the insurer's Super Top-Up Mediclaim covers medical expenses that exceed your deductible threshold — after your base health policy is exhausted OR across multiple hospitalisations in a year. No sub-limits on room rent, doctor fees, or day care. No co-payment. HIV/AIDS, bariatric surgery, maternity — covered up to sum insured. PED covered after just 12 months — the best PED wait in the insurer's health portfolio. Can be purchased even without a base health policy.
the insurer Health· NSTUMP
"National Super Top-up Mediclaim Policy is a high threshold health insurance product, covering the members of a family under a single sum insured on floater basis or each member on individual sum insured basis. The policy provides the customer an option to choose a high sum insured at reasonable cost." Unlike a base health policy, NSTUMP triggers only after your cumulative medical expenses in a year cross the chosen deductible (threshold). Once crossed, it pays all further hospitalisation expenses up to the sum insured.
Standard top-up: each claim must individually exceed the deductible. Super top-up: all claims in a year accumulate toward the threshold. Once cumulative medical expenses cross ₹X (your chosen deductible), NSTUMP pays everything beyond it across all subsequent hospitalisations in that policy year.
Aggregate = The Advantage"Medical expenses are reimbursed without any sub limits." No cap on room rent per day, no cap on doctor fees, no cap on ICU charges. Unlike NMP (1% SI room rent cap) or NMPP Plan A/B (1% cap), NSTUMP has absolutely no sub-limit restrictions. Full hospitalisation costs reimbursed above the threshold.
No Room Rent Cap"Waiting period of only one year in all Pre-Existing Diseases." All pre-existing conditions covered after just 12 months. Compare: NMP = 48 months; NMPP = 36 months; ASP = 48 months. NSTUMP's 12-month PED wait is uniquely short — making it ideal for buyers with chronic conditions who want supplementary cover.
12 Months — Best in PortfolioNo mandatory or optional co-payment under NSTUMP. "No Co-payment: The insurer takes" Unlike ASP's 5% mandatory co-pay, NSTUMP has no co-pay at all. 100% of admissible expenses above the deductible threshold: paid by the insurer.
Zero Co-Pay"This policy can be taken with/without a base policy." NSTUMP can be purchased standalone — no requirement to hold an existing health policy. The deductible can be self-funded (savings, corporate cover, or CGHS). For most buyers however, matching the deductible to base policy SI is the optimal strategy.
Standalone Eligible"Policy covers commonly excluded diseases/conditions like HIV/AIDS, Obesity-bariatric surgery and Maternity up to the Sum Insured, subject to waiting periods." Conditions excluded by most base policies are covered by NSTUMP — making it an ideal complement to restrictive employer cover or budget base policies.
Uncommon CoverageCritical Concept· The Aggregate Advantage· Why Super Top-Up Beats Regular Top-Up
the insurer offers both top-up plans. The single most important difference: a regular top-up checks each hospitalisation against the deductible separately. A super top-up accumulates all hospitalisations in the year — which makes it dramatically more valuable in years with multiple medical events.
the insurer· CME Mechanics· Threshold· First Claim Cashless Rule
"Threshold means the amount of Cumulative Medical Expenses, as chosen by the insured and mentioned in the schedule, up to which no amount can be claimed under this Policy." NSTUMP tracks ALL hospitalisation expenses across the year. Once the running total (Cumulative Medical Expenses = CME) crosses the chosen threshold, NSTUMP activates and pays all further expenses up to the sum insured.
You pay: ₹5L threshold (your base policy / savings). NSTUMP pays: ₹9L across 3 hospitalisations. Premium for this ₹20L / ₹5L deductible NSTUMP: ~₹1,591/year ( sample premium). Outstanding value.
