Top up health insurance policy offers floater benefit to cover the insured and its dependents for the same sum insured under the single policy. This is relatively cost-effective as a group discount is available under the policy.
Top up health insurance plan offers restoration benefit means your sum insured will be reset up to 100% if it gets exhausted due to the treatment of any illness. Hence the basic sum insured will automatically get reinstated after claim.
Pre-existing diseases such as high blood pressure, type 2 diabetes, and chronic health problems are covered under the policy immediately after the 12 months of continuous coverage after the issuance of the first policy.
Health insurance top up plan offers you a cashless claim facility wherein insurer will pay the hospitalisation expenses directly to the hospital, hence offering you a financial cushioning in case of emergency.
A top up health insurance, as the name suggests, is a plan that helps you increase the sum insured of your existing health plan by paying a premium in return. To understand it better, you can simply take the example of a mobile top-up recharger. When the mobile data of your existing plan exhausts, you buy a top-up to extend the data of your existing plan. So, let's suppose you have a health insurance plan with a sum insured of INR 5 lakhs. However, seeing the rise in diseases and the cost of healthcare treatments, you feel that the coverage might not be sufficient. You can now either purchase one more health plan for INR 5 lakhs, by paying a similar premium, or you could opt for a top-up plan for INR 5 lakhs by paying a much more affordable premium.
In case you exhaust your health plan, a top up health insurance would help you to increase the sum insured so you can further use it for your health benefits. However, a top up health insurance also requires the insured to pay the deductible (a part of the claim paid by the insured). You also need to bear in mind that a top-up plan would kick in only after the deductible limit has been crossed. Let's understand this with the following example:
Mrs. Leela Shrivastav, a 51-year-old college professor, has a health plan of INR 10 lakhs. However, when she was hospitalised for treatment of her gall bladder, the bill was INR 15 lakhs.
A top-up health insurance plan thus offers you coverage over and above your regular health plan. It is also an affordable way to enhance your group's health insurance coverage. However, in a top-up plan, you need to cross the deductible limit for every hospitalisation for the top-up plan to get triggered. An aggregate amount is not considered in a health insurance top-up plan.
This is where a super top-up plan comes in handy. In a super top-up plan, the aggregate amount is used as a deductible and the excess claim would be paid by the super top-up plan.
A cashless hospitalisation plan refers to a health insurance plan where the insured does not have to pay admissible bills. Rather, the hospital and your insurance company directly settle the bills. The insured only must pay for the bills that do not come under the coverage of the plan. So, under a hospitalisation cover, the insured does not have to empty his/ her pocket to get good quality treatment.
Depending on the insurance company and the plan, you may avail yourself of a health insurance top up plan. However, it is mostly possible when you purchase both the base plan and the top-up plan from the same insurance provider. It makes the bill settlement procedure easier for all parties. If you purchase both policies from different insurers, you would still be able to avail yourself of top up cashless hospitalisation plan, but the process is slightly more complicated.
A top up plan is an additional amount of coverage at a marginally higher cost, which is significantly lesser than a base plan since the claim is triggered only after the claim crosses the defined amount of deductible limit.
A top up health insurance plan comes into play when the sum insured by the base plan gets exhausted. It helps you increase the sum insured, so you do not have to pay from your end even when your sum insured is over. However, it is mandatory to fix deductibles, and the policyholder must pay the deductibles in order to avail of the benefit of the top up health plan.
By now, you may have come across several benefits that you get if you buy a top up health insurance plan. Check out the list below to better understand what advantages you enjoy with top up health insurance:
A top up health insurance plan makes the medical bill payment a lot easier and saves your hard-earned money from being exhausted. Before you buy top up health insurance, you must understand the various features and benefits of a top up health insurance:
There are broadly two types of top up health insurance plans in India as discussed below:
Health insurance top up plan works on the principle of per claim basis in one policy year. This means that each top up health insurance claim you make has to be higher than the base sum insured of your existing health plan. Let's understand this with an illustration:
Mr Bhuvan has a health plan of INR 5 lakhs sum insured and a top up plan of INR 10 lakhs. Bhuvan undergoes hospitalisation, and the total bill raised is INR 8 lakhs. In this case, the bill is higher than the sum insured, INR 5 lakhs. Hence, here, Bhuvan is eligible to avail itself of his top up plan for the extra INR 3 lakhs of his bill.
