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Understanding Top-up and Super Top-up plans in health insurance

Whether you already have a health plan or planning to buy a new one, this simple tip will help you to boost your health insurance coverage.

Although these days, employers do provide a health cover to their employees but that is not enough in severe medical emergencies. Moreover, due to high premiums, many avoid buying a health insurance plan throughout their lives even when they don’t have an employer’s health plan.

Because with the rise in medical inflation, it is imperative to have a higher sum insured to cover any unforeseen medical emergencies.

And so,if you are looking for a better way to manage the sum insured of your health plan and that too, without putting out a lot of money out of your pocket, then the answer is simple: Opt for a Top-up or Super Top-up Plan.

Let’s understand top-up and super top-up plans in health insurance.

Top-up plans in health insurance

The top-up plan offers you additional coverage beyond the maximum limit of the existing health insurance policy.

Most health plans offer automatic recharge of sum insured in a year after exhaustion during the tenure. But, what if the medical bill goes over and above the sum insured during the policy period? In that case, having a top-up plan helps. A top-up plan will cover medical costs after a declared deductible or threshold is reached.

For instance, Ranjana holds an employer’s health policy of Rs. 4.5 lakhs (also the threshold deductibles) along with a top-up health cover of Rs. 7 lakhs. Suppose, if Ranjana falls critically ill, and the claim goes to around Rs. 7.5 lakhs (which is higher than the threshold coverage of the plan), under this case. The medical bill up to Rs. 4.5 lakhs will be paid by your mediclaim policy, whereas the remaining amount of Rs. 3 lakhs will be paid by your top-up plan.

One of the key features of investing in the top-up plan is that it is quite simple as the policyholder can get this plan from any company and not necessarily from the existing insurer. For better understanding, let’s see some of the key features and advantages of a top-up plan.

Key features of a Top-up plan

  • Available for both individual plan as well as family floater plan
  • One of the cost-efficient way to increase your health cover
  • Option to enhance your policy coverage while renewing your current policy
  • You can buy a top-up plan even though you don’t have a basic plan as it is easily convertible to a basic health plan
  • Children can be included in the same plan if both the parents are covered
  • Family discounts are also available in some top-up plans. You have a free-look period of 15 days from the day of policy purchase
  • Most plans come with no pre-requisite of medical tests upto a specified age
  • Lifelong renewability option is available
  • Tax benefits on the insurance premium paid under Section 80 D of the Income Tax Act

Although the plan comes with a lot of benefits, one major drawback of the top-up covers is that it has restrictions on pre-existing diseases, pre and post hospitalization expenses and other conditions.

Super top-up plans in health insurance

Talking about the Super Top-up Insurance plan, this plan is a saviour when a single claim does not traverse the threshold limit of the regular plan, but multiple claims do. The super top-up plan helps you to enhance your base health plans coverage. If the base plan is not sufficient enough to meet the actual medical expenses in a single claim or your sum insure exhausts because of multiple claims in a year, then you can count on Super Top-up plan.

For instance, Suresh has an existing health insurance plan of Rs. 3 lakhs and has brought up a Super Top-up health cover of Rs 9 lakhs. Here, the total coverage goes up to Rs. 12 lakhs with a threshold of Rs. 3 lakhs.

Suppose, Suresh gets hospitalized due to a sudden major accident and if the medical expenses go up to Rs. 8 lakhs, then under this case, his regular policy would pay Rs. 3 lakhs and the Super Top-up Insurance Plan would pay Rs. 5 lakhs.

If another claim of Rs. 4 lakhs is made in the latter part of the year by Rajesh, the entire amount is paid by the Super Top-up plan since the regular policy cover is exhausted.

Let’s have a look at the key features of a Super Top-up plan for better clarity.

Key features of a Super Top-up plan

  • The claim is settled if the overall bill amount exceeds the deductible limit
  • Offers an additional benefit to your base plan which helps the insured if the medical expenses exceed the threshold value either due to a single claim or multiple claims in a year
  • Insured can make multiple claims till the sum insured gets exhausted
  • Comes with premiums which are lower than the regular health insurance premiums
  • Enhances the total sum assured value
  • The policy lapses only if the entire cover gets exhausted

Moreover, an individual doesn’t need to hold a base health plan to avail for a super top-up plan. However, it is advisable to have a base plan to cover the medical expenses up to declared deductibles.

Keep these things in mind before opting for any additional cover, consider rising medical inflation before finalizing health coverage and compare the premiums of regular health policies, top-up plans and super top-up plans to know the best fit for your needs, super top-up plans can be an ideal pick to enhance your base health policy and total sum assured.


About Mahender Bansal

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