Life is an unpredictable journey. It can take sharp, fatal turn at moments, which are capable of leaving one physically, mentally, emotionally and financially bruised.
Many of us ignore buying a personal Health Insurance plan (Mediclaim). Many of us also think that the mediclaim coverage provided by the employer is sufficient enough to cover any unforeseen medical expenses.
In my experience, the average medical cover opted (personal health insurance) or provided by an employer (group mediclaim) is generally in the range of Rs 3 Lakh to Rs 5 Lakh. Do you really think that this coverage is sufficient? What if the claim amount is more than the coverage amount? Can you afford to pay for the medical expenses out of your pocket? Do you agree that medical expenses are increasing at a very fast rate every year?
But, we are also aware of the fact that the premiums of health insurance plans are increasing every year. For some of us, the premiums are unaffordable. Also, it is not practically possible for everyone to increase the premium of their existing plan, or buy another mediclaim policy.
So, what are the available options? How to get higher coverage at affordable premium rates? How to deal with the inflating costs of medical treatment?
Have you heard of Top up Health Insurance plans / Super Top up Medical Insurance plans?
In this post, let us understand – What are Top up Health Insurance plans? What are Super Top up Health Insurance Plans? How does Top Up medical insurance work? How does Super Top up plan work? Which one should you buy, a Top up plan (or) a Super top up plan? Frequently Asked Questions (FAQs) on Top up Health Insurance Plans / Super Top up Health Insurance Plans.
Top up health insurance plans are a unique type of health cover policies that offer you (insured) an additional coverage, which is beyond the “threshold limit” (or) the maximum limit of the existing health insurance policies.
For example – Let’s say you have an Employer’s Mediclaim policy for Rs 3 Lakh and also a Top up Health cover for Rs 10 Lakh with the threshold limit (deductible) of Rs 3 Lakh.
If there is a claim for Rs 5 Lakh, your mediclaim policy (employer’s) will pay Rs 3 Lakh and the remaining claim amount of Rs 2 Lakh will be covered by your Top up policy.
So, such Top up health insurance policies come handy when the threshold of the existing health cover is already used or exhausted and there are some medical costs left to deal with, which would otherwise exert pressure on your financial savings. (To buy a Top up plan, it is not mandatory to have an existing health insurance policy. The threshold limit is the mandatory deductible, which can be borne by you or by your existing health insurance policy i.e., your company’s or personal regular health insurance policy)
How does Top Up Health insurance plan work?
Top up plans work on ‘per hospitalization’ basis. A Top up plan will pay you, if your claim amount for a single hospitalization is above the threshold limit.
Example – Mr Kejriwal has a personal Health Insurance policy of Rs 3 Lakh and also has a Top up health cover of Rs 10 Lakh sum assured, with the threshold limit of Rs 3 Lakh.
Scenario 1 – If there is a single claim of Rs 2 Lakh in a year, his regular policy will pay Rs 2 Lakh.
Scenario 2 – If there is a single claim of Rs 5 Lakh in a year, his regular policy will pay RS 3 Lakh and top up plan will pay the remaining Rs 2 Lakh.
Scenario 3 – If there is a single claim of Rs 10 Lakh in a year, his regular policy will pay Rs 3 Lakh and the remaining claim amount of Rs 7 lakh will be paid by the Top up plan.
Scenario 4 – If there are two claims in a year, one for Rs 3 Lakh (Claim 1) & another for Rs 2.5 Lakhs (claim 2), regular policy will pay the claim 1 amount (Rs 3 Lakh) and the total coverage is exhausted, the claim 2 amount (Rs 2.5 Lakh) is not covered by regular as well as the top up plan. (Though he has Rs 10 lakh as a top up cover, it is not applicable for 2nd claim as the threshold limit is Rs 3 Lakh. Top up cover will pay only if the bill amount is more than Rs 3 Lakh)
We are now clear that the Top up plans work on ‘per claim’ or ‘per single hospitalization’ basis, they are beneficial as long as the single claim amount is above the threshold limit.
In the above scenario 4, though Mr Kejriwal has Rs 10 Lakh Top up cover, his claim amount (claim 2) will not be paid. Super Top plans will be useful in these types of scenarios (multiple claims).
Example – Mr Kejriwal has a personal Health Insurance policy of Rs 3 Lakh and also has a Super Top up health cover of Rs 10 Lakh sum assured (total coverage Rs 13 Lakh), with the threshold limit of Rs 3 Lakh.
