Life is an unpredictable journey. It can take sharp, fatal turn at moments, which are capable of leaving one physically, mentally, emotionally and financially bruised.
Many of us ignore buying a personal Health Insurance plan (Mediclaim). Many of us also think that the mediclaim coverage provided by the employer is sufficient enough to cover any unforeseen medical expenses.
In my experience, the average medical cover opted (personal health insurance) or provided by an employer (group mediclaim) is generally in the range of Rs 3 Lakh to Rs 5 Lakh. Do you really think that this coverage is sufficient? What if the claim amount is more than the coverage amount? Can you afford to pay for the medical expenses out of your pocket? Do you agree that medical expenses are increasing at a very fast rate every year?
But, we are also aware of the fact that the premiums of health insurance plans are increasing every year. For some of us, the premiums are unaffordable. Also, it is not practically possible for everyone to increase the premium of their existing plan, or buy another mediclaim policy.
So, what are the available options? How to get higher coverage at affordable premium rates? How to deal with the inflating costs of medical treatment?
Have you heard of Top up Health Insurance plans / Super Top up Medical Insurance plans?
In this post, let us understand – What are Top up Health Insurance plans? What are Super Top up Health Insurance Plans? How does Top Up medical insurance work? How does Super Top up plan work? Which one should you buy, a Top up plan (or) a Super top up plan? Frequently Asked Questions (FAQs) on Top up Health Insurance Plans / Super Top up Health Insurance Plans.
What are Top up Health Insurance Plans?
Top up health insurance plans are a unique type of health cover policies that offer you (insured) an additional coverage, which is beyond the “threshold limit” (or) the maximum limit of the existing health insurance policies.
For example – Let’s say you have an Employer’s Mediclaim policy for Rs 3 Lakh and also a Top up Health cover for Rs 10 Lakh with the threshold limit (deductible) of Rs 3 Lakh.
If there is a claim for Rs 5 Lakh, your mediclaim policy (employer’s) will pay Rs 3 Lakh and the remaining claim amount of Rs 2 Lakh will be covered by your Top up policy.
So, such Top up health insurance policies come handy when the threshold of the existing health cover is already used or exhausted and there are some medical costs left to deal with, which would otherwise exert pressure on your financial savings. (To buy a Top up plan, it is not mandatory to have an existing health insurance policy. The threshold limit is the mandatory deductible, which can be borne by you or by your existing health insurance policy i.e., your company’s or personal regular health insurance policy)
How does Top Up Health insurance plan work?
Top up plans work on ‘per hospitalization’ basis. A Top up plan will pay you, if your claim amount for a single hospitalization is above the threshold limit.
Example – Mr Kejriwal has a personal Health Insurance policy of Rs 3 Lakh and also has a Top up health cover of Rs 10 Lakh sum assured, with the threshold limit of Rs 3 Lakh.
Scenario 1 – If there is a single claim of Rs 2 Lakh in a year, his regular policy will pay Rs 2 Lakh.
Scenario 2 – If there is a single claim of Rs 5 Lakh in a year, his regular policy will pay RS 3 Lakh and top up plan will pay the remaining Rs 2 Lakh.
Scenario 3 – If there is a single claim of Rs 10 Lakh in a year, his regular policy will pay Rs 3 Lakh and the remaining claim amount of Rs 7 lakh will be paid by the Top up plan.
Scenario 4 – If there are two claims in a year, one for Rs 3 Lakh (Claim 1) & another for Rs 2.5 Lakhs (claim 2), regular policy will pay the claim 1 amount (Rs 3 Lakh) and the total coverage is exhausted, the claim 2 amount (Rs 2.5 Lakh) is not covered by regular as well as the top up plan. (Though he has Rs 10 lakh as a top up cover, it is not applicable for 2nd claim as the threshold limit is Rs 3 Lakh. Top up cover will pay only if the bill amount is more than Rs 3 Lakh)
What are Super Top up Health Insurance Plans?
We are now clear that the Top up plans work on ‘per claim’ or ‘per single hospitalization’ basis, they are beneficial as long as the single claim amount is above the threshold limit.
In the above scenario 4, though Mr Kejriwal has Rs 10 Lakh Top up cover, his claim amount (claim 2) will not be paid. Super Top plans will be useful in these types of scenarios (multiple claims).
Example – Mr Kejriwal has a personal Health Insurance policy of Rs 3 Lakh and also has a Super Top up health cover of Rs 10 Lakh sum assured (total coverage Rs 13 Lakh), with the threshold limit of Rs 3 Lakh.
