1. Overview
Type: Top-up health insurance plan.
Policy Variants:
Silver Plan: Sum insured options with fixed deductibles.
Gold Plan: Flexible defined limits and higher coverage options.
Policy Term: 1 Year or 2 Years.
No carry-forward benefits between policy years.
2. Eligibility
Adults: 18 to 65 years.
Dependent Children: 91 days to 25 years.
Family Coverage:
Covers self, spouse, and dependent children.
3. Premium Payment
Modes: Quarterly, Half-Yearly, Annual, Biennial.
Quarterly: 3% loading.
Half-Yearly: 2% loading.
Discounts:
5% for advance payment of a 2-year premium.
4. Key Features
Silver Plan
Coverage begins only when hospitalization expenses exceed the deductible.
Sum Insured Options:
₹7,00,000 (deductible: ₹3,00,000).
₹10,00,000 (deductible: ₹3,00,000).
Gold Plan
Covers aggregate hospitalization expenses exceeding the defined limit.
Sum Insured Options:
₹5,00,000 to ₹1,00,00,000.
Defined limits: ₹3,00,000, ₹5,00,000, or ₹10,00,000.
Additional benefits include:
Maternity Cover: Up to ₹50,000 per policy period (maximum 2 deliveries lifetime).
Organ Donor Expenses: Covers costs for insured recipients (donor screening excluded).
Recharge Benefit: Additional indemnity coverage upon exhaustion of the sum insured.
Air Ambulance: Covers 10% of the sum insured for plans with ₹7,00,000 or above.
5. Coverage Features
Hospitalization Cover:
Silver: ₹4,000/day for room, boarding, and nursing expenses.
Gold: Single private A/C room.
Pre & Post-Hospitalization:
Silver: 30 days (pre) and 60 days (post).
Gold: 60 days (pre) and 90 days (post).
Day-Care Procedures: All are covered.
AYUSH Treatments: Covers inpatient expenses for Ayurveda, Unani, Siddha, and Homeopathy.
6. Waiver of Deductible (Gold Plan)
Available after 6 years of continuous renewal.
No claims must be made in the preceding 5 years.
7. Exclusions
Pre-existing Diseases:
Silver: Excluded for 36 months.
Gold: Excluded for 12 months.
Waiting Period:
30 days for general illnesses.
12-24 months for specific conditions (e.g., cataract, joint replacements, hernia).
Standard Exclusions:
Cosmetic surgeries.
Injuries from hazardous activities.
Experimental treatments.
Infertility or sterilization treatments.
8. Additional Details
Portability: Transfer of benefits to another insurer as per IRDAI guidelines.
Renewal:
Lifetime renewals allowed.
Grace period: 30 days (annual mode) or 15 days (monthly mode).
Claim Settlement:
Cashless in-network hospitals.
Reimbursement for non-network hospitals.
9. Premium Charts
Silver Plan
Example for deductible ₹3,00,000 (age-wise premiums):
₹7,00,000 sum insured:
Age 18-35: ₹1,165.
Age 61-65: ₹2,240.
₹10,00,000 sum insured:
Age 18-35: ₹1,460.
Age 61-65: ₹2,800.
Gold Plan
Premiums vary with sum insured and defined limits.
Example for ₹10,00,000 sum insured (age-wise premiums):
Defined limit ₹3,00,000:
Age 18-35: ₹1,835.
Age 61-65: ₹5,060.
10. Claims Process
Notify within 24 hours for emergencies.
Pre-authorization required for planned hospitalizations.
Submit necessary documents for reimbursement (e.g., medical bills, discharge summary).
1. What is Super Surplus Insurance Policy?
- Answer: Super Surplus Insurance is a top-up health insurance plan that offers additional coverage beyond an existing policy. It includes two variants: Silver (with fixed deductibles) and Gold (with flexible coverage limits).
2. How does the Silver Plan of Super Surplus work?
- Answer: The Silver Plan provides coverage only after hospitalization expenses exceed the deductible amount, with sum insured options of ₹7,00,000 or ₹10,00,000, both having a ₹3,00,000 deductible.
3. What are the benefits of the Gold Plan in Super Surplus Insurance?
- Answer: The Gold Plan covers aggregate hospitalization expenses above the defined limit, with additional benefits like maternity cover, organ donor expenses, recharge benefit, and air ambulance coverage.
4. Who is eligible for Super Surplus Insurance?
- Answer: Adults aged 18 to 65 years and dependent children aged 91 days to 25 years are eligible for the policy. Family coverage includes self, spouse, and dependent children.
5. How much does Super Surplus Insurance cost?
- Answer: Premiums vary by plan and sum insured. For example, the Silver Plan with a ₹7,00,000 sum insured costs ₹1,165 annually for ages 18-35, and ₹2,240 for ages 61-65.
6. Does Super Surplus Insurance cover pre-existing diseases?
- Answer: Yes, but with a waiting period. The Silver Plan excludes pre-existing diseases for 36 months, while the Gold Plan excludes them for 12 months.
7. What exclusions are there in Super Surplus Insurance?
- Answer: Standard exclusions include cosmetic surgeries, injuries from hazardous activities, experimental treatments, and infertility or sterilization treatments.
8. Can I get a discount on Super Surplus Insurance?
- Answer: Yes, you can get a 5% discount for paying the premium for 2 years in advance.
9. What is the waiver of deductible in the Gold Plan?
- Answer: The deductible can be waived after 6 years of continuous renewal without any claims made in the previous 5 years.
10. How do I file a claim with Super Surplus Insurance?
- Answer: Notify the insurer within 24 hours for emergencies, get pre-authorization for planned hospitalizations, and submit necessary documents (e.g., medical bills) for reimbursement.
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