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Why get a Top-Up or Super Top-Up, over and above a base plan?

why-get-a-top-up-or-super-top-up-over-and-above-a-base-plan

All of us try to focus on maintaining a healthy lifestyle. However, it is impossible to predict any future ailments or deterioration in health. Maintaining a good health insurance plan with ample Sum Insured helps in safeguarding your financial situation during a medical crisis.

What should one do though, if medical expenses exceed the sum insured of your basic health policy?

There are two kinds of plans, (i) Top-up Plans and (i) Super Top-up Plans, which help you get additional coverage on your existing policy for hospitalisations.  We are here to explain that this does not mean breaking the bank for paying higher premiums.

A top up plan is one in which each claim has to cross the deductible amount, before the policy will start to pay. On the other hand, a Super Top Up plan will consider whether the sum of all claims during a policy period has crossed the deductible amount, and start paying each claim thereafter up to the Sum Insured.

  1. Top-up: A Top-up plan offers extra coverage for claim exceeding the base amount. Under a typical base health insurance plan, the insurer pays for claims up to the coverage amount i.e. the Sum Insured. A top-up policy is applicable when your insurance claim passes the threshold limit (deductible). For example, in case of hospitalization if the bill exceeds the cover of your Basic health insurance plan, you can claim the differential amount from the Top-up plan. Top-up health insurance is a type of policy that covers expenses relating to a single hospitalisation. Therefore, every time the claimed expenses have to cross the threshold deductible, and anything beyond the threshold can be claimed subject to the Sum Insured limit of the Top-Up cover.
  2. Super Top-up: A Super Top-up plan covers the total amount of all hospitalisation bills in the policy period, above the deductible amount. After the deductible is paid, the plan becomes active for subsequent claims, just like a Base plan. Thus, the deductible is applied to the sum total of all claims in one policy year. Unlike a Top-up plan, there is no limit at a particular claim level, once the deductible threshold is crossed. This plan functions at a cumulative level and begins when you have used your base policy amount.

    Let’s take two examples to explain the difference:
    • Ms. Sita has the following:
      • A base policy of Rs. 4 Lacs Sum Insured
      • A Top-Up policy of Rs. 5 Lacs, with deductible of Rs 4 Lacs.
    • Ms. Gita, on the other hand, has the following:
      • A base policy of Rs. 4 Lacs Sum Insured
      • A Super Top-up policy of Rs. 5 Lacs, with a deductible of Rs 4 Lacs.

Unfortunately, both get hospitalized during the year, and their claim amounts are for Rs. 4 Lacs, Rs. 2 Lacs and Rs. 4 Lacs each.  Let’s see how their plans work with respect to their claims:

 

 

Claims During Same Year

Ms. Sita (Base + Top-Up)

Ms. Gita (Base + Super Top-Up)

1st Claim: Rs. 4 Lacs

Covered by base plan, whose Sum Insured is now exhausted.

Covered by base plan, whose Sum Insured is now exhausted.

2nd Claim: Rs. 2 Lacs

The full claim amount will have to be paid by Ms. Sita, as claim amount is less than deductible amount of the Top-Up plan.

The entire expenses of Rs 2 lacs will be covered by the Super Top-up plan. 

 

3rd Claim: Rs. 4 Lacs

The full amount will have to be borne by Ms. Sita, as claim amount is less than the deductible amount of the Top-Up plan.

Rs. 3 Lacs will be paid under the Super Top-up plan.  The remaining Rs 1 Lac has to be paid by her.

Ms. Gita had earlier exhausted Rs. 4 Lacs limit of her Base plan.  Now she will cross the Rs 5 lacs limit of her Super Top-up plan.

4th Claim: Rs. 6 lacs

Claim paid for Rs. 2 lacs by Top up Plan.

Ms Gita has to pay the entire amount, as Sum Insured for both the Base Plan and the Super Top-Up Plan have been exhausted for the year.

 

The benefit of opting for Top-ups or Super Top-ups are:

  • Affordability: Top-up and Super top-up plans are affordable options as they usually are at a lower premium compared to a base health policy of same sum insured amount.
  • Greater Health Coverage: Top-up/Super top up policies are available as both individual policy and family floater policy. The advantage of additional health cover can be extended to family members as well.
  • Financial Safety: The sum insured offered by these plans serves as an added financial cushion for your existing policy. Super / Top-ups are highly recommended for critical health needs and increased medical expenditures.

One key point to remember that impacts top-ups and super top-ups is “Deductible”, i.e. base amount or limit / cap over which a Top-up or Super Top-up policy comes into force.  Another point to remember is that hospitals are often unable or reluctant to handle cashless claims from two different insurers for the same patient.  Therefore, it is preferable to have the Top-Up or Super Top-Up plans from the same insurer as the Base Plan.

For help with deciding the best top-up and super top-up plans we invite you to visit our health insurance portal, sana.insure.  SANA Insure is a digital platform that provides expert, simple, and unbiased comparison on various health policies available in India. We simplify complex terms and conditions, product features, and provide transparent information, tailored to your needs.

We invite you to visit https://sana.insure/ to receive customized suggestions factoring in the diseases and conditions you want coverage for. You can also get in touch with us over WhatsApp chat on 8278271818 or call us on 1800 202 8118.

Wish you a healthy and happy life!

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