Scenario 5 – If there is a single claim of Rs 2 Lakh in a year, his regular policy will pay Rs 2 Lakh.
Scenario 6 – If there is a single claim of Rs 5 Lakh in a year, his regular policy will pay RS 3 Lakh and super top up plan will pay the remaining Rs 2 Lakh.
Scenario 7 – If there is a single claim of Rs 10 Lakh in a year, his regular policy will pay Rs 3 Lakh and the remaining claim amount of Rs 7 lakh will be paid by the Super Top up medical insurance plan.
Scenario 8 – If there are two claims in a year, one for Rs 3 Lakh (Claim 1) & another for Rs 2.5 Lakhs (claim 2), regular policy will pay the claim 1 amount (Rs 3 Lakh) and the total coverage is exhausted, the claim 2 amount (Rs 2.5 Lakh) will be paid by his super top up plan (though the claim 2 amount is less than the threshold limit)
Scenario 9 – If there are two claims in a year, one for Rs 5 Lakh (claim 1) & another for Rs 6 Lakh (claim 2), regular policy will pay upto Rs 3 Lakh (claim 1) & super top up plain will pay the remaining Rs 2 Lakh amount (a portion of claim 1). The entire claim 2 amount (Rs 6 Lakh) will be paid by Super top up plan, as the regular policy coverage is exhausted.
So, it is now clear that Super Top up plans consider ‘the total of all the bills’ in a given year. Super Top up plans cover ‘multiple’ hospitalizations and they look at the aggregate claim. This means they put together several cases of hospitalization to calculate the deductible limit (threshold limit).
FAQs & Important points about Top up / Super Top up Health Insurance plans ;
- Is it necessary to have a regular health insurance plan? – It is not mandatory to have an existing regular or group mediclaim to buy a top up or a super top up plan.
- Is it necessary to buy a top up plan from the same company? No, if you have a health insurance policy let’s say with ICICI Lombard, you may buy a top up or super top up plan with United India Insurance.
- Why are top up or super top up plans cheap? The deductible limit makes these plans cheaper when compared to regular plans. Higher the deductible (threshold limit), lower the premiums of top up plans. Generally, Top up plans are cheaper than super top up plans.
- Can I Top up a family floater policy? Yes, Top-up policies come as individual and floater plans.
- No Claim Bonus (NCB) & Top up plans – If you have accumulated no claim bonus (for claim free years), top up / super top up plans will pay the claim amounts over and above the regular plan’s sum assured + No claim bonus amount.
- Top up plans generally do not offer No-Claim Bonuses.
- Another important point is that most of the Top-up / Super Top plans work on reimbursement basis. They will pay the claim amount after the insurer gets the details of all the medical bills, to assess whether the policyholder has paid the deductible limit by himself or through any existing health insurance policy.
- Are there any Top up plans for Parents / Senior Citizens? – Yes, some companies do offer top up plans for senior citizens. Example : United India Super Top up Plan.
- Are there any income tax benefits on Top up plans? – Yes, the premiums paid on top up or super top up plans are eligible for Income Tax deductions under Section 80 D.
- What are the important things that I should watch out for, before buying a Top up plan? – It is advisable to go through the policy wordings of any health insurance plan. Understand the important points like the duration for pre-existing diseases, scope of cover, if day-care procedures are covered, cover for pre & post-hospitalization expenses etc., (If you have an existing health insurance policy with a continuous cover for last say 4/5 years, some health insurance companies waive off pre-existing diseases condition)
Below are some of the popular & best Top up Health Insurance Plans
- Bajaj Allianz’s Top up Plan – Bajaj Allianz Extra Care plan
- Star Health’s Top up Plan – Star Health Super Surplus Insurance Policy
- United India’s Top up Plan – Top up Medicare
- Apollo Munich Optima Plus Top up Plan
- ICICI Lombard Top up Plan – Health Care Plus Insurance Plan
- New India Assurance’s – Top Up Mediclaim Policy
Latest Update : Kindly note that Apollo Munich Health Insurance is now HDFC ERGO. The holders of Apollo Munich Health Insurance policies now become part of HDFC ERGO Health Insurance.
Below are some of the popular & best Super Top up Health Insurance Plans
Super Top up plans are offered by a few very health insurance companies;
- Apollo Munich Optima Super Top Up
- United India Super Top up plan
- L & T Super Top up Plan – Medisure Super Top Plan
- Max Bupa Super Top up plan – Heartbeat High Deductible Plan (under Silver Plan)
- HDFC Ergo Health Suraksha Top up Plus
- Cigna TTK Super Top Plan – ProHealth Plus Plan (Under ‘Protect’ & ‘Plus’ Plans)
My Opinion :
Should you top up your health cover?
