, length of stay, expected hospitalisation costs, etc., to the TPA via email or through the TPA’s web site.
- The insured must also give the TPA’s medical panel any further information or medical records that they may want.
- Following the determination of the claim’s eligibility under the policy, the TPA must give the hospital a pre-authorization guaranteeing payment of the hospitalisation costs, subject to the insured sum, terms, conditions, and policy limitations. The insured is responsible for paying any difference between the pre-authorization amount that was granted and the final hospital bill as a result of deductions such as non-payable items, excluded items, policy sub-limits, co-pay amounts, deductible amounts, etc.
- Notice of claim
In the event of planned hospitalisation, the insurer should be notified at least 72 hours before admission; in the event of emergency hospitalisation, the insurer should be notified no later than 48 hours before discharge. The preliminary information of the claim should include details relating to the policy number, name of the insured person in respect of whom the claim is made, nature of illness or injury, and name and address of the attending hospital.
- Submission of Claim
Not later than 30 days following discharge, the insured must submit the claim form, the attending physician’s certificate, and the remaining claim documentation.
Listed below are the documents required to file a claim for the policy.
- The hospital will provide a complete discharge statement that includes information about the complaints’ type, length, treatments, recommendations for discharge, etc.
- Letter of original settlement from the main insurer.
- If the covered individual passes away at a hospital, a death summary will be provided. Initial consultation documents.
- prescriptions from doctors recommending or confirming admission.
- All test reports such as X-rays, ECG, Scan, MRI, Pathology, etc., including doctor’s prescription advising such tests/investigations (CDs of the angiogram, surgery, etc., need not be sent unless specifically sought).
- Original hospital final bills, and receipts for initial and final payments.
- Prescriptions from doctors accompanied by cash payments for drugs acquired outside of the hospital.
- F.I.R / MLC. In the case of accidental injury and English translation of the same, if in vernacular language.
- In the event of claims deriving from injuries (in the absence of an FIR), a detailed self-description indicating the date, time, circumstances, and nature of the accident is required.
- Certificate of legal heirship in the absence of a nomination under the policy in the event of the proposer’s death. Evidence proving legal heirship may be offered in the absence of a legal heir certificate.
- For b) Cataract claims – IOL sticker c) PTCA claims – Stent sticker. d) Implant sticker for surgeries involving implants.
- A confirmation from the other insurer confirming the final claim amount decided by them and that original claim documents are kept at their end is required if any other insurer only partially resolves a claim.
- Comprehensive medical records of any prior hospitalisations or treatments.
- A certificate from the attending physician stating that the patient’s condition is such that they do not need to be transported to a hospital or that there are no beds available in the hospital close to the insured’s place of residence is required for claims involving domiciliary hospitalisation.
- A cancelled check leaf bearing the proposer’s name, the IFSC number, and the account holder’s name.
- CKYC number of the proposer. Assuming the insured does not already have a CKYC number, the proposer must properly complete the CKYC format and provide photo identification and address verification following the AML criteria set forth by the Government of India.
Steps to Follow to Renew Royal Sundaram Advanced Top-Up Health Insurance Plan
If you don’t renew your plan on time, it will lapse. In the future, if you want to purchase a health insurance policy again, you can be asked to pay higher rates or possibly be denied coverage entirely due to your age or health. Therefore, it is preferable to keep your policy in effect by renewing it. To renew your Royal Sundaram Advanced Top-Up Health Plan, listed below are the steps one must follow.
- Go to the official website of Royal Sundaram General Insurance.
- On the home page, in the banner, you will see “Renew Royal Sundaram Policy” in orange-coloured button. Click on it.
- After that, select the product to be renewed and then choose any one option to proceed. If you are renewing with your registered mobile number, then enter the valid details in the box and then click on “Generate OTP”.
- Once you click on it, an OTP will be sent to your mobile number. Enter it carefully and then you will see all your policy details.
- After that, the insurance renewal premium must be paid. You can then renew your insurance with a credit or debit card.
- When you make the payment, a message containing information about your insurance will be sent to your registered phone number and email address.
Frequently Asked Questions
Yes, the free look time begins when the policy is first issued. It is not applicable at the time of policy porting or renewals. The insured has 15 days from the date of receipt of the policy to review the terms and conditions, decide whether they are acceptable, and return the insurance.
Section 80 of the Indian Income Tax allows for a tax deduction for the insurance premium. The sum that you would have to spend towards your health insurance premiums might be subtracted from your taxable income. It guarantees a decrease in taxable income.
The plan will pay for the donor’s inpatient medical costs related to the donation of the organ. Costs related to organ donation will be covered by the amount. The receiver of the organ (who is undergoing the transplant) is insured for the patient who has been insured with the business.