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!
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(Image courtesy of Mister GC at FreeDigitalPhotos.net)
This post was last modified on July 10, 2023 6:32 pm
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My father age is 58, My mother age is 54. Please suggest good health insurance plan for them alone.
Shall i go with Star health family floater.
You can go ahead with Star's family floater plan.
Hi,
As per the different discussion - over the internet , it shows that "room rent limits" is the worst clause in buyinh Health insurence.
My under standing as per the below link
If so , then we have only 2 options
1) If we go to the Govt comp, then buy SA atleast 7-8 L
else
2) Have to go with private organization ...
I guess my under standing is correct ?
Thank you,
shankha
Dear Shankha,
Kindly note that it is highly impossible to fine the best health insurance plan.
Each plan has its own merits & de-merits. So, kindly opt for a plan which meets most of your requirements.
Hi,
Can you please explain - how limitations on room rent, copay/sub limit will affect a policy with
5 L SA
Most of the Govt. sector provider (New India, United India, Oriental, National Insurance) has same type of limitations on room rent, copay.
Please explain.
Thank you,
/shankha
Dear Shankha,
For example - You may Rs 5 L policy, but if there is a sub limit for room rent say maximum allowed is Rs1k per day, you can not claim charges under room rent beyond Rs1k.
Regarding co-pay clause, the policyholder has to pay certain agreed portion of claim amount, this can be say 80:20,in this case 20% of claim amount should be paid by the policyholder and the remaining 80% will be borne by the insurance company.
Hi ,
Thank you for your reply.
I have good 8 L insurence coverage for my family , from office.
But I have to do M. Insurence personally as I am working in private sector.
As per my convenience, (Age 34 ) I can took Rs 5 L SA .
1) Should I buy Super -Top-up with this 5 L SA?
2) What will be the good amout for Super -topto with 5 L SA?
3) If I buy 5 L SA from New India and Super -top-up from United India , How the claim will be done when we go for Super -top-up ? Beacuse all original documents needs to be submitted to the 5 L SA claim.
Thank you,
shankha
Dear Shankha,
It is a good decision to buy an independent medical insurance cover. Go ahead!
Suggest you to buy a regular health plan first for Rs 5 Lakh and then may be a year after you can buy a Super Top up plan with a deductible of Rs 5L or Rs 13L .
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.
Hi Sree,
Thanks for such nice information.
Don't we have any good term insurance plan + critical illness plans from any company , as this might be beneficial in those cases where employer is providing regular medical plan.
Dear Prashant,
SBI Smartshield has good CI rider.
But stand-alone mediclaim cover is very important as CI covers only few major illnesses.
Hello Sreekanth,
Firstly I wanted to thank you for the useful information you have posted.
My son had leukemia last year, I did the treatment thru my company's insurance(3 lacs). The total hospital charges costed me around 11laks. Now I am planning to take my personal Family Floater plan for 5 lacs (independent plan) and also take a family floater super top up plan for 10 lacs from United India.
Kindly advice if the plan is good to go.
regards,
dinesh
Dear Dinesh,
Thanks for your appreciation!
How is your child now?
Go ahead! Do mention the treatment details in the proposal form of Family Floater plan.
Hello Sreekanth
By God grace...My son is doing good... He is into the maintenance cycle and he is going to Montessori. Secondly I wanted to ask your suggestion. I am planning to take up the family floater from Untied India. But how about the TPA service. Can I opt for Vidal Health which was formerly know as TTK. Which TPA service is good so that we don't find any issue in the claims in the future... if in case touchwood.
kindly advice.
regards,
dinesh.
Dear Dinesh,
As long as we submit all the required details in proposal form honestly, chances of rejecting the claim are low.
I personally prefer private health insurance companies to PSU ones. (If ok, check out Apollo Munich / Star health / Cigna TTD ..)
Hello Sreekanth,
How are you doing,
Recently I enquired with one of insurance advisor (Maxbupa) regarding the Health insurance policy which I had early discussed with you. He confirmed that there are no insurance companies which will cover pre-existing disease i.e. for leukemia. I am bit tensed and worried when I heard about this. I am currently not able to think properly about my son future regarding with his health insurance. Do you know any insurance company which can cover my son pre existing disease converge.
regards,
dinesh
Dear Dinesh,
Your advisor can be right. Suggest you to check out with all major health insurance companies about this. Insurance company can cover the risk after initial waiting period for the pre-existing disease.
Kindly check out L&T insurance's MY Health Medisure Classic plan, I believe it covers Leukemia, but has 3 year waiting period.
Thank you. Sir. I will check and keep you posted. I really want to thank you. You are really doing a great job and service. Thank you so much for your advice.
regards,
dinesh
Dear Sir,
My mother aged 66 years is covered under AP government pensioners scheme. i wish to take a supertop up policy for here. can you suggest. she is having mild hypertensive.
regards
gupta
Dear Gupta,
You may consider United India's Super top-up plan. I have provided the link in the article itself.
You may also read my article - "Health insurance plans for Parents / Senior citizens".
