{"uin":"HDFHLIP21467V022021","name":"Health Suraksha Top -Up Plus","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021","insurer":{"slug":"hdfc-ergo-general-insurance","name":"HDFC ERGO General Insurance Company Limited","url":"https://indiainsurances.com/insurer/hdfc-ergo-general-insurance"},"line":"health","category":"health-topup","category_name":"Top-up and super top-up","irdai_type":"Revision","kind":"product","status":"unknown","approved_on":"2020-09-27","withdrawn_on":null,"summary":"Health Suraksha Top Up Plus from HDFC ERGO is an indemnity top-up that pays hospital expenses in India above an aggregate deductible of Rs. 1 to 5 lakh per policy year, for sums insured of Rs. 2 to 10 lakh on an individual or family floater basis. It has a 30-day initial waiting period, 24 months for listed illnesses, 36 months for pre-existing diseases and no loading for claims at renewal.","analysis":{"state":"extracted","analysed_at":"2026-10-16 07:11:53.691543+00","note":"Every stated fact carries a verbatim quote found in the cited clause."},"facts":[{"key":"plan_variants","label":"Plans and variants","section":"Overview","meaning":"The named plans inside this product (not cover types or payout options). Facts can differ between them.","status":"not-stated","value":null,"display":null,"note":"No named plans. The policy is sold on an Individual or a Family Floater sum insured basis, which are cover types; the rate chart prices family compositions such as 1 Adult, 2 Adult, 2A + 1 C and 2A + 2 C.","quote":null,"sources":[],"law":[]},{"key":"policy_term","label":"Policy term","section":"Eligibility","meaning":"How long one policy runs before it ends or must be renewed.","status":"cross-checked","value":"One year or two years.","display":"1 year or 2 years","note":"The policy wording's Cumulative Bonus notes also mention a Policy Period of two/three years.","quote":"The policy will be issued for 1 year /2 years period","sources":[{"clause":null,"heading":"Policy Period","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/130#c-policy-period"}],"law":[]},{"key":"claim_intimation","label":"Claim intimation deadline","section":"Claims","meaning":"How soon you must tell the insurer about a claim or hospitalisation.","status":"cross-checked","value":"At least 48 hours before admission for planned hospitalisation; within 24 hours of admission in an emergency.","display":"48 hours before planned admission; within 24 hours of emergency admission","note":"Benefits that depend on an accepted hospitalisation claim: within 15 days of discharge. Treatment required in an emergency: the wording also has a row saying within 15 days of completing it (the prospectus applies 15 days to reimbursement claims). Other cases: at least 7 days before treatment. If costs later look likely to exceed the deductible, intimate not later than 15 days after knowing it.","quote":"Immediately and in any event at least 48hours prior to the Insured Person’s admission. ... Within 24 hours of the Insured Person’s admission to Hospital. ... Within 15 days of the Insured Person’s discharge posthospitalization. ... Within 15 days of completion of such treatment, consultation or procedure. ... at least 7 days prior to any consequent treatment, consultation or procedure ... immediately but not later than 15 days on knowing that the Deductible is likely to be exceeded.","sources":[{"clause":null,"heading":"III. Notification of Claim","page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-iii-notification-of-claim"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 20, 21","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_documents","label":"Claim documents","section":"Claims","meaning":"Documents the insurer asks for when you claim.","status":"cross-checked","value":["Claim form, duly completed and signed","Original bills and receipts or prescriptions in support of the amount claimed","All reports, including medical reports, case histories, investigation reports, treatment papers, discharge summaries","A precise diagnosis of the treatment","A detailed list of the individual medical services and treatments provided and a unit price for each","Prescriptions naming the Insured Person, with drugs prescribed, their price and a receipt for payment"],"display":"Claim form, original bills, medical reports and discharge summaries, diagnosis, itemised list of services, prescriptions with receipts","note":"Documents are due within 15 days of the earlier of the insurer's request or discharge or completion of treatment. Where originals went to another insurer, attested photocopies are accepted.","quote":"Our claim form, duly completed and signed for on behalf of the Insured Person. ... Original Bills (including but not limited to pharmacy purchase bill, consultation bill, diagnostic ... bill) and any attachments thereto like receipts or prescriptions in support of any amount claimed ... All reports, including but not limited to all medical reports, case histories, investigation reports, treatment papers, discharge summaries. ... A precise diagnosis of the treatment for which a claim is made. ... A detailed list of the individual medical services and treatments provided and a unit price for each. ... Prescriptions that name the Insured Person andin the case of drugs: the drugs prescribed, their price and a receipt for payment. ... within 15 days of the earlier of Our request or the Insured Person’s discharge from Hospitalisation or completion of treatment. ... verified photocopies attested by such other organisation/provider have to be submitted.","sources":[{"clause":null,"heading":"V. Supporting Documentation & Examination","page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-v-supporting-documentation-examination"},{"clause":"1(i)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-i-6"},{"clause":"1(ii)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-ii-6"},{"clause":"1(iii)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-iii-5"},{"clause":"1(iv)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-iv-4"},{"clause":"1(v)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-v-3"},{"clause":"1(vi)","heading":null,"page":24,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-vi-3"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 