Guide to Super Top-up Health Plans in India

What are Top-up Health Insurance Plans?

The way the cost of medical treatments is increasing, do you sometimes ask yourself, “Will my health insurance policy be enough to cover my future expenses?” 

Especially, when you want quality healthcare for yourself and your family, it may happen that your policy may fall short, forcing you to dig into your hard-earned and long-standing savings. 

Buying one more health insurance policy may not seem like a very viable option. Or maybe completely out of budget.

And that’s where a Top-up and a Super Top-up health plan can come to your rescue. 

A Top-up health plan is something like an enhancement of your existing medical policy. You can use this when the maximum claim has already been made during the year. It is also very useful when you use up the threshold limit after adding the costs of different treatments that you underwent throughout the year.

Let's Take a Look at This Example to Understand the Concept of a Top-up Plan

A few years back Mr. Kohli bought a medical insurance policy worth INR 3 lakhs. Last year, he was diagnosed with coronary disease and had to undergo surgery that cost him INR 5 lakhs. Though his policy covered INR 3 lakhs, he had to pay the rest of the amount from his pocket. Therefore, despite having health insurance he had to take out a huge amount of money from his savings.

What could have helped Mr. Kohli was a backup plan, something like a Top-up plan. 

Let us see another example to understand the importance of top-up plans over your base health insurance cover:

Suppose that you have a certain company’s super top-up plan of INR 8 lakhs over a base plan of INR 5 lakhs. 

Case 1

You are diagnosed with a medical condition and are hospitalised, your expenses are around INR 3 lakhs, which you can claim from your regular health plan. So, only INR 2 lakhs is left from the base plan.

Case 2

In the same year, you fall unwell again. You are hospitalised and the cost of treatment is INR 5 lakhs. Now from your base health plan, you can claim only INR 2 lakhs. In such a case, the Super Top-up health plan will cover the amount that remains, i.e. INR 3 lakhs. 

Types of Top-up Plans

Top-up Plans

A top-up plan lets you make a claim that overshoots the deductible amount, which could be the sum insured of the regular health plan during a single hospitalisation. Under this plan, all the claims are taken individually and are not summated and the deductible is considered for each and every hospitalisation before the plan cover could be utilised.

Super Top-up Plans

A Super Top-up Plan pays the claims for collective medical expenses that are made within one year when it crosses the deductible value, which could be the sum insured of the base policy. 

In simple words, a Super Top-up Plan offers you cover even in a case where more than one claim in a year results in crossing the threshold of the deductible amount, whereas a Top-up Plan does not. 

This plan is not limited to your base health plan and may be bought from a different health insurance company.

Difference between Top-up and Super Top-up Health Plans

The difference between a Top-and Super Top-Up health plan may seem small but it can significantly affect the claims that you can make. Both the plans come with a deductible, that means that the claim will be processed only after a certain claim amount is reached. And both of them can be bought along with an existing health plan. But in case of a top-up plan, the claim can be made only if the single claim is greater than the deductible. 

Example: Ravi bought a regular health insurance plan of INR 5 lakhs and a Top-up Plan/Super Top-up Plan for INR 10 lakhs, with a deductible of INR 5 lakhs. 

Scenario 1

Ravi was hospitalised and his medical expenses reached INR 13 lakhs. His health insurance policy will cover INR 5 lakhs and the Top-up will cover the remaining INR 8 lakhs, as it exceeds the value of deductible. 

Scenario 2

Ravi was hospitalised and his medical expenses reached INR 4 lakhs and INR 3 lakhs in 2 subsequent hospitalisations. His health insurance policy will cover INR 5 lakhs (INR 4 lakhs for the first hospitalisation and INR 1 lakh from the second hospitalisation). The Top-up Policy will not get triggered as none of the claims individually cross the INR 5 lakh deductible. 

Scenario 3

On the contrary, in case Ravi had opted for a Super Top plan INR 10 lakhs with a deductible INR 5 lakhs. In the previous example of Scenario 2, Ravi was hospitalised and his medical expenses reached INR 4 lakhs and INR 3 lakhs in 2 subsequent hospitalisations. 

