How can employers design a voluntary top-up group health insurance? Suggest appropriate deducible amount

A top-up insurance plan within group health insurance covers hospitalization costs. But, only after a threshold limit is crossed. This threshold limit is known as deductible i.e portion of the claim amount that is not covered by the insurer and has to be paid by the policyholder. Once the claim amount crosses the deductible limit, the top-up policy kicks in and covers the claim cost up to the sum limit of the policy.

For example –

If the top-up policy sum insured is INR 10L and the deductible is INR 2L then the top-up policy will kick in only if the claim amount is > 2L. For instance, suppose the claim amount is INR 15L. Here the top-up policy will cover the claim cost of INR 10. L above the deductible limit i.e. INR 2L and the policyholder will bear the claim expenses under 2L. Insurers know that claims > 2L are rare. Hence, they offer a top-up policy at a lower premium making it a cost-effective way to increase health insurance coverage.

The deductible limit of a top-up policy is supplemented by the base health insurance policy.

For example –

Suppose you take a top-up policy with a deductible of INR 2L. You should take a base health insurance policy of a sum insured INR 2L. In this way, you can use your base health insurance policy to make a claim up to the deductible amount rather than bearing the cost of it.

Do Employers offer Group health insurance benefits?

Most employers offer group health insurance benefits to their employees. However, it is commonly seen that employers do not offer a high sum insured limits in the group insurance cover to keep premium costs under budget. Therefore, to compensate for lower sum insureds they often offer a choice to the employee to increase his/her cover through top-ups. Similarly, Multiple top-up limits (typically 3-5) are offered to the employees to choose from. A sample group health insurance program with top-up options is illustrated below –

Written By-

Mayank Sharma 

MBA Finance

He is a professional who brings extensive knowledge and expertise to the field of group health insurance. He has dedicated 7years to helping individuals and businesses navigate the complexities of insurance. Having worked closely with numerous clients and insurance providers, he deeply understands the nuances of group health insurance policies. With a reputation for providing insightful and informative content, he leverages his industry experience to educate readers about the importance of group health insurance and its benefits. Through their articles, Mayank Sharma aims to empower individuals and businesses to make informed decisions about their healthcare coverage, ultimately promoting healthier and more secure communities.