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 parents have a 5 lacs sum insured family floater policy from National Insurance (Parivar Mediclaim). My father is 58 years old and mother 52 years. Its a claim free policy since last 7 years. However, there is a limitation to the policy which allowes only 50% S.I as the maximum amount for one claim which limits the coverage to 2.5 lacs for my mother and father each.
Additionally i have a family floater plan from my employer covering my parents for 5 lacs. I am trying to buy a Super Top Up Plan for 15 lacs with a 5 lacs deductible limit. However, there is a condition that my father suffers from Hypertension (BP) and is on a regular medication. Moreover, he had an Angioplasty way back in 1998 and since then he is leading a normal healthy life. As he has crossed 55 years age, most companies want medical tests to be conducted. But, as we know his reports (ECG) specially doesnt come out to be perfect because of the angioplasty done in 1998. I am afraid, if we propose to buy a Super Top Up policy, this would be a big issue for my father to get coverage.
Otherwise, i had selected L&T's and Religare's Super Top Up Plan. Can you advice on this case. Many thanks.
Regards
Ankit
Dear Ankit,
Suggest you to consider buying an independent policies for your father and mother separately.
hello shree
I have a family floater policy of SI Four Lakhs. after the age of 55 as per the policy norms 20% co- pay for all hospitalizations upto 80 years. It means if a medical bill is 4 lakhs and 20% co pay 80,000/- I have to pay from my own pocket
So if I buy United india health super top up policy , that ratio is 3 rest to 5 and 7 lakhs
It means united india will pay that amount or i have to pay
Kidly guide me
Dear praveen..I am unable to understand this sentence of yours : " that ratio is 3 rest to 5 and 7 lakhs". Kindly rephrase it.
i found the artcle very useful. thanks. we are 3 seniors , self 75, wife 69 and motherin law 86! i am porting from National healths varishta to united india. because:
varishta in critical illness component (CIC) does not cover angioplasty, as per the policy. in small print it also says for bypass limit is 20% of insured amount ie rs 60000. and when one gets hospitalised for other than CIC, the max cover is Rs one lakh. it cannot be increased. i think the policy is a real rip off for seniors.
please advice on this matter: when we took varishta 7 years back we had no BP. now with age it is there though under treatment. if asked by united, is it better to declare BP and pay higher premium. if so will there be a period where they will not cover BP related surgeries like angioplasty or by pass?
very informative article. thanks for the same. we are family of 3, self 75, wife 69, mother-in-law 86! i am shifting from national insurances varishta mediclaim to united india insurance, because:
varishta' s critical illness component does not cover angioplasty (as mentioned in the policy). it covers by pass surgery but limit is 20% of insured amount. i guess this limits the expenses paid to rs 60000, which is a measly amount.
other than critical illness component, cover is max rs 1 lakh. so if one gets hospitalised due to other than critical illness, what one gets is peanuts. i think the policy is a rip off for seniors.
please advice on this matter- when we took varishta about 7 years back we did not have BP. now when i port the policy to united, is it better to declare the BP which has come with advancing age and under medication, and pay additional premium if asked ?
Dear Subbarao,
It is advisable to disclose all the details pertaining to Pre-existing disease(s) (if any) while shifting from national to united.
Hello Sir,
I am 24 years old and I have a floater policy (Group Policy) from Company's side (Of UIIC-Tailor made policy). Sum Assured is Rs. 4 lacs. I have a younger sister who is 20 years old. My parents are 51 years old. I want to provide my family a larger cover, with minimum premium possible due to financial burdens. Keeping in view the age constraints and the situation in which after marriage, they no longer be covered, Please suggest a good policy such that they are covered for maximum possible tenure. Please help. Thank you so much.
AkG
Dear AKG,
Suggest you to buy an independent mediclaim policies for three of them. Consider policies provided by United india / national insurance / star health.
Pl refer to your reply dated July 15,2015 to a query by Mr Anurag Kalra. His query was that if he has a base plan cover of Rs. 3 lacs and if he buys an additional super top plan of United Insurance, then whether the total c over available to him would be 3+7=10 lacs or 3+4=7 lacs. You have mentioned 7 lacs. I believe your reply requires more elaboration else it is confusing. I believe that the Total cover available to Mr Anurag would be 10 lacs [3 from base policy and 7 from super top us] ;whereas the liability of United Insurance would be limited to 7 lacs beyond expenses of 3 lacs. Please confirm if I am correct or not. Example : if the bill is 11 lacs. 3 lacs would come from the base policy. 7 Lacs from supertop up and 1 lac from his own sources
Dear Aggarwal,
Yes, it is Rs 10 Lakh. I have corrected my comment. Your understanding is right.
Hi Guys ,
If Your Are Looking Good Health Insurance Policy , You can Go for , iffco tokio`s Skp, and Health Protector Series, competitive Rate and Good Penetration of Company`s Representative and Service Offices .
Under super top up policy issued by UIICL, my wife was operated for her bilateral knee replacement surgery, after 4 days of hospitalization she was discharged; she had physio-therapy treatment from a registered qualified Dr. Physio Therapist for 60 days (since the surgery was for both the legs). Is physio therapy treatment payable ? The policy conditions provide (clause 5.4) that "IN CASE OF POST -HOSPITALIZATION, TREATMENT (LIMITED TO 60 DAYS), ALL CLAIM DOCUMENTS SHOULD BE SUBMITTED WITHIN 15 DAYS AFTER COMPLETION OF SUCH TREATMENT" Pl advise.
Dear Malesha,
Looks like you can claim the expenses. Kindly talk with the company's customer care executive or your agent.
1. United India has a super top-up plan, Insurance cover 7 lacs and threshold limit 3 lacs. This means total insurance cover is Rs. 10 lacs ( 3+7) or 7 lacs ( 3+4).
2. Can we combine 2 policies. For example if I have one policy of 3 lacs and it gets exhausted and I have another policy of 2 lacs. Can two different policies be used for one treatment in continuation.
Dear Anurag,
1 - It is Rs 10 Lakh
2 - Yes, you can claim.
Hi, I am trying to understand these concepts and this article explains what I am looking for. I still have few queries to clarify. Let's consider the same example as above where the person has 3 Lakhs base cover and 7 Lakhs top up cover. Let's assume this as scenario 10. What if there are multiple claims in a year with claim1 - 3 Lakhs and claim2 - 4 Lakhs ? I understand the first claim will be paid by the base policy and it will be exhausted. For claim 2, will the topup plan pay the entire 4 Lakhs or just 1 lakh after deducting the threshold limit from the claim??
Scenario 11- what if the first claim is for 2 Lakhs and he still has 1 lakh left in the base cover and he has a second claim for 4 Lakhs in the same year? How much will the topup insurance provider pay?
Dear Sabari,
Scenario 10 - Claim 2 will be covered under Top up plan as it is above the Threshold limit of Rs 3 Lakh.
Scenario 11 - Calim 1 will be paid by regular plan and Rs 4 lakh (claim 2) will be serviced by top up plan.