Two Distinct NSTUMP Products Available from the insurer· Original + Revised· Different SI Caps
the insurer currently offers two versions of the Super Top-Up Mediclaim Policy on its website. The linked URL (national-super-top-mediclaim-policy) is the Original NSTUMP. The Revised version (national-super-top-mediclaim-policy-revised) offers SI up to ₹80L. Both share the same mechanics, PED wait, and no-sub-limit advantage. Contact Probitas (022 4302 0000) to confirm which version is currently available for new issuance.
Strategy for Choosing the Right Deductible
"National Super Top-Up Mediclaim Policy comes with sum insured options of Rs. 3 Lakh, Rs. 5 Lakh, Rs. 7 Lakh, Rs. 10 Lakh, Rs. 15 Lakh, and Rs. 20 Lakh. The deductible options available are of Rs. 2 Lakh, Rs. 3 Lakh, Rs. 5 Lakh, Rs. 8 Lakh, Rs. 10 Lakh.For Individual plans both Sum insured and the deductible applies to each insured person. For Family floater plans both Sum insured and the deductible applies on a floating basis for all the insured family members."
| Sum Insured | Best Paired With Deductible | Total Max Cover | Best For |
|---|---|---|---|
| ₹3 Lakh | ₹2L deductible | ₹3L + base cover | Those with ₹2L base policy / corporate cover |
| ₹5 Lakh | ₹3L or ₹5L deductible | ₹5L–₹8L total | ₹3–5L base policy holders |
| ₹7 Lakh | ₹3L or ₹5L deductible | ₹10L–₹12L total | Mid-tier coverage enhancement |
| ₹10 Lakh | ₹5L deductible | ₹15L total | Standard urban family upgrade to ₹15L effective cover |
| ₹15 Lakh | ₹5L or ₹8L deductible | ₹20L–₹23L total | Metro families wanting ₹20L+ total protection |
| ₹20 Lakh | ₹5L or ₹10L deductible | ₹25L–₹30L total | High-SI seekers with strong base policy |
All Coverage Above the Threshold
Once your cumulative medical expenses in a year cross the chosen deductible, NSTUMP covers all further hospitalisation expenses across these categories — up to your sum insured, with zero sub-limits.
Room, ICU, nursing, surgeon/anaesthetist/consultant fees, anaesthesia, blood, oxygen, OT charges, diagnostic tests, medicines, surgical appliances. "Medical expenses are reimbursed without any sub limits. (For e.g. Room rent per day, Doctor fees & etc.)" Any room type. No cap.
No Sub-Limits"No sub limits for In-patient treatment, Day Care treatment." All 140+ day care procedures covered above the threshold with no sub-limit restriction. Dialysis, chemotherapy, cataract, all day care — above threshold, paid in full.
All Day Care· No Sub-Limit (Revised)Pre and post hospitalisation expenses covered. Standard the insurer pre/post windows apply (30–45 days pre, 60 days post depending on policy wording version). Expenses incurred before and after the hospitalisation that caused the CME to cross the threshold: covered.
Pre + Post Included"Coverage for all streams of AYUSH up to SI" Ayurveda, Yoga, Unani, Siddha, Homeopathy — all covered up to the full sum insured above the deductible. No sub-limit on AYUSH treatment unlike many base policies.
All AYUSH Streams· Full SI"Policy covers commonly excluded diseases/conditions like HIV/AIDS.up to the Sum Insured, subject to waiting periods." All three stages of HIV (acute, latency, AIDS) covered above the deductible. Waiting period applies. A critical benefit for policies that exclude HIV.
All 3 Stages· Waiting Period"Policy covers commonly excluded diseases/conditions like.Obesity-bariatric surgery.up to the Sum Insured, subject to waiting periods." BMI ≥40 or BMI ≥35 with co-morbidities — bariatric surgery covered above deductible. Many base policies exclude this.
Up to SI· Waiting Period"Policy covers.Maternity up to the Sum Insured.No sub limits for.Maternity cover*" Normal and caesarean delivery, complications. "Coverage for newborn baby from Day 1 up to SI*" Waiting period applies.