Scenario 5 – If there is a single claim of Rs 2 Lakh in a year, his regular policy will pay Rs 2 Lakh.
Scenario 6 – If there is a single claim of Rs 5 Lakh in a year, his regular policy will pay RS 3 Lakh and super top up plan will pay the remaining Rs 2 Lakh.
Scenario 7 – If there is a single claim of Rs 10 Lakh in a year, his regular policy will pay Rs 3 Lakh and the remaining claim amount of Rs 7 lakh will be paid by the Super Top up medical insurance plan.
Scenario 8 – If there are two claims in a year, one for Rs 3 Lakh (Claim 1) & another for Rs 2.5 Lakhs (claim 2), regular policy will pay the claim 1 amount (Rs 3 Lakh) and the total coverage is exhausted, the claim 2 amount (Rs 2.5 Lakh) will be paid by his super top up plan (though the claim 2 amount is less than the threshold limit)
Scenario 9 – If there are two claims in a year, one for Rs 5 Lakh (claim 1) & another for Rs 6 Lakh (claim 2), regular policy will pay upto Rs 3 Lakh (claim 1) & super top up plain will pay the remaining Rs 2 Lakh amount (a portion of claim 1). The entire claim 2 amount (Rs 6 Lakh) will be paid by Super top up plan, as the regular policy coverage is exhausted.
So, it is now clear that Super Top up plans consider ‘the total of all the bills’ in a given year. Super Top up plans cover ‘multiple’ hospitalizations and they look at the aggregate claim. This means they put together several cases of hospitalization to calculate the deductible limit (threshold limit).
FAQs & Important points about Top up / Super Top up Health Insurance plans ;
Below are some of the popular & best Top up Health Insurance Plans
Latest Update : Kindly note that Apollo Munich Health Insurance is now HDFC ERGO. The holders of Apollo Munich Health Insurance policies now become part of HDFC ERGO Health Insurance.
Below are some of the popular & best Super Top up Health Insurance Plans
Super Top up plans are offered by a few very health insurance companies;
Should you top up your health cover?
As health expenses increase, you may find that your base health insurance is no longer sufficient for your needs. A serious illness or accident can require long term care and complicated treatment, that can quickly become expensive and exhaust your health cover.
If you think that the sum assured of your existing health insurance plan (personal or employer’s group mediclaim) does not suffice for expenses due to illness or accidents, you may definitely consider buying a top up or super top up health insurance plan.
Before choosing an additional cover, compare the premiums of additional regular policies, top up plans and super top up plans. Do not buy Top up health insurance plans just because they are cheap, they may not serve the purpose (as mentioned above). Super Top up Plans can be the best way to enhance your total Sum Assured. Always, keep in mind about the medical inflation before finalizing the required sum assured.
In case your basic policy and the top-up policy are from two different companies, informing two insurers and getting the claim settled may be cumbersome. So, you may consider taking a top up or super top up plan from the same company (not mandatory).
To summarize;
Secure yourself with Super top up cover and never worry about your medical expenses again.
Did you like this post? Kindly share your views & comments. Cheers!
Continue reading :
(Image courtesy of Mister GC at FreeDigitalPhotos.net)
This post was last modified on July 10, 2023 6:32 pm
Filing your Income Tax Return (ITR) is not just about meeting deadlines—it’s about choosing the…
Retirement planning in India is often misunderstood. Many people think any long-term savings or investment…
You’ve probably seen the same property quoted at different prices. One person says ₹60 lakh,…
Buying insurance is easy. Getting your claim settled—that’s where the real test begins. For any…
Gifting immovable property—like land, plots, or houses—is super common in India. Families often do it…
Most people believe that investing alone is enough to create wealth. But in reality, many…
This website uses cookies.
View Comments
Sir,
I have INDIVIDUAL MEDICLAIM policy of my mother since year 2005 and its being renewed continuously with out any gap. The policy in the year 2018 has been increased from 200000 to 500000. my question is will the policy can be claimed 500000 in case of any hospitalization or we have to wait for 4 years wait time for pre-existing issues for upgraded 300000 lacs amount. In the year 2019 can I increase the policy amount to 8 lacs. again the same question, when I increase from 5 lacs to 8 lacs, should i have to wait 4 years for pre-existing issue. the policy name is INDIVIDUAL MEDICLAIM which is not available for new takers, its available only for renewal.