17","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 23","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"claim_settlement_time","label":"Claim settlement time promised","section":"Claims","meaning":"How quickly the policy says a claim is decided or paid, and from when that is counted (intimation or last document).","status":"cross-checked","value":"The insurer settles or rejects a claim within 15 days from receipt of intimation; for delay it pays interest at 2% above the bank rate.","display":"Within 15 days of receipt of intimation","note":"CIS: cashless pre-authorisation decision within 1 hour, final bill authorisation within 3 hours.","quote":"The Company shall settle or reject a claim, as the case may be, within 15 days from the date of receipt of intimation. ... the Company shall be liable to pay interest to the Policyholder from the date of receipt of intimation to the date of payment of claim at a rate 2% above the bank rate. ... Decision on cashless authorization to be provided within 1 hour from the time of receipt of request ... Within 3 hours of the receipt of discharge authorization request from the hospital","sources":[{"clause":"1(i)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-i-2"},{"clause":"1(ii)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-ii-2"},{"clause":"Excl14(vi)","heading":null,"page":6,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/131#c-excl14-vi"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64UM(4) to (6)","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 10","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 15","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 16","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 22","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(i), V.3(ii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, V.3(iii)","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, V.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 23","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"The Motor Vehicles Act, 1988: Chapter XI, insurance of motor vehicles against third party risks","section":"Section 149","url":"https://indiainsurances.com/law/motor-vehicles-act-1988"}]},{"key":"exclusions_main","label":"Main exclusions","section":"Exclusions","meaning":"What the policy does not pay for, in the policy's own words.","status":"cross-checked","value":["Any illness in the first 30 days, except accidents","Pre-existing diseases until 36 months of continuous coverage","Listed conditions and surgeries until 24 months of continuous coverage","Admission primarily for diagnostic and evaluation purposes","Rest cure, rehabilitation and respite care","Surgical treatment of obesity unless conditions are met","Cosmetic or plastic surgery","Hazardous or adventure sports as a professional","Alcoholism, drug or substance abuse","Sterility and infertility","Maternity","War, invasion and nuclear, chemical or biological attack","Intentional self-injury or suicide","Treatment taken on outpatient basis","Non-medical expenses"],"display":"Initial 30 days, pre-existing diseases for 36 months, listed conditions for 24 months, plus standard and product exclusions","note":"The 30-day exclusion does not apply after more than twelve months of continuous coverage. The waiting periods apply afresh to any increase in sum insured.","quote":"Expenses related to the treatment of any illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident ... Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage ... Expenses related to the treatment of the listed Conditions, surgeries/treatments as mentioned in table A. and B. below shall be excluded until the expiry of 24 months of continuous coverage ... Expenses related to any admission primarily for diagnostic and evaluation purposes only are excluded. ... Rest Cure, rehabilitation and respite care ... Obesity/Weight control:Code – Excl06: Expenses related to the surgical treatment of obesity that does not fulfil all the below conditions ... Cosmetic or plastic surgery ... Expenses related to any treatment necessitated due to participation as a professional in Hazardous or Adventure sports ... Treatment for Alcoholism, drug or substance abuse or any addictive condition ... Sterility and Infertility ... Maternity: Code – Excl18 ... War or any act of war, invasion, act of foreign enemy ... Nuclear, Chemical orBiologicalattack or weapons ... Any Insured Person committing or attempting to commit intentional self-injury or attempted suicide or suicide ... Treatment taken on Outpatient basis ... Non-Medical expenses such as Food charges ... This exclusion shall not, however, apply if the Insured Person has continuous coverage for more than twelve months. ... In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of sum of Sum Insured increase.","sources":[{"clause":null,"heading":"3. 