Up to SI· No Sub-Limit (Revised)Organ donor's hospitalisation expenses for harvesting: covered above the deductible. Confirmed from/. Organ donor cover extends the protection to living donors who donate organs to the insured — their hospitalisation costs are covered by NSTUMP.
Donor Hospitalisation CoveredRoad ambulance charges for emergency transport to hospital: covered above the deductible threshold. Confirmed from /. Ambulance cost from home to hospital, between hospitals — covered once CME crosses threshold.
Road Ambulance Covered"Annual Increase in SI by 5% for each claim free year up to maximum 50% of SI opted.Cumulative bonus shall be aggregated over the years and available, subject to maximum of 50% (fifty percent) of the sum insured.In the event of a claim.CB reduced by 5% of sum insured."
5%/Year· Max 50%IRDAI Policy Wording· 12-Month PED Is the Key Differentiator
"Waiting period of only one year in all Pre-Existing Diseases. Waiting periods for specific diseases are limited to 90 days, one and two years instead of the usual one, two and four years.All pre-existing diseases. Any complication arising from pre-existing diseases shall be considered as a part of the pre-existing disease. Such diseases or complications thereof shall be covered after the Policy has been continuously in force for twelve months."
3 Discount Types· Early Entry· Family· Online/Direct/Walk-In
"Attractive discounts for Early Entry, Family (in individual policies only) and Online/Direct/Walk in customers." NSTUMP also qualifies for Section 80D tax deduction on premium paid.
Discount for younger buyers entering NSTUMP at an early age. The specific discount percentage — confirm exact quantum with Probitas at 022 4302 0000. Best for buyers in their 20s–30s who want to lock in NSTUMP coverage at lower age-band premiums.
"Family (in individual policies only)" Family discount applies on individual-basis NSTUMP policies (not floater). When multiple family members are each covered on individual NSTUMP, a family discount applies on the aggregate premium.
"Online/Direct/Walk in customers" Discount for purchasing NSTUMP online through the insurer's portal, walking into the insurer's office directly, or through select direct channels. No intermediary involvement required for this discount.
"No pre policy health check-up for the insurer policyholders covered under any retail indemnity health insurance policy for a continuous period 3 years or more." Existing the insurer health policyholders (3+ years continuous): no pre-medical required, at any age.
Premium paid for NSTUMP qualifies for deduction under Section 80D of the Income Tax Act 1961. ₹25,000 deduction for self/family under 60; ₹50,000 for senior citizen proposers. Separate ₹25,000/₹50,000 for parents' NSTUMP premium.
5%/year SI increase for each claim-free year — max 50%. Not a premium discount but effectively increases your SI at no extra premium. After 10 claim-free years: ₹20L SI NSTUMP grows to ₹30L effective SI at the same premium.
IRDAI Policy Wording· Standard NSTUMP Exclusions
Exclusions confirmed from and IRDAI policy wording. Note: NSTUMP covers HIV/AIDS, bariatric surgery, and maternity (with waiting periods) — conditions that many base policy exclusion lists omit. The exclusions below are universal health insurance exclusions.
"Only claims arising out of accidents are payable for the first 30 days of Inception of the Policy." All non-accident illness claims: excluded in first 30 days of the policy. Accident-related hospitalisations: payable from Day 1.
"All pre-existing diseases.covered after the Policy has been continuously in force for twelve months." Pre-existing conditions: excluded during the 12-month waiting period. After 12 months: fully covered — the most favourable PED window in the insurer's portfolio.
"90 days, One, Two and Three Years waiting period for specific diseases." Specific conditions (hernia, cataract, calculi, etc.) excluded during their respective waiting periods. NSTUMP's max specific-disease wait: 2–3 years (shorter than NMP/NMPP).
"Change-of-Gender Treatments, Cosmetic or Plastic Surgery, Excluded Providers." Gender reassignment and cosmetic procedures excluded. Reconstructive plastic surgery for accident/disease: covered.