His health insurance policy will cover INR 5 lakhs (INR 4 lakhs for the first hospitalisation and INR 1 lakh from the second hospitalisation). The Super Top Up plan will pay for the remaining 2 lakhs as it gets triggered as soon as INR 5 lakhs aggregate claim gets exhausted or utilised in one policy year, which could result from multiple claims as well. Therefore, he will be able to claim the entire amount.

Let's see the explanation with a table below:

The plan that you choose depends on your personal requirements and also your medical condition. If you suffer from any health issues and require hospitalisation often, you may want to opt for a Super Top-up plan, however, if you are healthy and disease-free, a Top-up plan may suffice.

It is recommended that you study and understand the policy that you wish to opt and read all the fine-print information carefully.

Benefits of a Super Top-up Health Plan

Over the last decade, medical treatment costs have increased by almost 50%. This data may often make you wonder whether a health plan that you bought 3 years ago may not be sufficient for treatment in today’s time. If you are still wondering why you should opt for a Super Top-up plan, here is a list of its benefits:

1. No need of a Base Policy
   You do not need to have a base health policy to purchase a Super Top-up plan, just pay the threshold limit and you can use the plan to pay for the rest of the expenses.
   Tip: A super top-up plan can be taken with an existing corporate plan as well.
2. Add More Value to your Health Plan, Increase the Sum Insured
   A Super Top-up plan gives more value and cover to an existing health plan. It comes in all the handier when you have the responsibility of your parents, spouse, and children.
3. Medical Inflation
   A Super Top-up plan can be a great way to deal with the growing medical inflation. 
4. Huge Cover
   It has very extensive coverage as it covers multiple treatments and takes into account the sum of all medical bills in a policy year.
5. Flexibility
   You have the flexibility of purchasing the base health policy from one health insurance company and the Super Top-up plan from another company. Though, making a claim is easier when there is a single insurer.
6. Family Floater/Individual
   A Super Top-up plan can be bought as a family floater as well as an individual plan.
7. Save on Your Taxes
   You can claim the premium amount that you pay under Section 80D of the Income Tax Act.
8. Affordable covers for Senior Citizens
   Healthcare, as well as senior citizen health insurance plan, are quite expensive, a Super Top-up plan helps them with a wider cover at a nominal charge.
9. Uncertain Rainy Days
   The uncertainty of life has increased many folds with the rise of COVID-19. A Super Top-up plan can be a very cost-effective alternative to keep yourself and your family away from a financial meltdown

Best Super Top Up Health Insurance Plans in India (2020)

To help you select the right Super Top-up plan, here's a list of top 5 plans, go through all of  them in detail before you make up your mind:

Super Top-up Health Plan Claim Process

1. Step 1
   Whether your hospitalisation is planned or because of an emergency, make sure you inform the insurance company without any delay. Inform both companies in case you have bought the base policy and the Super Top-up plan from 2 different health insurance companies.
2. Step 2
   Next, you need to fill in the Claim form available on the website of the company, where you wish to file the claim first.
3. Step 3
   Apart from the claim form, you also need to submit the following documents: 

• Policy document and Authorised Photo Identification 
• Doctor’s letter that advises hospitalisation
• Prescription of all tests, medicines and consultations
• All treatment-related bills and receipts
• Once the claim is reimbursed by the company, you will receive a summary of the settlement.

Generally, companies may take 3-4 days to process a claim. 

Cashless Claim: If your base policy and the Super Top-Up plan were bought from a single company, you can easily go for a cashless claim in any Network Hospital. Just present your policy papers/ health card made by the company and inform the company about the hospitalisation, your health insurance company will do the rest.

Reimbursement: Even if you are hospitalised at a non-network hospital, inform the company as soon as possible. As per the plan you have chosen, the company executives will guide you on how to proceed.

Super Top-up Health Plan Tax Benefits

As mentioned earlier, the premium that you pay on the Super Top-up plan is exempted from income tax under Section 80D. If you have a family floater health insurance plan and a Super Top Up Plan that covers you, your spouse and your children, you can claim an Income Tax deduction upto INR 25,000 under section 80D. However, if you pay a premium that covers your parents then you can claim another INR 25,000. And in case your parents are above 60 years of age, you are eligible to claim up to INR 50,000.