Top-up and Super Top-up Plans in Health Insurance

The coronavirus pandemic proves that taking healthcare expenses for granted is a huge mistake. In the case of hospitalization, the total treatment costs may run into lakhs. You may wonder if your current coverage is adequate to meet these expenses.

The best way to enhance coverage is to opt for a top-up or super top-up plan, which offers additional cover at an extra premium.

Top-up plans

If your current cashless health insurance plan is inadequate to cover possible medical expenses, you need to enhance the coverage. A top-up plan allows you to increase the coverage and expand the sum insured (SI). The insurer will cover the balance amount if the limit of your base policy is exhausted. Do not that for critical illness insurance policies the top-up limits may differ hugely.

Super top-up plans

A top-up health insurance policy provides additional coverage only after the base coverage is used for a single hospitalization. A super top-up plan offers cumulative expenses incurred during the policy duration if they exceed the SI in your base policy.

Comparison between the two options

Although top-up and super top-up plans enhance the SI, here are some differences between these:

Top-up plan Super top-up plan
Working Based on the principle of per hospitalization Allows multiple claims during the policy duration
Termination Ends once a claim is made Lapses when the entire cover is used
Claim settlement Allowed only, if single hospitalization expenses exceed the deductible Settled when the total bill is more than the deductible limit

To understand how these two options work with your base medical insurance, here is an example:

Base policy: INR 4 lakh; top-up and super top-up plan of INR 20 lakh with a threshold limit of INR 10 lakh

Scenario 1: Total single hospitalization expenses amounts to INR 16 lakh

  • The base policy pays INR 4 lakh, while the top-up plan covers the balance INR 12 lakh.
  • The single bill amount is lower than the super top-up cover; thus, the base policy pays INR 4 lakh, and the top-up plan covers theremaining amount.

Scenario 2: Multiple hospitalization bills amounting to INR 12 lakh, INR 4 lakh, and INR 2 lakh

  • Base policy pays INR 4 lakh, and the top-up plan covers the balance INR 8 lakh, as it is below the threshold limit (INR 10 lakh); you need to pay the other two bills through your sources.
  • Base plan covers INR 4 lakh, and the super top-up plan takes care of the first, second, and third bill, as these are below the annual threshold limit

A top-up plan is adequate if you do not suffer from a chronic illness. However, choosing a super top-up mediclaim is advisable if your ailment requires multiple hospitalizations during the year.

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