Choosing a health insurance policy best suited for you can be tedious. Most of us go about our lives without ever securing proper health insurance. Health insurance coverage for most is only INR 3 lakhs to INR 5 lakhs, greatly undermining how quickly they get depleted amid the rising healthcare costs. Medical inflation combined with multiple hospitalisations, which many can have, only compounds your worries. So, the health insurance coverage chosen by you may prove inadequate, causing you medical as well as financial pain. What’s more, purchasing a second health insurance plan may not seem feasible. Top-up and super top-up plans are for such individuals, which might provide higher coverage for medical bills. Let’s discuss them in detail.
Top-up and Super Top-up Health Plans
Insurance benefits provided under super top-up health plans are analogous to top-up health insurance plans. They both provide higher insurance coverage, keeping the total amount of premium to be paid at a minimum. The only major difference between the two is that a top-up policy covers only a single hospitalisation claim above the threshold limit, whereas a super top-up plan provides coverage for complete hospitalisation bills even after the threshold limit is crossed.
A Brief on Top-up and Super Top-up Plans In India
There are two types of top-up health plans available in India:
- Top-up Plan: This plan provides health insurance coverage by replacing the insured amount up to a certain extent. This plan gets activated when medical expenses cross the deductible limit of the base health insurance plan.
- Super Top-up Plan: This plan provides additional coverage after the medical costs exceed the threshold limit. A Super top-up health plan evaluates all claims within the policy period altogether, unlike a simple top-up plan which considers a threshold limit/deductible for every claim.
If there is a relapse within 45 days of discharge from the hospital, it is regarded as a single illness. However, if the patient relapses beyond 45 days, it is considered a new illness.
How Top-up and Super Top-up Health Plans Differ
| Top-up Health Plan | Super Top-up Health Plan | |
| Meaning | Offers additional coverage only after the deductible amount of 1 claim has been surpassed. | Offers coverage after the cumulative of hospitalisation bills cross the threshold limit. |
| Deductible Paid | On every claim | Once during a policy year |
| Premium Payable | The amount to be paid is comparatively lesser than super top-up insurance. | The amount to be paid is higher when compared to top-up insurance. |
| Mechanism | Works on the principle of “per claim” or “per hospitalisation.” | Works on the permit of multiple claims. |
| Hospitalisation | A single hospitalisation is covered | Multiple hospital admissions are covered |
| Claims | A claim is compensated only if the deductible amount has been surpassed. | Multiple claims can be filed only once the deductible has been surpassed. |
| Termination of claim | The policy is terminated after 1 claim. | The policy is terminated only when the entire amount paid is exhausted. |
Features of Top-up Insurance Plans
- They can easily be converted into a base health plan during a medical emergency.
- If you are below 45 years of age, you are not required to undergo a health checkup before opting. However, the age limit might vary among different companies.
- If you have not availed a health insurance claim in the previous policy year, the health insurance provider pays out a no-claim bonus (NCB) or cumulative bonus on the insurance.
- You can get a tax exemption under section 80D of the income tax act, up to INR 1 lakh.
- It is not mandatory to purchase the top-up plan from the same company you have base health insurance with.
- There is a free look-up period of 15-30 days. During this period, if you want to cancel the plan, you can get a 100% refund of the premium if you’ve not already availed of any benefits from the plan.
Features of a Super Top-up Plan
In addition to features of the top-up plan, the super top-up plan has:
- The option of customisation through which the individual can create a plan as per his/her requirements.
- The coverage of pandemics, including complications associated with COVID-19.
- No limit on room rent, which makes it easy for insured individuals to have their choice of private hospital rooms.
- A low and affordable premium such that the insured’s cover exhausts only when the amount invested has been exhausted.
An Example
Top-up Health Plan (INR) | Super Top-up Health Plan (INR) | |
Sum insured | 20 Lakhs | 20 Lakhs |
Claim 1 | 10 Lakhs | 10 Lakhs |
Deductible | 4 Lakhs | 4 Lakhs |
Insured pays | 4 Lakhs | 4 Lakhs |
Insurance Company Pays (Claim- Deductible amount) | 6 Lakhs | 6 Lakhs |
Claim 2 | 12 Lakhs | 12 Lakhs |
Deductible | 4 Lakhs | - |
Insured pays | 4 Lakhs | - |
Insurance Company Pays (Claim- Deductible amount | 8 Lakhs | 12 Lakhs |
Who Must Opt for a Top-up or Super Top-up Health Insurance Plan?
- Parents and Senior Citizens: As there are higher medical expenses for the elderly, the premiums also increase. But using top-up plans with a base policy is quite affordable.
- Corporate Employees: You might already be covered by health insurance offered by your employer. But the insured sum may not be enough. So, you can buy top-up plans to cover the difference.
- Low Premium Policyholders: If the insured sum by your health insurance provider is low, you can choose a top-up plan instead of buying a new base plan.
Are There Any Exclusions Under Top-up And Super Top-up Plans?
Yes. Some medical expenses are not covered under these plans, such as:
- Self-inflicted injury
- Prenatal and postnatal services not requiring hospitalisation
- Medical expenses during the waiting period
- Infertility treatment
- Cosmetic surgeries
Verdict
You should opt for a top-up or super top-up plan in case you run out of your base premium plan. But choose the one best suited for you as both have different benefits.
If you are elderly, a corporate worker, or at a higher risk of critical and chronic illness, you should opt for a super top-up plan. However, if you are young and do not suffer or have a family history of chronic illness, a simple top-up plan might be the best choice for you.
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