However, after a few months, Bhuvan underwent another surgery, and this time, the bill was INR 3 lakhs. Here, the bill is lower than the deductible and so he cannot claim top up health insurance. However, since the base plan is also exhausted, the entire amount of INR 3 lakhs need to be paid out-of-pocket.
A best super top up health insurance plan works on an aggregate basis. This implies that when the overall medical bill of your policy year surpasses the deductible limit, the super top up plan becomes active. Let's see an example:
Mr Ankit has a health plan that offers a sum insured of INR 5 lakhs and a super top up plan of INR 10 lakhs sum insured. The deductible agreed upon for the super top up plan is INR 5 lakhs. Now, if Ankit gets the medical treatment of INR 8 lakhs, he can avail INR 5 lakhs from his base plan and the remaining amount of INR 3 lakh more from his super top up plan.
However, after a few months, Ankit underwent another surgery, and this time, the bill was INR 3 lakhs. This amount would also be paid by his super top up health insurance plan as the aggregate claim for the entire year is more than the deductible threshold amount.
There are quite a few differences between a top-up and a super top-up health insurance plan such as :
| Top Up Health Insurance Plan | Super Top Up Health Insurance Plan | |
|---|---|---|
| When does the claim get triggered? | When every single claim is more than the defined deductible limit. | When the aggregate claim in the policy year is more than the deductible limit. |
| Which is cheaper? | This is comparatively cheaper than a super top-up health insurance plan. | This is comparatively more expensive than a top-up plan but cheaper than a base health insurance plan. |
Let us clearly understand the difference with an example:
| TBase Health Plan | Top Up Health Insurance Plan | Super Top Up Health Insurance Plan | |
|---|---|---|---|
| Policy details | INR 5 lakhs | INR 10 lakhs with a deductible of INR 5 lakhs. | INR 10 lakhs with a deductible of INR 5 lakhs. |
| 1st Claim- INR 3 lakhs | Paid by the base plan | The top-up health plan doesn’t pay as it is not triggered. | The super top-up health plan doesn’t pay as it is not triggered. |
| 2nd Claim- INR 8 lakhs | POnly INR 2 lakhs is paid as INR 3 lakhs were already paid before. | Only INR 2 lakhs is paid as INR 3 lakhs were already paid before. However, the remaining INR 2 lakhs need to be paid out-of-pocket | The super top-up health plan gets triggered and pays INR 8-2= INR 6 lakhs as the deductible of INR 5 lakhs is considered as INR 3 lakhs (1st Claim) + INR 2 lakhs (2nd Claim) = INR 5 lakhs. Thus, the remaining INR 6 lakhs would be paid by the super top-up health plan. |
| 3rd Claim- INR 2 lakhs | Nothing would be payable as the entire amount of INR 5 lakhs is already exhausted. | Nothing would be payable as the deductible amount is not crossed in this particular claim for the top-up plan to be triggered. | The entire amount of INR 2 lakhs would be paid by the super top-up health plan as the deductible amount has been crossed in the earlier 2 claims (aggregate). |
Thus, even if super top-up plans are slightly more expensive than top-up plans, it is prudent to opt for that so as to avoid maximum damage at the time of a claim.
Like a regular indemnity-based health insurance plan, the top up health insurance policy also enjoys wide coverage. Before you sign up for a policy, make sure you read all the terms. Here are some of the most common inclusions provided under a health insurance top up plan:
A top up cashless hospitalisation plan is availed when the base sum insured of your existing health insurance plan is exhausted. When you get hospitalised for medical treatments, and your final medical bill exceeds your sum insured's limit, you can use your top up cashless hospitalisation plan to save yourself from paying.
However, because there is a mandatory deductible associated with a top up health insurance plan, you need to pay the agreed deductibles in order to utilise the benefit of a top-up cashless hospitalisation plan successfully.
There are a few things that you must consider before you buy top up health insurance. Check out the pointers below for a better understanding:
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