HDFC ERGO Optima Super Top-Up

Plan details

Every field, in one place

Honesty note: Super Top-Up marketed as deductible can be met across multiple hospitalisations within policy year — confirm with policy wording.

Indicative premium

Order-of-magnitude only — NOT a quote

Indicative figures vary by city, family member count, medical loading and policy term. Always confirm on the insurer's premium calculator.

Known exclusions

What this plan typically does NOT cover

• ✕Standard exclusions list
• ✕Maternity (unless rider)
• ✕Self-inflicted injury, substance abuse
• ✕Adventure activities
• ✕Experimental treatments

Known traps

The fine print that decides claim outcomes

• ▸Aggregate deductible — claims must cross threshold within policy year for top-up to activate.
• ▸No room rent cap (a positive), but other HDFC ERGO hospital definition rules apply.
• ▸PED waiting 36 months — same as base.
• ▸Cumulative bonus does not stack on top-up — only on base plan.
• ▸Coordination at cashless requires pre-authorisation across BOTH policies.

How to claim

Cashless vs reimbursement — the steps

1. 1Notify insurer. Within 24 hours of emergency admission or 48-72 hours for planned hospitalisation. Use HDFC ERGO's helpline or app — keep the reference number.
2. 2Cashless: Pre-authorisation form filled by hospital, sent to HDFC ERGOvia the hospital's TPA desk. Approval typically 4-6 hours during business; longer overnight. If your hospital is OUT of network (or PPN-only), you'll be on reimbursement.
3. 3Reimbursement:Pay hospital out-of-pocket, then submit claim form + original bills + discharge summary + investigation reports + KYC. Insurer's IRDAI-mandated turnaround is 30 working days from receipt of complete documents.
4. 4Watch for deductions. Room rent above your eligible category triggers proportionate deduction across the WHOLE bill, not just room rent. Sub-limits on cataract / modern treatment apply even when total SI is far higher.
5. 5If denied: Ask for a written denial citing the exact clause. Internal grievance redressal first, then IRDAI Bima Bharosa or the Insurance Ombudsman.