Overview
The Oriental Insurance Super Health Top-up plan offers a maximum sum insured of up to ₹30 lakhs, with deductibles starting from ₹3 lakhs. It includes telemedicine benefits, maternity coverage (up to 10% of sum insured), and optional riders. It is designed to bridge the gap between basic health insurance and high-cost medical expenses, offering comprehensive protection for unforeseen health emergencies.
Experts' Review
Written by Nikhil Nair
Senior Writer
The Oriental Insurance Super Health Top-up plan is a versatile option for those seeking additional coverage beyond their base health insurance, with limits up to ₹30 lakhs. Its key USP is the fairly high maximum cover, making it suitable for families or individuals with potentially high medical costs.
However, the plan’s deductible structure is a significant consideration. For instance, if the deductible is ₹5 lakhs, the insured must pay the first ₹5 lakhs out of pocket (in a year) before the insurer covers expenses, which could be a financial burden for some.
Additionally, the plan mandates that room rent does not exceed 1% of the deductible amount, meaning if the deductible is ₹5 lakhs, the room rent limit is ₹5,000 per day, potentially restricting choice and leading to out-of-pocket expenses if higher room categories are selected, but note this can be removed with an add-on.
Also, premiums are generally competitive but may be slightly higher (around 10-15%) compared to similar plans from private insurers offering broader benefits or lower deductibles.
Pros
Insurer has a solid track record with great claim and service metrics.
Cons
Not very feature-rich.
No Restoration Benefit, which is a notable gap.
No Bonus for being healthy and not claiming insurance, which could be a drawback for some.
Your insurer doesn’t provide free health check-ups, which is a key feature.
Oriental Insurance
Key Insights
Founded
1947
Oriental Insurance was established 78 years ago and has built strong credibility over time, backed by its long-standing presence in the market.
Claims Experience
94% CSR, calculated as a 3-year average
Oriental Insurance settles 94% of all claims it receives demonstrating strong credibility.
Network Hospitals
4,000+
Oriental Insurance has a limited network of 4,000 hospitals, which may restrict access to cashless services for policyholders.
Complaints
7 complaints per 10,000 claims registered
Oriental Insurance maintains a low volume of complaints, reflecting strong customer satisfaction and effective service.
Features
All
Great
Good
Bad
Maternity
STANDOUT
The insurer will also cover expenses related to maternity— Think hospitalization expenses incurred while giving birth. But they’ll only pay upto 10% of the sum insured and make you wait 1 year before covering this expense. Also, you’ll only get the benefits if both, you and your spouse are enrolled in a single-family floater plan.
Co-payment
The insurer will bear the entire cost of treatment (up to the sum insured). You won’t have to pay a single penny. Meaning this policy has no co-payment.
Room Rent
Your insurer won’t let you stay in a room whose rent exceeds 1% of the sum insured. If it’s an ICU they’ll bump it to 2% of the sum insured. And in the event you breach these limits, then you’ll have to pay a lot more.
Disease sub-limit
Your insurance cover won’t be fully available in case you are treated for modern treatments, cataracts and a few other diseases. Meaning the insurance company has a cap on the total amount they’ll pay out if you are treated for these specific illnesses.
Pre existing diseases waiting
If you’re already dealing with diabetes, cardiovascular problems or any such illnesses, the insurer will cover all costs arising out of these pre-existing problems after you wait for 3 years.
Permanent Exclusions
Conditions or treatments that the policy clearly says it will not cover.
Treatments such as Rotational Field Quantum Magnetic Resonance (RFQMR), External Counter
Pulsation (ECP), Enhanced External Counter Pulsation (EECP), Hyperbaric Oxygen Therapy.
Expenses related to any admission primarily for diagnostics and evaluation purposes are excluded.
Diagnostic expenses not related or incidental to current diagnosis and treatment are excluded.
Expenses for admission primarily for bed rest and not for treatment are excluded.
Disclaimer: For illustration purposes only - exact terms are in the policy wording.
Specific Illness
The following illnesses are not covered under the policy for 3 years.
Benign ENT disorders and surgeries (e.g. Tonsillectomy, Adenoidectomy, Mastoidectomy, Tympanoplasty)
Polycystic ovarian diseases
Surgery of hernia
Surgery of hydrocele
Non-infective Arthritis
Waiting Period
30 days Initial waiting period
3 years Specific illness waiting period
3 years Pre-existing disease waiting period
Ditto's Take
◦ Standard ◦
After a close look at the waiting periods, it’s safe to say they are fairly standard.
What's missing in the policy
No Restoration Benefit.
No Bonus for being healthy and not claiming insurance.
Your insurer doesn’t provide free health check-ups.
No coverage if you are forced to hospitalize at home.
Doctor consultations are not covered.
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Frequently Asked Questions
Does Super Health Top-up have waiting periods?
- 30-Day Waiting Period: Hospitalizations won’t be covered for the first 30 days of the policy unless it’s an accident.
- Specific Illness Waiting Period: There's a 1 to 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Pre-Existing Disease Waiting Period: There's a 3-year waiting period for any pre-existing disease you may have while buying the policy.
- Maternity and Newborn Waiting Period: There’s a 1-year waiting period before you can make claims related to pregnancy and childbirth.
Does Super Health Top-up have room rent restrictions?
Does Super Health Top-up offer a restoration benefit?
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