30 day Waiting Period: Code- Excl03","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-3-30-day-waiting-period-code-excl03"},{"clause":"Excl01","heading":"Pre-existing Diseases - Code - Excl01","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-excl01"},{"clause":"2(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-i"},{"clause":"2(a)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-a"},{"clause":"2(b)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-b"},{"clause":"2(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-b-2"},{"clause":"2(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-b-4"},{"clause":"Excl15","heading":"dioptres.","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-excl15"},{"clause":"3","heading":"Specific Exclusion","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-3-2"}],"law":[{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 11","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grievance","label":"Grievance route","section":"Claims","meaning":"Who to complain to first, as stated in the policy, before going to the Insurance Ombudsman.","status":"cross-checked","value":"First call 022 6158 2020 / 022 6234 6234 or www.hdfcergo.com; then write to the Complaints & Grievance Cell (grievance@hdfcergo.com); if not resolved within 15 days, the Chief Grievance Officer (cgo@hdfcergo.com).","display":"Call 022 6158 2020 / 022 6234 6234, then grievance@hdfcergo.com, then cgo@hdfcergo.com","note":"After these levels, the Insurance Ombudsman or the IRDAI Bima Bharosa portal. Senior citizens: seniorcitizen@hdfcergo.com.","quote":"First Point of Contact | Call us at 022 6158 2020 / 022 6234 6234/www.hdfcergo.com ... Write to The Complaints & Grievance Cell (C&G Cell) HDFC ERGO General Insurance Company Limited ... You can also write an email to grievance@hdfcergo.com ... If you're not satisfied with the resolution or if no response was received within 15 days, you can: 1. Write to the Chief Grievance Officer ... You can also write an email to cgo@hdfcergo.com","sources":[{"clause":"1(VII)","heading":null,"page":18,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-vii"}],"law":[{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 3","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 4","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"Consumer Protection (Jurisdiction of the District Commission, the State Commission and the National Commission) Rules, 2021","section":"Rule 5","url":"https://indiainsurances.com/law/consumer-jurisdiction-rules-2021"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(11)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 2(42)","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 34","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Consumer Protection Act, 2019","section":"Section 69","url":"https://indiainsurances.com/law/consumer-protection-act-2019"},{"title":"The Insurance Act, 1938","section":"Section 38","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 12","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 19","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 20","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 13","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 2","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(5), 5(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 5(9)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 25","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.1","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, VI.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 26","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 11","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 3","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 13","url":"https://indiainsurances.com/law/ombudsman-rules-2017"},{"title":"Insurance Ombudsman Rules, 2017","section":"Rule 14","url":"https://indiainsurances.com/law/ombudsman-rules-2017"}]},{"key":"sum_insured_options","label":"Sum insured options","section":"Cover","meaning":"The cover amounts you can choose from.","status":"cross-checked","value":"Rs. 2.00, 3.00, 4.00, 5.00, 7.50 or 10.00 lakh, per insured person (individual) or per policy (family floater), per policy year.","display":"Rs. 2, 3, 4, 5, 7.50 or 10 lakh","note":"The prospectus pre-policy checkup table offers only deductibles below the chosen sum insured (for Rs. 2 lakh, only the Rs. 1 lakh deductible).","quote":"Sum Insured (Rs. in Lac) per Insured Person per Policy Year | 2.00; 3.00; 4.00; 5.00; 7.50; 10.00 ... Sum Insured (Rs. in Lac) per Policy per Policy Year | 2.00; 3.00; 4.00; 5.00; 7.50; 10.00","sources":[{"clause":"Schedule OF","heading":"BENEFITS","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-schedule-of"}],"law":[]},{"key":"initial_waiting","label":"Initial waiting period","section":"Waiting periods","meaning":"Days from the start of the first policy during which illness claims are not paid (accidents usually are).","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Accidents are covered from day one. Applies afresh to any increase in sum insured.","quote":"Expenses related to the treatment of any illness within 30 days from the first Policy commencement date shall be excluded except claims arising due to an Accident ... This exclusion shall not, however, apply if the Insured Person has continuous coverage for more than twelve months. ... The within referred waiting period is made applicable to the enhanced Sum Insured in the event of granting higher Sum Insured subsequently.","sources":[{"clause":null,"heading":"3. 30 day Waiting Period: Code- Excl03","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-3-30-day-waiting-period-code-excl03"}],"law":[]},{"key":"ped_waiting","label":"Pre-existing disease waiting period","section":"Waiting periods","meaning":"How long you wait before conditions you already had when you bought the policy are covered. The law caps it at 36 months.","status":"cross-checked","value":{"unit":"months","amount":36},"display":"36 months","note":"Applies afresh to any increase in sum insured; reduced by prior continuous coverage under portability.","quote":"Expenses related to the treatment of a pre-existing disease (PED) and its direct complications shall be excluded until the expiry of 36 months of continuous coverage after the date of inception of the first policy with insurer. ... In case of enhancement of Sum Insured the exclusion shall apply afresh to the extent of sum of Sum Insured increase. ... waiting period for the same would be reduced to the extent of prior coverage.","sources":[{"clause":"Excl01","heading":"Pre-existing Diseases - Code - Excl01","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-excl01"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.6","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting","label":"Specific illness waiting period","section":"Waiting periods","meaning":"Waiting period for a list of named illnesses and procedures (cataract, hernia, joint replacement...). With several tiers (24 and 36 months), the shortest in the answer, the others in the note.","status":"cross-checked","value":{"unit":"months","amount":24},"display":"24 months","note":"If a listed condition is also pre-existing, the longer of the two waiting periods applies.","quote":"shall be excluded until the expiry of 24 months of continuous coverage after the date of inception of the first Policy with us. This exclusion shall not be applicable for claims arising due to an Accident. ... If any of the specified disease/procedure falls under the waiting period specified for Pre-existing diseases, then the longer of the two waiting periods shall apply.","sources":[{"clause":"2(i)","heading":null,"page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-i"},{"clause":"2(iii)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-iii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.7","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"specific_waiting_list","label":"Illnesses with a specific waiting period","section":"Waiting periods","meaning":"The named illnesses and procedures that carry the specific waiting period.","status":"cross-checked","value":["arthritis if non infective","calculus diseases of gall bladder and urogenital system","cataract","fissure/fistula in anus, hemorrhoids, pilonidal sinus","gastric and duodenal ulcers","gout and rheumatism","internal tumors, cysts, nodules, polyps including breast lumps (unless malignant)","osteoarthritis and osteoporosis","polycystic ovarian diseases","sinusitis, Rhinitis, Tonsillitis and skin tumors unless malignant","benign ear, nose and throat (ENT) disorders and surgeries","dilatation and curettage (D&C)","hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy","joint replacement","myomectomy for fibroids","surgery of gallbladder and bile duct unless necessitated by malignancy","surgery of genito urinary system unless necessitated by malignancy","surgery of benign prostatic hypertrophy","surgery of hernia","surgery of hydrocele","surgery for prolapsed inter vertebral disk","surgery of varicose veins and varicose ulcers","surgery on tonsils and sinuses","surgery for nasal septum deviation"],"display":"Cataract, hernia, joint replacement, hemorrhoids and fistula, calculus diseases of gall bladder and urogenital system, ENT surgeries and other listed conditions","note":null,"quote":"Illnesses: arthritis if non infective; calculus diseases of gall bladder and urogenital system; cataract; fissure/fistula in anus, hemorrhoids, pilonidal sinus, gastric and duodenal ulcers; gout and rheumatism; internal tumors, cysts, nodules, polyps including breast lumps (each of any kind unless malignant); osteoarthritis and osteoporosis; polycystic ovarian diseases; sinusitis, Rhinitis, Tonsillitis and skin tumors unless malignant. Treatments: benign ear, nose and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy and tympanoplasty); dilatation and curettage (D&C); hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy; joint replacement; myomectomy for fibroids; surgery of gallbladder and bile duct unless necessitated bymalignancy; surgery of genito urinary system unless necessitated by malignancy; surgery of benign prostatic hypertrophy; surgery of hernia; surgery of hydrocele; surgery for prolapsed inter vertebral disk; surgery of varicose veins and varicose ulcers; surgery on tonsils and sinuses; surgery for nasal septum deviation.","sources":[{"clause":"2(v)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-v"}],"law":[]},{"key":"moratorium","label":"Moratorium period","section":"Renewal and rights","meaning":"After this many months of continuous cover, the insurer cannot reject a claim for non-disclosure, except for proven fraud or permanent exclusions. The law sets 60 months.","status":"cross-checked","value":{"unit":"months","amount":60},"display":"60 months","note":"For an increased sum insured, the sixty months run from the date of enhancement, on the enhanced limits only.","quote":"After completion of sixty continuous months of coverage (including portability and migration) in health insurance policy, no policy and claim shall be contestable by the insurer on grounds of non-disclosure, misrepresentation, except on grounds of established fraud.","sources":[{"clause":"1(IX)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-ix"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 13","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 8","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"portability","label":"Portability","section":"Renewal and rights","meaning":"Whether you can move this policy to another insurer and keep waiting-period credit.","status":"cross-checked","value":"Yes. The whole policy can be ported to another insurer by applying at least 30 days but not earlier than 60 days before renewal, with accrued continuity benefits in waiting periods.","display":"Yes, apply 30 to 60 days before renewal; waiting-period credit carried over","note":"Migration to other HDFC ERGO health products is also allowed, applying at least 30 days before renewal.","quote":"The Insured Person will have the option to port the Policy to other insurers by applying to such Insurer to port the entire policy along with all the members of the family, if any, at least 30 days before, but not earlier than 60 days from the policy renewal date as per IRDAI guidelines related to Portability. If such person is presently covered and has been continuously covered without any lapses under any health insurance policy with an Indian General/Health insurer, the proposed Insured Person will get the accrued continuity benefits in waiting periods as per IRDAI guidelines on portability. ... The Insured Person will have the option to migrate the Policy to other health insurance products/plans offered by the Company by applying for Migration of the policy at least 30 days before the policy renewal date","sources":[{"clause":"1(X)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-x"},{"clause":"1(XI)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-xi"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 11","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 12","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.6","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, VII.