When your smartphone's battery gets exhausted while travelling, you have a power bank as a backup to recharge it. Similarly, the top-up plans are the backup plans for those individuals who already have a health insurance plan but want more coverage when their sum insured exhausts. Have you ever thought that if your medical bills exceed the sum insured, you will have to pay the exceeding amount from your own pockets? Therefore, top-up health insurance can be a good option to deal with such problems.
What is a Top-up Health Insurance Plan?
A top-up health insurance plan is an additional health insurance coverage that can be taken along with your existing comprehensive indemnity health plan. Thus, if you have a base plan of INR 5 lakhs and wish to increase the coverage, some options are available for you:
- Enhance the coverage of your existing plan
- Opt for another additional plan
In both these options, the premium payable would be quite high. However, if you wish to enhance the coverage without shelling out a large amount of money as a premium, then you can opt for a top- up or a super top-up health insurance plan, which will get activated only after your base plan is exhausted.
How Do Top-up Health Plans Work?
A Top-up plan can be a good option for you if you think that the amount of the sum insured is not enough to cover your medical expenses. This plan allows you to cover the medical expenses if the sum insured by your existing health insurance plan gets exhausted.
For Example:
Suppose you have an existing health plan with a sum insured of INR 5 Lakhs. Now, if you wish to enhance your medical coverage, you can opt for a top-up plan of INR 10 lakhs with a deductible of INR 5 lakhs.
Now let’s understand how these plans would work in different claim scenarios:
- Till the first INR 5 lakhs of hospitalisation claim, your base plan takes care of all expenses.
- Once the aggregate claim amount for hospitalisation in a given policy year exceeds the deductible limit, i.e. INR 5 lakhs, in this case, the top-up plan gets activated.
In Top-up plans, every hospitalisation claim amount needs to exceed the deductible limit for the claim to get triggered. However, in super top-up plans, the aggregate claim amount is considered.
Claim Amount | Base Plan Limit (INR 5 lakh) | Top Up | Super Top Up | |
| First Hospitalisation Claim | INR 5 Lakhs | Paid | Does not get triggered as it is within the deductible limit. | Does not get triggered as it is within the deductible limit. |
| Second Hospitalisation Claim | INR 6 Lakhs | Does not pay as the limit is exhausted. | Pays only INR 1 lakh (i.e. amount after the deductible limit). | Pays the entire amount of INR 6 lakhs (as the aggregate claim is more than the deductible limit). |
| Third Hospitalisation Claim | INR 2 Lakhs | Does not pay as the limit is exhausted. | Does not get triggered as it is within the deductible limit. | Pays the entire amount of INR 2 lakhs (as the aggregate claim is more than the deductible limit). |
| Fourth Hospitalisation Claim | INR 3 Lakhs | Does not pay as the limit is exhausted. | Does not get triggered as it is within the deductible limit. | Pays INR 2 lakhs only as the total payable amount is INR 10 lakhs after deducting the base plan limit of INR 5 lakhs. |
This is how a top-up Insurance Plan works, and you will have to buy an extra plan in order to enjoy the benefits.
Features and Benefits of Top-up and Super Top-up Health Plans
Here are some of the outstanding features of the top-up plans that you can explore below and see how they can be beneficial for you during medical emergencies.
- These are indemnity health plans with a deductible limit wherein the health insurance claim gets triggered only after the deductible limit.
- The premium for a top-up or a super top-up plan is much less as compared to a base plan of similar coverage.
- One can also include their children in the same plan if both parents are covered.
- The hospitalisation expenses are also covered in this plan.
- You can grab some discounts if you cover all family members in the same plan.
- After every claim-free year, you are entitled to a cumulative bonus on the sum insured.
- You will get a free-look period of 15 days during which you can return the policy if you don’t find it suitable.
- The term of the top-up health insurance plans can be 1 or 2 years, depending upon your insurer.
- You can renew the plan throughout your life.
- The deductions under Section 80D of the Income Tax Act are allowed while computing your annual income.
Coverage of Top-up Plans
The coverage of the Top-up plans might differ from one insurer to another, but you might get the following benefits depending upon the plan you are buying.
- Expenses for in-patient hospitalisation are covered in this plan. Some of the expenses are:-
- Charges for Nursing and Boarding
- Room’s Rent
- Fees of the Doctors
- Operation Theatre Charges
- Oxygen's Cost
- Use of Prosthetic Devices or Implantation Equipment During Surgery
- Blood Diagnostic
- Expenses related to pre-hospitalization are covered before 60 days of hospitalisation.
- Expenses for post-hospitalization are covered immediately after 90 days of hospitalisation.
- Daycare procedures expenses are covered when the insured doesn’t need hospitalisation for more than a day.
- Some top-up plans also cover the organ donor expenses.
- Expenses done for calling an emergency ambulance are covered up to a specified limit.
- Get a cumulative bonus if you don’t make any claim during the policy year.
- Expenses for the domiciliary treatment are covered as suggested by the doctor.
Why are Super Top-up Plans Better than Top-up Plans?
The Top-up health insurance plans give you additional coverage over and above the sum insured of the base plan provided each hospitalisation claim is more than the deductible limit. However, a super top-up plan covers all hospitalisation bills above the aggregate deductible limit.
In both plans, you can claim multiple claims in a year, get tax benefits, and get cashless benefits.
Let’s have a look at the working of both these plans.
Suppose Mr. Ankit Gupta has a health insurance policy of INR 3 lakh and a top-up and super top-up plan of INR 9 Lakhs, each with a threshold of INR 5 Lakhs.
| Conditions | Top-up Benefits | Super Top-up Benefits |
| A single medical expense of INR 7 lakh has been incurred | In this condition, your health insurance plan will be INR 3 lakh, and the top-up plan will pay the remaining amount, which is INR 4 lakh. | A similar thing will happen in the super-top up plan. INR 3 lakh will be paid by the health insurance plan, and INR 4 lakh will be paid by the super top-up plan. |
4 medical expenses have been Incurred:-
| In this case, your health insurance plan will pay INR 3 lakh and the top-up plan will be INR 4 lakh as your 1st expense has surpassed the threshold limit. The patient will have to pay the other three expenses in his own pockets of INR 1 lakh, INR 2 lakh, and INR 2 lakh because you have already made each of them below the threshold limit. | In this case, your health insurance will pay INR 3 lakh, and INR 4 lakh will be paid by the super top-up plan on your first bill. The super top-up plan will also pay the next three expenses of INR 1 lakh, INR 2 lakh, and INR 2 lakh, respectively, because you have crossed the deductible limit of INR 5 Lakh in that particular year. |
That is why a super top-up plan can benefit you if you make multiple claims in a year and the criteria for crossing the threshold limit is taken as a whole rather than a single claim.
Difference Between a Rider Benefit and Top-up Plan
Some people mix the rider benefits with the top-up plans, but they are different. If you buy health insurance, you can add the rider benefit to it that will cover the risks against accidents, hospital cash, critical illnesses, personal accidents, and others. Whereas the top-up plan increases the entire coverage amount (sum insured). Also, the top-up plan is an indemnity health insurance plan and hence covers regular hospitalisation benefits.
Rider benefits will cover the risk for a particular type of illness/situation and the sum insured remains the same whereas top-up plans will cover all the risks that are already covered in your existing health plan and the sum insured will be increased.
Take Away
So, you have seen various benefits of top-up health insurance and now it is justified why you should buy it. You buy a power bank for mobile battery backup, so why don’t you get a top-up plan for your health risks and medical expenses backup? The ball is in your court, and you will have to decide what is best for you.
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