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
hi Mr Sreekanth Reddy,
your article is quite simple but covering all aspects of policy thus very useful for a layman like me.
i need your advice.
i am a 43 yrs old executive working in a PSU that almost fully covers me and my family for all type of diseases without any upper limit and provides cashless facilities with MOU hospitals and the bills amount is also unknown to the employee.However an employee has to bear some cost of non-refundable things and partial payment of medical tests.So
1.Should I go for regular family floater plan?What would be the mechanism for interfacing between my employer's facility and the insurer in such case?
2.Or Would you suggest me to go for a top up/super top up plan? If yes, then how my bill amount will be known to the insurers?
thanks in advance
Ranjan Sharma
Dear Ranjan...Is this cover available even after you retire from the Org?
I have check some super top up plan for my mother from apollo , religare and L&T, however when I have check the cost of these plans, their price are too steep and if When I have compared super top against policy with higher sum insured cover, there was no difference .
my mother age is 60 as of now.
I am bit confused to go with smaller cover and then super top up it or buy the policy with higher sum insured.
Could you suggest.
Dear manish ..Kindly go ahead as per your requirements & affordability.
Read: Best Health insurance plans for Parents or Senior Citizens.
dear Srikanth ,
My fathers age is 62(retd. state govt employee) and mothers age is 56 both are covered under State Govt Employees Pensioners Health Cards ,both are healthy at the moment no bp or sugar , iam confused wether to take any meidcalim policy or top up since they are already covered under NTR health plan however the wordings of the plan are (In AP, Medical Expenses Limit is Rs2,00,000. However, in the cases where the cost of treatment exceeds Rs.2.00 lakhs, cashless treatment will continue. No network hospital shall deny the treatment in such cases.) so please advice me whether that would be sufficient or take a new plan to cover extensively ,if so please advice me
thanks and regards
Anil
Dear Anil ..Whether the amount is sufficient or not, it is very tough to say and predict, am I right?
We all know that one requires lakhs of rupees for any major surgery or treatment if any unforeseen things happens.
You may consider buying at least a Super Top-up plan (floater) for them.
Thank you so much for your suggestion .
regards
Hi Shreekanth,
The policy wording for New India Top Up Mediclaim says the following...
"This policy will respond only when the aggregate of all Hospitalisation expenses (except Pre / Post hospitalization expenses) of one or all members of the policy, exceeds the “Threshold” stated in the policy."
Doesn't the above imply that this product is a Super Top Up plan?
--
Thanks
Hari
Dear Hari..The statement is not clear as to it is per claim’ / ‘per single hospitalization’. Suggest you to check with the company directly before buying the plan.
I just called: Each time the total cost has to be larger than the deductible. Then only the (Cost - Deductibe) will be covered by this plan. In summary: This is NOT super-top up!
wanted to take a super top up plan., Please suggest the best one among the market to avail.
Dear sunil ..Kindly go through the plans suggested in the article and pick one as per your requirements.
Kindly read below articles;
Evaluate these 11 factors when buying a health plan.
Best portals to compare health insurance plans.
Hi Srikanth,
My mother is 56 years old. since 3 years we have a Oriental Happy family floater policy. Now her office is providing corporate health care policy of 3Lakhs for their employees. Now i am planning to remove her name from oriental happy family floater since the premium is coming to 25000/- and take super top up plan for her. What insurance companies do you recommed for super top-up plans. She has hyper thyroid problem.
My one more doubt is , how to get cashless treatment if the hospital bill is more than 3Lakhs. And one more doubt is how to claim above 3 lakhs hospital bill. since, all original bills will be submitted to New India insurance for cashless treatment. What to submit to the super topup policy insurance claims department?. please reply me in detail.
Dear Mahesh,
Ideally it is not prudent to include senior or parents in family floater policy if the age gaps is on a higher side. Because the premium on floater policy is based on the senior member's age.
May I know her retirement age? Will the corporate group cover be continued even if after her retirement?
You have to take photocopies of all bills and can get Claims settlement summary from insurer X (New India). These bills will need to get attested by the hospital and you can submit the attested photocopies along with the claims settlement summary to insurer Y (Top up). Insurer Y will then pay the remainder.
Hi Sreekanth,
I recently bought a Super Top Up from L&T, they declined my policy stating they don't cover Non Alcoholic fatty liver i has in 2013, my recent medical reports being crystal clear and recently have purchased a life insurance
Now what do you advice?
Dear Faraaz..Based on their underwriting rules they would have declined. Did you mention about the medical condition (past data) in the proposal form? Suggest you to contact a different non-life insurance company.
Read: Best portals to compare Health plans.
Why do u suggest to go for super top up after 1 yr or two years after taking the policy.
I’m looking for an extended/top-up Health Insurance plans for dependents (Mother) heart surgery.
Currently I hold a policy of Rs 3,00,000 and cannot be claimed completely as there is a cap limit for each procedure i.e. in my case its only Rs 1,50,000.
Estimated cost of surgery would be around Rs 3,00,000 to Rs 5,00,000.
I have already enquired with HDFC ERGO, United Insurance for top ups plans but they said:
1. One cannot claim half amount from existing plan and remaining from top up plan.
2. Complete limit of existing policy should be exhausted. But we have cps limits for each procedure.
It would be great if anyone could advise some tips with respect to managing funds efficiently (i.e. any top up plans without restriction on above mentioned points or some efficient way that you have cracked)
Any immediate help on this is much appreciated.
Dear Vishnu,
The top up plans trigger after the utilization of the SA of base policy.
Suggest you to check out with other health insurance companies too.
I am working in a Central Govt PSU and covered with Employers Medical Benefit. Though there is no upper limit of SA but the hospitalization expenses are paid as per CGHS(Central Govt Health Scheme) rate. Presently I am posted in Kolkata and there are few Cashless Hospitals here. Many (though not all)of the Hospitals are empanelled under the employer and medical bills are re-imbursed after treatment as per CGHS rate.
My question is Do I need to take any Mediclaim/Health Insurance Policy? If yes, what SA should I take.
(In recent check I found my BP is 151/87 & Pulse rate is 101)
My age is 29. Weight 85 Kg, Height- 5'10".
Dear Indrajeet,
It is advisable to have a health insurance plan which is independent of your employment.
Read : Best websites to compare health insurance plan.
Dear Srikanth
I have posted my query to know why do I need additional Health Insurance when I am being provided Medical Benifit by Central Govt till my entire life (even after my retirement) free of cost.
Would you please mind to explain the neccessacity (pros ) of taking independent policy?
Dear Indrajeet..You have not mentioned about the cover being applicable even during your retirement. Also, if there is no upper limit and you can afford to bear the expenses from your pocket and then reclaim later, you may consider not to buy an additional plan.
What about your family members? Are they covered under the same plan?