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 24","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.4 and 1.5","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 10","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"lifelong_renewal","label":"Lifelong renewal","section":"Renewal and rights","meaning":"Whether the policy can be renewed for life without a maximum age.","status":"cross-checked","value":true,"display":"Yes, no exit age","note":null,"quote":"However there will be no exit-age for ceasing of the cover ... A health insurance policy shall be renewable except on grounds of established fraud or non-disclosure or misrepresentation by the insured, provided the policy is not withdrawn","sources":[{"clause":null,"heading":"Eligibility","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/130#c-eligibility"},{"clause":"1(XII)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-xii"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch II D.II","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"claim_loading","label":"Premium loading after claims","section":"Renewal and rights","meaning":"Whether the premium can go up at renewal because you made a claim.","status":"cross-checked","value":"No. No loading applies on renewals based on individual claims experience.","display":"No loading for claims at renewal","note":"A risk loading based on health status at proposal (up to 100% per condition, 150% overall) can apply from commencement and on renewals.","quote":"c) No loading shall apply on renewals based on individual claims experience ... We will not apply any additional loading on Your policy premium at Renewal based on claim experience in Your Policy.","sources":[{"clause":"1(XII)","heading":null,"page":20,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-xii"},{"clause":null,"heading":"II. Loadings","page":22,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-ii-loadings"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 10","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.5","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 9","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 4","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"Review of revision in premium rates under health insurance policies for senior citizens, 2025","section":"Para 7","url":"https://indiainsurances.com/law/irdai-senior-premium-2025"}]},{"key":"permanent_exclusions","label":"Permanent exclusions","section":"Exclusions","meaning":"Conditions or treatments that are never covered: the standard IRDAI exclusion codes Excl04 to Excl18 and the product's own permanent exclusions. Excl01 to Excl03 are waiting periods, not permanent exclusions.","status":"cross-checked","value":["Excl04 Investigation & Evaluation","Excl05 Rest cure, rehabilitation and respite care","Excl06 Obesity/Weight control","Excl07 Change-of-Gender treatments","Excl08 Cosmetic or plastic surgery","Excl09 Hazardous or Adventure Sports","Excl10 Breach of Law","Excl11 Excluded Providers","Excl12 Alcoholism, drug or substance abuse or any addictive condition","Excl13 Treatments in health hydros, nature cure clinics, spas or similar establishments","Excl14 Dietary supplements and substances that can be purchased without prescription","Excl15 Correction of eye sight due to refractive error","Excl16 Unproven Treatments","Excl17 Sterility and Infertility","Excl18 Maternity","War, invasion, act of foreign enemy, nuclear, chemical or biological attack, radiation","Intentional self-injury, attempted suicide or suicide","Participation in naval, military or air force operation","Investigative treatment for sleep-apnoea, general debility or exhaustion","Congenital external diseases, defects or anomalies","Stem cell harvesting","Investigative treatments for spinal subluxation and manipulation of the skeletal structure","Circumcisions unless necessitated by illness or injury","Convalescence, sanatorium treatment, private duty nursing or long-term nursing care","Preventive care and nutritional and electrolyte supplements","Vaccination including inoculation and immunisations (except post animal bite treatment)","Non-Medical expenses","Treatment taken on Outpatient basis","Hearing aids, spectacles or contact lenses","Alopecia, baldness, wigs, toupees, hair pieces","Treatment not Reasonable and Customary or not Medically Necessary","Artificial limbs, external durable medical equipment, cochlear implants unless necessitated by an Accident","Claims arising due to non-disclosure of pre-existing illness or material fact"],"display":"IRDAI standard exclusions Excl04 to Excl18 plus the product's own specific exclusions","note":"The wording's Excl15 omits the dioptre figure; the CIS says refractive error less than 7.5 dioptres. Excluded providers: expenses up to stabilisation are paid in life-threatening situations or after an accident.","quote":"Investigation & Evaluation:Code Excl04 ... Rest Cure, rehabilitation and respite care–Code – Excl05 ... Obesity/Weight control:Code – Excl06 ... Change-of-Gender treatments - Code – Excl07 ... Cosmetic or plastic surgery:Code – Excl08 ... Hazardous or Adventure SportsCode – Excl09 ... Breach of Law:Code – Excl10 ... Excluded Providers- Code – Excl11 ... Treatment for Alcoholism, drug or substance abuse or any addictive condition and consequences thereof.Code – Excl12 ... Treatments