"Vitamins, Tonics Drug/alcohol abuse, Self-Inflicted Injury." Health supplements, vitamins, tonics. Conditions arising from drug or alcohol dependency. Intentional self-harm.
"Non Prescription Drug, Massages, Steam Bath, Alternative Treatment (Other than AYUSH treatment)." Wellness treatments, non-prescription drugs, massages, steam baths, and alternative therapies that are NOT part of AYUSH systems: excluded. AYUSH is explicitly covered.
"Dental treatment (unless arising out of accident and requiring hospitalization) and Out Patient Department treatment (OPD treatment)." Routine dental and OPD consultations: excluded. Dental treatment necessitated by accident requiring hospitalisation: covered.
Treatment received outside India: excluded. confirmed. NSTUMP covers only treatment received in India at empanelled hospitals. International medical treatment: not covered under NSTUMP at any sum insured level.
4-Stage CME Claim Process· Document Preservation Critical
NSTUMP claims have a unique structure driven by the CME (Cumulative Medical Expenses) tracking mechanic. The process differs from standard health insurance claims — especially for the first claim where proof of CME crossing the threshold must be established. All confirmed from the insurer's NSTUMP page.
"The Insured shall preserve and submit all original documents and/or certified copies of documents related to all Hospitalisations during the Policy Period to enable the Company to calculate the Cumulative Medical Expenses and Threshold." From the first day of your NSTUMP policy year: keep every hospital bill, discharge summary, and receipt. Even hospitalisations that don't trigger NSTUMP must be documented — they count toward your CME total.
Track the running total of your hospitalisation expenses across all events in the year. When your CME approaches your deductible threshold, prepare to activate NSTUMP. If you have a base policy: your base insurer's claim settlement advice showing the amount paid/payable also counts. Notify your TPA/the insurer proactively as CME approaches the threshold.
"For planned hospitalisation, intimation is to be sent to the TPA/Company in advance (72 hours prior) with details of Name and address of the hospital and condition requiring hospitalisation." If CME is likely to cross the threshold during this admission, bring all previous hospitalisation documentation to the hospital's insurance desk for cashless pre-authorisation.
"For the first claim under the Policy (i.e., the claim in which Cumulative Medical Expenses exceeds the Threshold) cashless facility shall be available provided all evidences and documents are produced prior to cashless authorisation, to substantiate that the Cumulative Medical Expenses (CME) exceeds the Threshold." The TPA must be satisfied that CME genuinely exceeds the threshold. Bring all prior hospital bills + base insurer settlement letters to prove the CME total.
"In case of Hospitalisation where initially the Cumulative Medical Expenses are not foreseen to exceed the Threshold but subsequently exceeds the Threshold, notification of claim shall be sent to the TPA mentioned in the Schedule/Company, immediately." If a hospitalisation that started below the threshold escalates beyond it: notify TPA the moment this becomes clear. Switch from self-pay to NSTUMP cashless mid-admission if possible.
"For all subsequent claims under the Policy, cashless facility shall be available as usual." Once the threshold is crossed in your policy year: all subsequent NSTUMP hospitalisations proceed through the standard cashless pre-authorisation process. No need to re-prove CME each time. Submit documents to TPA within 15 days of discharge.
National Super Top-Up Mediclaim Policy — Frequently Asked Questions
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By submitting you agree to our Privacy Policy and Terms & Conditions. National Super Top-Up Mediclaim Policy (NSTUMP)· the insurer· IRDAI Original: SI ₹3L–₹20L, Deductibles ₹2L–₹10L. Revised: SI up to ₹80L*. PED 12 months. No sub-limits. No co-pay. Cumulative Medical Expenses aggregate mechanic. All terms per NSTUMP policy wording. *Confirm availability of SI options from the insurer. Probitas Insurance Brokers Pvt. Ltd.· IRDAI Lic. No. 528.