A top-up plan offers additional coverage beyond the maximum limit of your existing health insurance policy.
By Rakesh Goyal
While employers do provide health cover to their employees, it is often not enough to meet medical expenses. Many avoid buying a health insurance plan throughout their lives because of high premiums. So, if you are looking for a better way to manage the sum insured of your health plan and that too, without spending a lot of money, then opt for a top-up or super top-up plan.
A top-up plan offers you additional coverage beyond the maximum limit of the existing health insurance policy. Most health plans offer automatic recharge of sum insured in a year after exhaustion during the tenure. But, what if the medical bill goes over and above the sum insured during the policy period? In that case, having a top-up plan helps. A top-up plan will cover medical costs after a declared deductible or threshold is reached.
For instance, Ranjana holds an employer’s health policy of Rs 4.5 lakh (also the threshold deductible) along with a top-up health cover of Rs 7 lakh. If she falls critically ill, and the claim goes to around Rs 7.5 lakh (which is higher than the threshold coverage of the plan), the medical bill up to Rs 4.5 lakh will be paid by the mediclaim policy and the remaining Rs 3 lakh will be paid by the top-up plan.
One of the key features of investing in the top-up plan is that the policyholder can get this plan from any company and not necessarily from the existing insurer. It is available for both individual plan as well as family floater plan. It has an option to enhance the policy coverage at the time of renewing the policy. Children can be included in the same plan if both the parents are covered.
Super top-up plans
A super top-up insurance plan is a saviour when a single claim does not traverse the threshold limit of the regular plan, but multiple claims do. The super top-up plan helps you to enhance your base health plan’s coverage. If the base plan is not sufficient enough to meet the actual medical expenses in a single claim or your sum insured is exhausted because of multiple claims in a year, then you can count on a super top-up plan.
For instance, Suresh has an existing health insurance plan of Rs 3 lakh and has bought a super top-up health cover of `9 lakh. Suppose, he gets hospitalised and if the medical expenditure is `8 lakh, his regular policy would pay `3 lakh and the super top-up insurance plan would pay Rs 5 lakh.
If another claim of Rs 4 lakh is made in the latter part of the year by him, the entire amount is paid by the super top-up plan since the regular policy cover is exhausted. The claim is settled if the overall bill amount exceeds the deductible limit.
It offers an additional benefit to the base plan which helps the insured if the medical expenses exceed the threshold value either due to a single claim or multiple claims in a year. A policyholder can make multiple claims in a year till the sum insured gets exhausted. It is advisable to have a base plan to cover the medical expenses up to declared deductibles. Keep these things in mind before opting for any additional cover.
The writer is director, Probus Insurance Brokers