received in health hydros, nature cure clinics, spas or similar establishments ... wholly or partly for domestic reasons.Code – Excl13 ... Dietary supplements and substances that can be purchased without prescription ... as part of Hospitalization claim or day care procedure.Code – Excl14 ... refractive error less than 7.5 dioptres ... Expenses related to the treatment for correction of eye sight due to refractive error less than ... dioptres.Code – Excl15 ... Unproven Treatments ... Code – Excl16 ... Sterility and Infertility –Code – Excl17 ... Maternity: Code – Excl18 ... War or any act of war, invasion, act of foreign enemy ... Nuclear, Chemical orBiologicalattack or weapons, radiation of any kind. ... Any Insured Person committing or attempting to commit intentional self-injury or attempted suicide or suicide ... Any Insured Person’s participation or involvement in naval, military or air force operation. ... Investigative treatment for Sleep-apnoea, General debility or exhaustion ... Congenital external diseases, defects or anomalies ... Stem cell harvesting ... Investigative treatments for analysis and adjustments of spinal subluxation,diagnosis and treatment by manipulation of the skeletal structure ... Circumcisions (unless necessitated by Illness or Injury and forming part of treatment). ... Any Convalescence, ,sanatorium treatment, private duty nursing or long-term nursing care. ... Preventive care, and other nutritional and electrolyte supplements ... Vaccination including inoculation and immunisations (Except post Animal bite treatment) ... Non-Medical expenses ... Treatment taken on Outpatient basis ... The provision or fitting of hearing aids, spectacles or contact lenses. ... Any treatment and associated expenses for alopecia, baldness including corticosteroids and topical immunotherapy wigs, toupees, hair pieces ... Any treatment or part of a treatment that is not of a Reasonable and Customary charge, not Medically Necessary ... Expenses for Artificial limbs ... external durable medical equipment of any kind ... cost of cochlear implant(s) unless necessitated by an Accident ... Any Claim arising due to Non-disclosure of Pre-existing Illness or Material fact","sources":[{"clause":null,"heading":"2. Standard Permanent Exclusions","page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-standard-permanent-exclusions"},{"clause":"2(b)","heading":null,"page":13,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-b"},{"clause":"2(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-b-2"},{"clause":"2(b)","heading":null,"page":14,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-2-b-4"},{"clause":"Excl15","heading":"dioptres.","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-excl15"},{"clause":"3","heading":"Specific Exclusion","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-3-2"},{"clause":"Excl14","heading":null,"page":4,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/131#c-excl14"}],"law":[{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 16","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"cancellation_refund","label":"Cancellation by you","section":"Renewal and rights","meaning":"What you get back if you cancel during the year.","status":"cross-checked","value":"On 7 days' written notice, a pro-rata premium for the unexpired policy period is refunded. No refund if any claim has been admitted or any benefit availed.","display":"Pro-rata refund for the unexpired period; none if a claim was admitted","note":"Instalment policies: after an admissible claim, future instalments for the policy year are adjusted in the claim and no premium is refunded for that year.","quote":"The Policyholder may cancel this Policy by giving 7 days’ written notice and in such an event, the Company shall refund to the Insured a pro-rata premium for the unexpired Policy Period. ... no refunds of premium shall be made in respect of Cancellation where any claim has been admitted or any benefit has been availed by the Insured Person under the Policy.","sources":[{"clause":"1(V)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-v-2"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 64VB","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on General Insurance Business, 2024","section":"Ch I, Para 8","url":"https://indiainsurances.com/law/irdai-general-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 6","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 17","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.4","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part C, IV.3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"territory","label":"Where it covers","section":"Overview","meaning":"Geographic area of cover: India only, worldwide, or listed countries. 'As stated in the schedule' is not an answer.","status":"cross-checked","value":"India only. The policy covers treatment taken within India and pays in Indian Rupees within India.","display":"India only","note":null,"quote":"This Policy only covers medical treatment taken within India, and payments under this Policy shall only be made in Indian Rupees within India.","sources":[{"clause":"1(v)","heading":null,"page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-v"}],"law":[]},{"key":"free_look","label":"Free-look period","section":"Renewal and rights","meaning":"Days after you receive the policy in which you can return it for a refund if you do not agree with its terms.