Chola Group Super Topup Insurance Plan covers medical expenses of the employees of an organization/company. This policy can cover the employee, his/her spouse, parents and up to 2 children aged between 3 months to 26 years. The primary insured member should be a minimum of 18 years on the commencement date of the policy. Chola Group Super Topup Insurance Plan can be issued on an individual or family floater basis. Keep reading this page to learn more about the coverage and exclusion of the Chola Group Super Topup Insurance Plan.
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Chola Group Super Topup Insurance Plan Cover
Under this group insurance plan, the permanent employees of an organization/company shall be covered against the following expenses incurred due to illness/injury during the policy term –
- In-patient Hospitalisation Expenses: Under this, the insurer will cover all the necessary charges incurred during the hospital stay, such as room rent, boarding and nursing charges, ICU charges, surgeon, anesthetist, medical practitioner, consultant and specialist fees, miscellaneous medical costs such as laboratory, x-ray, and diagnostic tests, cost of anesthesia, blood, oxygen, operation theatre charges, surgical appliances and prescribed medicines & drugs, diagnostic materials and the cost of the pacemaker, prosthetic and other devices implanted internally during surgery. Organ donor in-patient hospitalization expenses shall also be covered under this policy
- Pre-hospitalization Expenses: Any medical expenses incurred 60 days before the date of hospitalization shall be covered under this policy if the insured is hospitalized for the same condition.
- Post Hospitalisation Expenses: Any medical expenses incurred within 90 days post-discharge from the hospital shall be covered under this policy, provided the medical expenses are related to the condition for which the insured has been hospitalized
- Emergency Ambulance Expenses: The policy shall cover the ambulance service and reimburse the incurred amount on submission of original bills.
- Day Care Procedures: Any medical expenses incurred as a daycare procedure/treatment shall be covered up to the sum insured. The insured can receive daycare treatment/procedure both at network and non-network hospitals. In the case of a non-network hospital, you need to send a pre-authorization form to the insurer at least 72 hours before a planned admission and within 24 hours in case of emergency hospitalization.
- Domiciliary Hospitalization: The insurer shall reimburse the medical expenses incurred due to medical treatment at home. Domiciliary hospitalization expenses shall be covered under this policy if it is advised by the attending medical practitioner due to the patient’s condition, unavailability of room at the hospital, etc. The condition for which the medical treatment is provided must continue for at least 3 days. Pre and post-hospitalization expenses are also covered under this benefit.
Nothing shall be payable under this benefit if you receive medical treatment towards the following ailments – Tonsillitis and Us: Asthma, Bronchipper Respiratory Tract infection including Laryngitis and Pharyngitis, Cough and Cold, Influenza, Arthritis, Gout and Rheumatism, Chronic Nephritis and Nephritic Syndrome, Diarrhoea and all type of Dysenteries including Gastroenteritis, Diabetes Mellitus and Insipidus, Epilepsy, Hypertension, Pyrexia of Unknown Origin.
AYUSH Coverage Expenses: This policy covers non-allopathic treatments where the hospitalization is more than 24 hours and the treatment has been received in a Central or State Government AYUSH Hospital, Teaching hospital attached to an AYUSH college recognized by Central Government/Central Council of Indian Medicine/Central Council for Homeopathy, AYUSH Hospital, standalone or co-located healthcare facility of any recognized system of medicine.
Exclusions from Chola Group Super Topup Insurance Plan
The insurer shall not cover the following medical expenses if they are incurred due to the following –
- No claims are admissible for the treatment of illness during the initial waiting period of 30 days, except the treatment of the injury occurring due to an accident.
- No claims shall be admissible for the specified illnesses during the first 12 months as mentioned in the policy schedule.
- Pre-existing disease and its complications won’t be covered until the expiry of a 36-month waiting period
- Hospital admission primarily for diagnostics and evaluation purposes
- Hospital admission primarily for enforced bed rest and not for receiving treatment
- Expenses related to the surgical treatment of obesity and other weight control programs
- Change-of-Gender treatments
- Cosmetic or plastic surgery unless required for the reconstruction due to an accident, burn or Cancer
- Treatment due to participation in hazardous or adventure sports
- Treatment due to breach of law
- Treatment for alcoholism, drug or substance abuse
- Treatments received in health hydros, nature cure clinics and similar establishments
- Non-prescribed dietary supplements and substances such as vitamins, minerals and organic substances
- Treatment for correction of eyesight due to refractive error of less than 7.5 dioptres
- Unproven treatments
- Sterility and infertility treatment
- Medical expenses related to childbirth, cesarean sections, miscarriage except for ectopic pregnancy and miscarriage due to accident
- External congenital anomaly/illness/diseases/condition
- Pre & post-hospitalization expenses of the organ donor
- Injury/illness due to war, invasion, an act of the foreign enemy or warlike operations
- Injury/illness due to radioactive material, nuclear fuel or nuclear waste combustion
- Intentional self-injury or attempted suicide
- Circumcisions unless required for an illness or injury treatment
- Dental treatment or surgery unless necessitated due to an accidental injury
- Sexually transmitted diseases or illnesses
- Outpatient treatment
- Vaccination or inoculation unless required for post-animal bite treatment
- Any treatments or Investigation happening outside India
- Non-medical expenses incurred during hospitalization