(Do mention about mother's hypertensive thing in proposal form)
Hi
My parents have a 5 lac policy with oriental
We want to buy a top up from united india insurance now
a) Suppose mu parents make 2 claims in a year - 3 lacs and 7 lacs. Then will the super top plan reimburse the additional (7+3 - 5) = 5 lacs or it has to be a single claim ?
b) Any sub limits on different operations here in govt super top up plans?
Hi Sree,
One query regarding the claim process when you have a top up plan along with regular mediclaim policy...
Scenario: I have 3 L (Regular Cashless) + 10 L (Top Up).
Now suppose the toal bill for hospitalization is 6 Lakhs. My regular cashless policy will cover first 3 L of bill since it has tie up with hospital and the settlement of bills & documents will be done without hassles.
But for the rest of 3L bill how will I produce bills to top up insurer company, since the hospital will not issue me duplicate bills nor the top up company will entertain duplicate bills.
How does this work in such case?
Thanks,
Pawan
Dear Pawan,
If it is a cashless scenario (planned hospitalization), you may have to inform both the insurance companies (so it makes sense to have both the plans from the same company but not mandatory though).
If it is a reimbursement scenario, depending on the claim amount, you need to follow up..
Dear Sreekanth,
Your all articles are really getting useful for me.
I need your help.
I have health insurance policy with sum assured of 4 lakhs from my employer.
It is family floater plan. ( for Self+Spouse+Parents).
Recently we already spent more 3 lakhs (2 claims in 3 months) for my father's treatment
( lungs and heart problem - Angioplasty).
Yesterday, I read your article regarding Health Insurance - Top up & Super Top up plans.
Please suggest me which super top up plans should I take ? or
Suggest me if some other plans are there...
Thanks.
Dear Jalpesh,
Suggest you to first take a Family floater plan for self & Spouse and then add a Super-Topup plan (may be after 1 or 2 years).
For parents do consider separate Mediclaim policies. Kindly read my article - " Best health insurance plans for parents / senior citizens".
Hello Sreekanth,
Thanks for your suggestions.
Yea, I am planning to take family floater plan for my self U& my spouse.
I am confused between " Apollo munich Easy health standard plan" & "L&T medisure classic plan".
Can you please help me to pick one of these ?
I saw some other plans too, but, I feel, these 2 are good plans.
Thanks.
Dear Jalpesh,
I believe Apollo would be a better choice. Do remember to provide all relevant and accurate information in proposal form.
Dear Sreekanth,
Thanks for your suggestions.
I am going to take Apollo munich Easy health plan.
Thanks again.
Dear Jalpesh..good decision..keep visiting my blog! Cheers!
Hi Sreekanth,
I have 6L floater policy (3L basic + 3L additional top up) from UnitedHealthcare through my company.
Due to cancer medical treatment for my mother, we have claimed the full amount(6L) this year. we are left with zero medical cover now.
I want to take another health plan for this year.
Which super top up plan from which company will be suitable for me?
What are the main difference from super top up plan (except premium rate) compared to basic medical plan..because when i enquired some waiting period and Deductibles rules are applied in super top up plan.. please share me your opinion..should i go for basic medical plan or super top up plan ?
Dear Jebastan,
How is your mother now? Trust she is fit and fine.
How old is she? What is your age? Other dependents details?
Hi Srikanth,
Thanks for your help!.
She is getting better now. she is 60 now. my age is 31. and my wife age is 28.
Now i will (have to) spend other treatment expense from my hand for mother since no medical insurance company will accept her for top up plan now.
But i want to take another medical plan for me and my wife since we are left with zero cover now.
Kindly recommend a suitable medical plan.
[my company medical plan will be renewed in November]
Dear Jebastan,
Kindly buy a Regular Family Floater plan (covering self & spouse) immediately. Do not depend on employer's group mediclaim alone.
Nest year or so, you may buy a Super-Top up plan with a deductible of say employer provided cover + new regular plan's cover.
Hi Sreekanth,
I have coverage of 3 lakhs from my company. I'm planing to take super topup for 10 lakhs with 3 lakhs deductible. Do you recommend family floater super top up or individual super top plan?
Regards,
Rajesh
Dear Rajesh,
Did you include your dependents in group mediclaim (employer's)?
Yes. Dependents are covered.
Dear Rajesh,
Suggest you to take personal Family Floater plan (independent plan) and consider taking a family floater super top up plan (may be with employer's + this new plan coverage amount as deductible amount, the premium can be lower because of high deductible amount).
Hi Sreekanth, thats a good suggestion. But my company provider floater plan is having portable option so i can carry forward even if i leave company. Do you think i should still buy personal family floater.
More over there is only 200 to 300 difference in premium above 3 lakhs Deductible.
Dear Rajesh,
What if your company changes the Insurance provider? (I have seen this happening..)
It is always better to have you own personal health insurance cover.
thanks for responding to my quires My last query is if i go for another individual family floater of 3 lakhs. is it mandatory to take super top with 6 lakhs deductibles or i can take 3 lakhs as per my wish?
Dear Rajesh,
It is not mandatory.