Dear JP,
Normally, the pre-existing diseases (if any) will be covered within the new coverage amount.
However, advisable to get this checked and confirmed with your Insurer.
Many thanks, let me check with Insurer. I have a different question. Can a senior citizen star health can be ported with normal PUS insurance. The PUS insurance company are interested in accepting our application. The new plan does not have co-pay. Will the new insurance company will treat the senior citizen claims as with other claims which does not have co-pay.
Dear JP,
Yes, can..
But, did you check with other features and T&Cs (of the new Insurer)?
Excellent article again. Thanks !
I have a basic 3 lakhs policy from United India covering me (father) and my 4 year old which is expiring in Nov 2019.
My wife is moved back to India now and I am thinking of increasing the cover to say about 20 lakhs. My wife is also planning to start work soon and may get a cover of upto 5 lakhs from her employer.
I am confused about how to structure the policy in this scenario. Please could you give me specific tips in this regard? Please note I have read most of the articles on this blog and I think I did not see this info in them.
Other doubts I have are:
1. Say we don't have a company insurance policy and we have to take personal health insurance policy. When super top up policy is so beneficial, why would we not just have only super top up policy?
2. Any guidelines on how to structure the basic policy and super top up policy? For example: 30% of total SA for basic and 70% of total SA for super top up.
3. If I am doctor working in a private hospital, do I have to consider any other things?
Hi,
You can check with your Insurer (United India) to add your spouse name in the existing Family floater policy.
1 - You can have. But, you need to bear the expenses till the threshold limit.
2 - No one can ever come to a conclusion as to what is the expected ideal sum assured that one should have under Health insurance plan. It is a factor of many things, can vary from individual/family to family.
Ideal way is to have a medical cover of up to say Rs 10 lakh and then Super top up it + accumulate a corpus (emergency fund) for unforeseen contingency.
3 - Do have sufficient 'Professional indemnity insurance cover'.
Dear Sreekanth,
My father age is 75 completed. but he is having some health issues like:- normal prostate surgery done(That was not malignant), Engiograpy done before 6 yrs..and the same time BP is also detected. His 1 basic policy running from Aditya birla health insurance.
So kindly suggest me any best Super top up plan so i can make insure my father.
Dear Mohar,
You need to check with any Insurer of your choice if he is eligible to get a (regular) Super Top up policy. (They may load the premium..)
Else, you may consider taking an additional stand-alone policy for Senior citizens..
Topup is not good and Super top is good.
Reason 1: If you go for topup then every time you have to pay basic amount from basic policy or from your pocket to use top up.
Reason2: If you go for supertop up then no need to worry about every time payment from basic policy or from your pocket always you need to utilize your super top-up amount for a year.
I have employer provided Medicare policy from united India of 12L for self (age 31). And for my mom (age 52) 6L from same insurer., She has hypothyroid and anemia as existing disease.
I have one younger brother for whom I want to take health insurance and selected Religare care with 5L SI and 6300/- premium. Existing disease depression.
Now I have questions
1. Shall I take indivual policy separately for my brother and myself or any policy which can cover both of us under one family cover ?
2. Or shall I go for super top for me and individual policy for my brother?
3. Which super top up plan can be an option for my mom considering her age.
Dear Sadhli,
1 - Advisable to take separate mediclaim policies, and do disclose the existing diseases / medical treatments in proposal form(s).
2 - Have base policy (independent to your employment) and then can Super top up it. In your brother case also, same suggestion.
3 - May be from the same insurer. (Is your mother's base policy provided through your employer?)
Thanks sreekanth.
And yes mother's current policy is on united india through employer.
Regarding no claim bonus if I have accumulated bonus for 5 years (10l base sum and plus bonus it's 15l) and I claim the policy 6th years how sum insurer will be calculated 7th year.
Dear Sadhli,
Kindly do not depend entirely on Employer provided group cover. Risky!
Earlier, the IRDA guidelines on NCB for Health Insurance policies stipulated that once an individual files for a claim, he/she loses the entire No Claim Bonus accrued over the years. However, this norm has now been changed.
For example, you have a 3 years and you have enjoyed 3 healthy no claim years. Now, if insurance provider increases your sum insured by 5% every claim free year, then in your 4th year, for an original sum insured of 5 lakhs, you will be eligible for Rs. 5,75,000.
If you file a claim in your 4th year, then your NCB on your sum insured will decrease proportionately by 5%. So now your sum insured for the 5th year will be Rs 5,50,000. Hence, the cycle of accumulating NCB starts again.