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"New individual health policies only, not renewals or ported or migrated policies. Refund less medical examination and stamp duty costs, or less proportionate risk premium if cover has started. The CIS also says 'within 30days from the beginning of the policy'; the wording counts from receipt of the policy document.","quote":"The Insured Person shall be allowed free look period of thirty days from date of receipt of the policy document to review the terms and conditions of the policy, and to return the same if not acceptable. ... a refund of the premium paid less any expenses incurred by the Company on medical examination of the Insured Person and the stamp duty charges ... a deduction towards the proportionate risk premium for period of cover ... You may cancel the insurance policy if you do not want it, within 30days from the beginning of the policy.","sources":[{"clause":"1(XIII)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-xiii"},{"clause":"1(i)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-i-4"},{"clause":"1(ii)","heading":null,"page":21,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-ii-4"},{"clause":"Excl14(ix)","heading":"Email","page":10,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/131#c-excl14-ix"}],"law":[{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 5","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 5","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(1), 20(2)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(3) to 20(5)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Insurance Regulatory and Development Authority of India (Protection of Policyholders’ Interests, Operations and Allied Matters of Insurers) Regulations, 2024","section":"Reg 20(6)","url":"https://indiainsurances.com/law/irdai-ppi-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, II.8","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, III.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"}]},{"key":"grace_period","label":"Grace period","section":"Renewal and rights","meaning":"Days you get after the due date to pay without losing cover or continuity.","status":"cross-checked","value":{"unit":"days","amount":30},"display":"30 days","note":"Premium received after the grace period makes a fresh policy.","quote":"A Grace Period of 30 days is available for Renewal of the Policy.","sources":[{"clause":null,"heading":"XI. Grace Period","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-xi-grace-period"}],"law":[{"title":"The Insurance Act, 1938","section":"Section 50","url":"https://indiainsurances.com/law/insurance-act-1938"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 8","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Health Insurance Business, 2024","section":"Ch I Para 9","url":"https://indiainsurances.com/law/irdai-health-mc-2024"},{"title":"Master Circular on Life Insurance Products, 2024","section":"Chapter 1, Para 8","url":"https://indiainsurances.com/law/irdai-life-products-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part A, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Sec 1, Part B, IV.2","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"Master Circular on Protection of Policyholders' Interests, 2024","section":"Para 3","url":"https://indiainsurances.com/law/irdai-ppi-mc-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule I, Para 1.2","url":"https://indiainsurances.com/law/irdai-products-regs-2024"},{"title":"IRDAI (Insurance Products) Regulations, 2024","section":"Schedule III, Para 1.3","url":"https://indiainsurances.com/law/irdai-products-regs-2024"}]},{"key":"eligibility_entry_age","label":"Entry age","section":"Eligibility","meaning":"The youngest and oldest age at which you can buy this policy.","status":"cross-checked","value":"From 5 to 65 years; children from 91 days if both parents are covered under the same policy.","display":"5 to 65 years; children from 91 days with both parents covered","note":"From the prospectus.","quote":"This policy covers persons in the age group 5-65 years. The maximum entry age is restricted upto 65 years. ... Children covered from 91 days onwards if both parents are covered under same policy.","sources":[{"clause":null,"heading":"Eligibility","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/130#c-eligibility"}],"law":[]},{"key":"premium_modes","label":"Premium payment options","section":"Premium","meaning":"How often you can pay: yearly, half-yearly, quarterly, monthly.","status":"not-stated","value":null,"display":null,"note":"The documents mention premium paid by instalment but do not list the instalment frequencies.","quote":null,"sources":[],"law":[]},{"key":"optional_covers","label":"Optional covers","section":"Cover","meaning":"Covers you can add for an extra premium. They change the answers above only if you buy them.","status":"not-stated","value":null,"display":null,"note":"No optional covers are described in the documents.","quote":null,"sources":[],"law":[]},{"key":"grace_cover","label":"Cover during the grace period","section":"Renewal and rights","meaning":"Whether a claim during the grace period is paid.","status":"cross-checked","value":"No for single (non-instalment) premium: illness contracted during the grace period is not covered and is treated as pre-existing. Yes if premium is paid in instalments.","display":"Not covered, unless premium is paid in instalments","note":null,"quote":"Any Illness, disease or condition contracted during Grace Periodwill not be covered and will be treated as Pre-existing diseases. ... If premium is paid in instalments then coverage will be available during the grace period also. (Note: In case of non-instalment premium payment, coverage shall not be available for the period for which no premium is received).","sources":[{"clause":null,"heading":"XI. Grace Period","page":25,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-xi-grace-period"}],"law":[]},{"key":"deductible","label":"Deductible","section":"Limits and co-pay","meaning":"The amount (per claim or per year) that must be crossed before this policy pays. Your base policy or you pay this part.","status":"cross-checked","value":"An aggregate deductible of Rs. 1, 2, 3, 4 or 5 lakh, as chosen, applies per policy year; the policy pays only once covered medical expenses in the year exceed it.","display":"Rs. 1, 2, 3, 4 or 5 lakh per policy year (aggregate)","note":"Applied per insured person on an individual