Health Insurance Top-up plans offer additional coverage to the insured when the primary health plan is exhausted of its maximum sum assured.
A health insurance top-up plan extends your maximum insurance limit without being a burden on your pocket. It is like having a spare wheel to your basic health insurance plan.
Let us assume that you have a health insurance policy of Rs. 10 lakh, and you buy an additional top-up plan of Rs. 5 lakh (Subject to T&C)
- If you get a medical bill of Rs. 8 lakh, only your basic health plan will be utilized.
- If the medical bill is of Rs. 14 lakh, then the first Rs. 10 lakh will be claimed from the health insurance plan and the balance Rs. 4 lakh will be settled through the top-up policy.
- If the medical bill is Rs. 17 lakh, then Rs. 10 lakh will be from the health insurance plan, Rs. 5 lakh from the top-up plan, and the remaining amount of Rs. 2 lakh will have to be borne by the insured themselves.
FEATURES AND BENEFITS OF A TOP-UP PLAN –
- A top-up plan can be bought at a minimal cost of a basic insurance plan.
- Top-up plans can be bought with family health insurance plans and health insurance plans for seniors.
- Top-up plans can be purchased with an Employers’ Group Insurance Scheme as well.
- A top-up plan can be converted to a basic plan.
- No limits and restrictions on hospitalization charges.
- Cumulative bonus is paid for every claim free year.
- Policy term can be up to 3 years as well.
- The policy can be obtained without medical check-up up to a certain age.
- Free look-up period of 15-30 days is provided with top-up plans.
- Top-up plans can be renewed lifetime.
- Tax benefits under Section 80D of Income Tax Act of 1961 are applicable for the premium paid for top-up plans.
INCLUSIONS IN A TOP-UP HEALTH PLAN –
Even though the coverage of a top-up plan varies from insurer to insurer, the following are some of the primary benefits on offer –
- In-patient hospitalization cover – room rent, doctor’s fees, nursing fees, OT charges, oxygen charges, a device implanted in surgery, pathology charges, diagnostic procedure charges, etc.
- Pre-hospitalization – up to 60 days prior
- Post-hospitalization – Up to 90 days immediately after hospitalization
- Daycare procedures
- Organ donor expenses – some plans cover this
- Emergency Ambulance charges – up to a specified limit
- Domiciliary treatment – only prescribed by doctors
TYPES OF TOP-UP PLANS
To understand the two kinds of top-up plans, let us take the example of Mr. Singh. He has existing general health insurance of Rs. 2 lakh and he buys an additional top-up plan of Rs. 5 lakh with a deductible of Rs. 2 lakh as that can be settled by his general health policy. Now, there are two types of top-up plans –
1.Basic top-up plans –
- Deductible calculated separately for each hospitalization
- Deductible limit refreshed for every hospitalization
2.Super top-up plans –
- Deductible calculated for the total medical expenses in a given policy term
- Is not dependent on the number of hospitalizations
Now let us take two scenarios –
- Mr. Singh’s hospitalization bill is Rs. 6 lakh. The general insurance plan will pay Rs. 2 lakh, as per the sum assured, and his top-up plan will pay the additional Rs.4 lakh. The case will be similar for both basic top-up or super top-up.
- In the second case, Mr. Singh gets hospitalized twice in a policy term period. The first time his bill is Rs. 1 lakh and the second time the invoice is Rs. 2 lakh. If Mr. Singh has a basic top-up, it won’t get activated, as it considers each hospitalization is below the deductible limit.
The total expenses in the year are Rs. 3 lakh and his general policy will cover Rs. 2 lakh. Thus, Mr. Singh will have to pay Rs. 1 lakh from his pocket in spite of having a top-up as each hospitalization is considered separately.
If Mr. Singh has a Super top-up, then it will consider total expenses in the year. So, out of the total expense Rs. 2 lakh will be borne by his general health insurance and his super top-up plan will cover Rs.1 lakh.
Thus, it is advisable to buy super top-up plans in case of frequent hospitalizations and higher medical expenses.
While buying a good top-up plan –
- Check the waiting period for pre-existing conditions
- Ensure that the top-up covers the family members as well