(This is just an example, suggest you to refer to policy wordings and T&Cs)
Understood.
I should first buy a base health insurance for my mom from same insurer and then Super top up from same insurer... am I right with the understanding ?
So NCB point is clear to me. And I think its not bad even if NCB gets reduced by 5% yearly after accumulating full bonus. Thanks again.
Is Religare a good company (in terms of how they handle grievance and queries) to buy Health insurance for my brother and me ? Reason I am asking is for 5L sum its recommended on both on coverfox and bankbazar, with super NPB till 150% and unlimited recharge once you exhaust yearly Sum insured.
Thanks lot for your suggestions.
Dear sadhli,
Same insurer or not - its purely your choice and based on your requirements.
If you are ok with its features and premium affordability, you may go ahead with Religare plan. Do disclose all the required info honestly and accurately in proposal form.
Hi Sree,
I am having an employer cover of 4 lakhs for my family of 3 (ages - 39,34,11).
1. Is it good idea to go for top up or a parallel base policy?
2. Considering retirement at 60, would it help taking a base cover now and top it up at 60? Would that save on premium as compared to taking a fresh policy at 60?
3. Should I go for a family floater or separate cover for myself and other family member? (I have some medical history)
Dear Pravin,
Suggest you to take family floater policy (regular / stand-alone) and then may consider taking Super top up plan.
Advisable to take health insurance (regular or top up) when your family is young.
In case, you had certain health challenges, you can take separate policy and your spouse+kid can take a family floater plan.
I have a health policy of Rs. 1 lakh and there is a room rent capping of 1% of SI i.e. Rs. 1000 per day. Suppose the total room rent incurred is Rs. 50000. This is for 20 days (Rs. 2500 per day). The total hospitalisation bill is Rs. 1,30,000.
Now if I have a super top up with 1 Lakh as deductible, so will the super top up policy reimburse Rs. 30,000 of room rent. Since this was capped by my base policy.
The super top up policy do not have a capping on the room rent, but they do not reimburse any deduction done due to the capping imposed by the base policy.
Dear Shyam,
So, it again depends on the terms & conditions applicable on Super Top-up policy.
I am 34 Yrs. old and covered under company group insurance with SA as 5 Lakhs. I also have a Religare Health Insurance of base SA of 7 Lakhs. Due to NCB and super NCB, SA has increased to 16 Lakhs now. If I continue not to claim anything for next 3-4 years, the SA would touch 21 Lakhs (maximum allowed). I don't want to touch this and want to keep this amount for old age or major illness (god forbid). Also, if you claim even 1 Lakh rupees from the policy, it makes entire bonus to zero.
Now, I am looking for Super Top Up plan with deductible as 5 Lakhs (group insurance) and SA as 5 Lakhs. Idea is to have claims in this order (1) Company Group Insurance (2) Super Top Up (3) Either out of pocket in case of small outstanding or from Religare in case of Huge outstanding. Please help if this approach right. Also, what information I will have to share with different insurers. Will there be any challenges in case of claim. Can a super top up insurer reject the claim stating that I should have claimed from Religare first before raising it to them? Please help.
Dear Ankit,
As per new regulations have been put in place, you can decide to against which insurer you would like to claim. If the amount of claim is less than or equal to the amount insured then you can claim the entire insurance from a single agency.
If the claim amount meets above criteria, it is advisable to claim from Company group cover first.
Suggest you to kindly go through this detailed article on 'how to claim Health insurance from multiple insurers?' (ET article).
Dear Sir, I have one doubt. Some insurer provide super top up for which pre medical test is compulsory, while some don't. Which insurer should we choose? I already have MaxBupa policy. Is super top up also available from MaxBupa? Thank you.
Dear Vivek ..Yes, super top up policy is available with Max bupa.
You can take super top up on your base policy from Max itself.
Dear Sreekanth,
this is a very nice article with very good explanation. One small doubt. When we make a claim from two different insurance companies, as both of them require original bills to be submitted. In such cases how we can get two original bills for these companies. Usually hospitals does not provide two original bills. ( In our hospital also we dont provide). In such cases how they honour the claim?
regards
RAJ
Dear Raj,
The policyholder has to inform both the insurance companies simultaneously regarding the claim. The first company that receives the original bills will share them with the other one. Also, advisable to save a copy of all the bills.
thanks a lot for clearing the doubt
regards
RAJ