policy and on the family floater basis on a floater policy. The prospectus tables offer only deductibles below the chosen sum insured.","quote":"Deductible (Rs. In Lacs) (As mentioned in Policy Schedule) | 1.00; 2.00; 3.00; 4.00; 5.00 ... Deductible shall be applicable per Policy Year basis. ... the aggregate of covered Medical Expenses in respect to Hospitalisation(s) of Insured Person (on Individual basis in case of Individual Policy and on Family Floater basis in case of Family Floater Policy) exceeds the Deductible","sources":[{"clause":"Schedule OF","heading":"BENEFITS","page":31,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-schedule-of"},{"clause":"3","heading":"Specific Exclusion","page":15,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-3-2"},{"clause":"Section B(I)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-section-b-i"}],"law":[]},{"key":"deductible_basis","label":"Per claim or aggregate","section":"Limits and co-pay","meaning":"Top-up: deductible applies to each claim. Super top-up: to the total of all claims in the year.","status":"cross-checked","value":"aggregate","display":"Aggregate (per policy year)","note":null,"quote":"Any claim under this Policy shall be payable by Us only if the aggregate of covered Medical Expenses in respect to Hospitalisation(s) of Insured Person (on Individual basis in case of Individual Policy and on Family Floater basis in case of Family Floater Policy) exceeds the Deductible applicable on per Policy Year basis.","sources":[{"clause":"Section B(I)","heading":null,"page":9,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-section-b-i"}],"law":[]},{"key":"room_rent","label":"Room rent limit","section":"Limits and co-pay","meaning":"Daily room limit, if any.","status":"not-stated","value":null,"display":null,"note":"Room rent is listed as a covered in-patient expense, but the documents state no daily room limit.","quote":null,"sources":[],"law":[]},{"key":"copay","label":"Co-payment","section":"Limits and co-pay","meaning":"Share of each admissible claim you pay.","status":"not-stated","value":null,"display":null,"note":"The documents do not mention any co-payment.","quote":null,"sources":[],"law":[]},{"key":"cashless","label":"Cashless treatment","section":"Claims","meaning":"Whether and where the insurer pays the hospital directly instead of you paying and claiming back.","status":"cross-checked","value":"Yes, at Network Hospitals: notice at least 48 hours before planned treatment, or within 24 hours in an emergency.","display":"Yes, at network hospitals","note":"Cashless only up to the insurer's liability, that is the amount above the deductible.","quote":"If any treatment, consultation or procedure for which a claim may be made is to be taken at a Network Hospital, then We will provide a cashless service by making payment to the extent of Our liability direct to the Network Hospital as long as We are given notice that the Insured Person wishes to take advantage of a cashless service accompanied by full particulars at least 48 hours before any planned treatment or Hospitalisation or within 24 hours after the treatment or Hospitalisation in the case of an Emergency.","sources":[{"clause":"1(iv)","heading":"Cashless service","page":17,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129#c-1-iv"}],"law":[]},{"key":"claims_handled_by","label":"Claims handled by","section":"Claims","meaning":"The insurer itself or a third-party administrator (TPA).","status":"cross-checked","value":"Either a Third Party Administrator (TPA) licensed by IRDA or the insurer itself.","display":"TPA or the insurer","note":"The prospectus asks claimants to contact their designated TPA.","quote":"All claims under this policy will be processed and settled by specified either the Third Party Administrator (TPA) licensed by IRDA or Us.","sources":[{"clause":null,"heading":"Claim Procedure","page":12,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/130#c-claim-procedure"}],"law":[]},{"key":"family_floater","label":"Family floater available","section":"Cover","meaning":"Whether one sum insured can be shared by the whole family.","status":"cross-checked","value":true,"display":"Yes","note":"Dependent parents have to be covered under a separate family floater policy.","quote":"The policy offers option of covering on individual sum insured basis and on family floater basis.","sources":[{"clause":null,"heading":"Eligibility","page":1,"url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/130#c-eligibility"}],"law":[]}],"documents":[{"kind":"wording","label":"Health Suraksha Top Up_Plus","pages":31,"fetched_at":"2026-10-16 07:11:37.1481+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/health-suraksha-top-up-plus-pw-638815876665.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/129"},{"kind":"prospectus","label":"Health Suraksha Top Up_Plus","pages":34,"fetched_at":"2026-10-16 07:11:37.1481+00","source_url":"https://customer-portal-assets.hdfcergo.com/documents/HealthSurakshaTopUpPlus-870183530109.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/130"},{"kind":"cis","label":"Health Suraksha - Top Up Plus","pages":13,"fetched_at":"2026-10-16 07:11:37.1481+00","source_url":"https://customer-portal-assets.hdfcergo.com/assets/v2/docs/default-source/downloads/cis/cis---health-suraksha---top-up-plus/PDF193-257244180506.pdf","url":"https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021/document/131"}],"versions":[],"where_to_buy":[],"claims_and_complaints":[],"notice":"Information, not advice. IndiaInsurances is not an insurer or an insurance intermediary, does not sell insurance and earns no commission. Policy terms change and your own policy schedule can differ: always confirm with the policy document and the insurer before you buy or claim.","cite_as":"Health Suraksha Top -Up Plus (UIN HDFHLIP21467V022021), IndiaInsurances, https://indiainsurances.com/policy/hdfc-ergo-general-insurance/health-suraksha-top-up-plus-hdfhlip21467v022021"}