In the last one decade, the cost of healthcare in India has increased at a double-digit rate. The regular health insurance cover either provided by your employer or bought by you with a sum insured of Rs 2 to Rs 3 lakh is no more sufficient to meet your future or even current medical expenses. For instance, the cost of dialysis for treatment of kidney related ailments in India is anywhere between Rs 2,000 and Rs 3,000 per session and the amount can easily reach around Rs 25,000 per month. Talking about cancer, the cost of treatment can often go beyond Rs 20 lakh, including surgery and chemo sessions. A person who needs to undergo an angioplasty or an open-heart surgery in order to unclog the arteries, may need to spend Rs 3 lakh to Rs 7 lakh.
In order to bridge this gap, it is important that along with your regular health policy with a significantly higher sum insured, you must also buy a Super Top-up and Restoration Plan that enhances the health cover in a cost-effective manner.
Super Top-up health insurance plan reimburses you the expenses, provided your hospital bills cross a certain deductible limit. Under the plan, you can avail financial relaxation when your hospital bill crosses the total sum insured of the standard policy. For instance, in case you have a top-up plan with a deductible of Rs 5 lakh and an SI (sum insured) of Rs 15 lakh, the top-up plan will only come into force once the combined medical bills in a policy year exceed Rs 5 lakh. Also, it will only reimburse you for the amount exceeding Rs 5 lakh. The 5 lakh needs to be paid from your own pocket or even your standard health insurance policy. A major reason that the insurers consider these plans less risky is that these plans come with a deductible element. One thing that you must know is that under a super top-up plan, multiple claims in a policy year are combined and the reimbursement is only made after the amount exceeds the deductible limit.
Some of the prominent insurers offering super top-up plans at affordable premiums include Religare’s Enhance, Apollo Munich’s Optima Super, HDFC ERGO’s my: health Medisure, ICICI Lombard’s Health Booster and Bajaj Allianz’s Extra Care Plus. For a 30-year-old man, his wife and two children (family floater), a super top-up plan with an SI of Rs 10 lakh and a deductible of Rs 5 lakh will have a premium of Rs 3,500 – 7,600. However, if you buy a super top-up plan along with the regular health cover with an SI of Rs 3 – 5 lakh, the premium will be significantly lower.
Buying a restoration plan along with your base health policy significantly enhances your health insurance cover. Under this plan, the entire SI gets restored in a policy year when it gets exhausted due to hospitalisation and other healthcare expenses. The plan is best for family floater covers, wherein there is a chance that the entire SI may get exhausted due to a serious illness of a single family member. Under such a scenario, the other family members are left without a health insurance cover. This is when the restoration feature comes into play, as the insurer immediately restores the entire SI. The insured does not need to pay an additional premium for the restoration and the feature can be used for any subsequent claims in the given policy year.
Some of the prominent insurers offering restoration plan at affordable premiums include Star Health’s Comprehensive, Apollo Munich’s Optima Restore, HDFC ERGO’s Health Suraksha Gold Regain, Max Bupa’s Health Companion, Reliance’s Health Gain, CignaTTK’s ProHealth, and Aditya Birla’s Active Assure Diamond. However, one must know that most health policies restore only upon complete exhaustion of the sum insured. Also, some of the policies do not offer the restoration of SI for the same illness.
(By Amit Chhabra, Head-Health Insurance, Policybazaar.com)