As health expenses increase, you may find that your base health insurance is no longer sufficient for your needs. A serious illness or accident can require long term care and complicated treatment, that can quickly become expensive and exhaust your health cover.
If you think that the sum assured of your existing health insurance plan (personal or employer’s group mediclaim) does not suffice for expenses due to illness or accidents, you may definitely consider buying a top up or super top up health insurance plan.
Before choosing an additional cover, compare the premiums of additional regular policies, top up plans and super top up plans. Do not buy Top up health insurance plans just because they are cheap, they may not serve the purpose (as mentioned above). Super Top up Plans can be the best way to enhance your total Sum Assured. Always, keep in mind about the medical inflation before finalizing the required sum assured.
In case your basic policy and the top-up policy are from two different companies, informing two insurers and getting the claim settled may be cumbersome. So, you may consider taking a top up or super top up plan from the same company (not mandatory).
To summarize;
- Top up / Super top up health insurance plans are cheaper than regular mediclaim policies.
- You can buy them to enhance the basic sum assured.
- Top up plans are beneficial when the claim amounts are over and above the threshold limit.
- If you have an employer’s mediclaim policy, consider buying a top up or super top up plan.
Secure yourself with Super top up cover and never worry about your medical expenses again.
Did you like this post? Kindly share your views & comments. Cheers!
Continue reading :
- HDFC Ergo my:health Medisure Super Top Up Health Insurance Plan : Features, Benefits & Review
- 11 vital factors to consider when choosing the Best Health Insurance Plan!
- Difference Between Individual (Personal) & Employer based Health Insurance Plans – Pros & Cons
(Image courtesy of Mister GC at FreeDigitalPhotos.net)
Hi Srikanth,
Should we inform to Super top up insurance policy team also whenever claim is happening from Base policy ?
Bcaz claim 1 for 5 L through base policy (my base ploicy is 5L)
when 2nd claim is happening I have to use super top up as my base is exceeded ..then how they will come to know ,base is already exceeded and now we have to approve for 2L?
Giri
Dear Giri,
You can inform both the insurers, but, can get the claim paid from your base policy insurer.
Hi Sreekanth ,
my question is – when 2nd claim is happening I have to use super top up as my base is exceeded ..then how they will come to know ,base is already exceeded and have to approve for 2L?
Dear Giri,
The concerned Insurer will contact the base policy issuer..
Dear Srikanth. I have Group Insurers to retired staff of our bank from national insurance with base policy of 4 Lacs and Super Top Up of 5 Lacs for myself and my spouse. I have second health insurance of5lacs from Universal Sompo with 20 percent copayment for last five years. For triggering Super Top Up is it necessary that the base cover of both policies should be exhausted first. If it is so than renewing Sompo cover is of no use I think. Please guide me as I am to renew Sompo policy next week. Please send me reply on my mail.
T D Singh
Deat Sreekanth,
If I have 2 base health policies from different insurance companies ( say 5 lacs each) in case of a claim for 8 lacs, can I claim from both polcies? till how much max sum insured and how many claims I can use from both base policies? Will this be useful instead of taking a super top up plan. Please clar this doubt. or better to have one more super top up?
Thanks,
Venkat.
Dear Venkat,
You may go through this wonderful article – Claiming from Multiple Health Insurance Plans
Dear SR
Is Star Health’s Super Surplus health Insurance Plan a Super Top Up Health Plan ???
Dear
I believe its is Top up plan and not Super top up one. Do check with them!
Star Health’s Top up Plan – Star Health Super Surplus Insurance Policy
Sreekanth,
Also please confirm if we have base policy and super top up from different companies , supertop claim cannot be cashless?
Thanks
Venkat.
Dear Venkat,
Yes, can be from two different insurers.
But, it makes sense to have both the plans from the same company but not mandatory though.
Most of the super top up plans work on ‘reimbursement’ basis.
“Another important point is that most of the Top-up / Super Top plans work on reimbursement basis. They will pay the claim amount after the insurer gets the details of all the medical bills, to assess whether the policyholder has paid the deductible limit by himself or through any existing health insurance policy.”
Hi Sreekanth,
I Have base mediclaim health policy of 7 Lacs from Oriental. I am planning to take super top up with 10 lac deductible and 10 lac sum insured. please let me know if it is a wsie choise. Thanks
Dear Venkat,
Any specific reason for not taking deductible as 10 Lakh and not Rs 7 lakh ??..
Sreekanth,
I am planning to increase the base cover from 7 to 10 soon that’s why pls suggest.
Dear Venkat.. You may kindly go ahead!
Advisable to have high SA under a mediclaim plan..
Assume I take 1 lacs critical illness policy at the age 45, the premium is 2500 per year. By the age of 85 the premium is around 35000. If you calculate the premium from age ot 45 to 85, I would have paid more than 1 lacs as premium for 1 lac critical illness policy. Can you pls explain me how come is it worth to pay more then the sum insured for critical illness policy Or could you pls explain with example for critical illness policy understanding.
Dear JP,
What if there is a scenario where-in the policyholder claims the insurance amount in the first year itself??
Insurance is not an investment.
Star health wordings : Super topup plan. What does “waiver of Deductible” mean and what is “option is exercised”
Waiver of Deductible : The Proposer can opt at the beginning of 6th year before renewal of
this policy or later during any successive renewal, for an Indemnity Health Insurance policy
without defined limit offered by the Company with continuity of benefits for the average sum
insured of immediately preceding 5 years period subject to the following :-
ü All Insured Persons are insured with the Company for the first time before the age of 50
years and have been continuously renewed without any break
ü No claim has been made during the immediately preceding 5 years
ü This policy shall not be further renewed if the option is exercised
Dear JP,
The mandatory ‘deductible’ limit gets waived off (optional) after 5 policy years. If this waiver is opted, the current policy may cease to exist and a new indemnity policy will be issued.
Deductible is applied under each and every claim for ‘Silver’ plan. The above option is available for ‘Gold’ plan.
whether it is possible to claim medical bill both by insurance company and CGHS
Dear jyoti .. Yes, it is possible (assuming you are referring to different claim amounts..)
What does this mean, can you explain with example, this is in super topup plan in united india insurance. your expert explanation will help me to understand pre-existing clause
4. EXCLUSIONS:
The company shall not be liable to make any payment under this policy in respect of any expenses whatsoever incurred by
any Insured Person in connection with or in respect of:
4.1 Any pre-existing condition(s) as defined in the policy, until 48 months of continuous coverage of such insured person
have elapsed, since inception of his/her SUPER TOP UP MEDICARE Policy with the Company.
Pre-Existing Condition/Disease definition – Any condition, ailment or injury or related condition(s) for which insured
person had signs or symptoms, and/or were diagnosed, and/or received medical advice/treatment, within 48 months
prior to his/her SUPER TOP UP MEDICARE policy with the Company.
N.B.: In case of persons having any other Health Insurance Policy from any Company with a Sum Insured above
Threshold Level at the time of taking this policy, the exclusion period of 48 months for Pre-existing Disease/Condition
will be reckoned from the date of inception of the policy for such portion of Sum Insured, including Cumulative Bonus
earned if any, above the Threshold Level. If expiring policy sum insured has increased over the years, the 48 months
of continuous coverage has to be completed for the incremental sum insured.
Dear JP,
1 – The pre-existing Diseases are covered after 4 years of policy inception. Looks like, this is applicable for stand-alone Super top up policies.
2 – If one has an existing Mediclaim policy for say Rs 5 lakh and Rs 2 lakh is the Threshold limit, then the SA above the threshold limit (Rs 3 lakh) will have 4 year pre-existing disease clause applicable to it..
Any increase in the SA over the policy duration, that incremental hike SA has to meet the 4 year pre-existing diseases clause..
You may kindly cross-check this with the Insurer as well..
Sir,
I have INDIVIDUAL MEDICLAIM policy of my mother since year 2005 and its being renewed continuously with out any gap. The policy in the year 2018 has been increased from 200000 to 500000. my question is will the policy can be claimed 500000 in case of any hospitalization or we have to wait for 4 years wait time for pre-existing issues for upgraded 300000 lacs amount. In the year 2019 can I increase the policy amount to 8 lacs. again the same question, when I increase from 5 lacs to 8 lacs, should i have to wait 4 years for pre-existing issue. the policy name is INDIVIDUAL MEDICLAIM which is not available for new takers, its available only for renewal.
Dear JP,
Normally, the pre-existing diseases (if any) will be covered within the new coverage amount.
However, advisable to get this checked and confirmed with your Insurer.
Many thanks, let me check with Insurer. I have a different question. Can a senior citizen star health can be ported with normal PUS insurance. The PUS insurance company are interested in accepting our application. The new plan does not have co-pay. Will the new insurance company will treat the senior citizen claims as with other claims which does not have co-pay.
Dear JP,
Yes, can..
But, did you check with other features and T&Cs (of the new Insurer)?