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Health Insurance Top up plans

19 June, 2019

A health insurance policy provides reimbursement for surgical and other medical expenses incurred for hospitalization caused by an injury or illness. All the health insurance providers have several network hospitals linked to it, where you can avail cashless treatment by providing your insurance details. If you are not availing treatment at a network hospital, you will have to bear the expenses yourself at first, and then apply for reimbursement by submission of bills and receipts.



Consider a scenario wherein you end up in a hospital for a procedure that costs Rs.1 lakhs. Your existing policy covers up to Rs.2 lakhs, so there is nothing to worry. However, let’s say you anticipate the expenses going up much higher with time, say up to Rs.4 lakh. What do you do then? Well, you get a top-up plan for your health insurance that gives you the additional coverage you need.


Top-up plans are small, independent plans over and above your existing health insurance. You can buy a top-up from either the same company as your health insurance provider or another insurance provider. Most of the insurance companies sell separate top-up health insurance.


When you buy top-up insurance, you need to determine a deductible. When a claim arises, the amount equal to the deductible has to be borne by the claimant or the existing health insurance policy. A top-up insurance provider settles only the amount exceeding the deductible.



Health Insurance top-up plans offer the flexibility to act as the backup to your existing health insurance plan while ensuring it doesn’t hurt your pocket much.


Getting a top-up plan is also advantageous because:

  1. Purchasing it is independent of whether you already have an existing health insurance policy or not.
  2. They are more economical than basic health insurance policies.
  3. These Top-ups provide protection when your existing policy is exhausted, thereby ensuring your constant security.
  4. The add-on covers come with a range of options to improve your current policy coverage based on your specific needs



The popularity of these pop-up plans arises from their flexibility to include various members of the family within the same single plan or easy floater plans without putting restrictions on hospitalization costs like doctor fees, room charges, procedure costs, etc. Several plans offer discounts as well as insured bonus sums for not filing any claims in a year. These health insurance add-on covers come with an ease of access by exempting you from medical screening up to a certain age & by providing a free-look period of 15 days once the policy is purchased. Also, these covers can be issued for 1 to 2 years based on the provider and can be renewable lifelong. The best part is that it can be easily converted to a basic medical plan if needed. These top-up plans also provide tax benefits on premium under 80/D of the Income Tax Act.




While the final details of each Health Insurance Top-up Plan may vary from provider to provider, in general, a wide range of benefits can be availed. For example, treatments that do not require being admitted for more than a day are covered as are hospitalization costs extending to both 60 days before hospitalization & 90 days after hospitalization. In the case of admission, the benefits may include doctors’ & nursing fees, room charges, cost of oxygen, blood, devices, implantations and the likes. Specific plans may also cover donor expenses & emergency ambulance charges. The coverage may be wider based on the plan/provider but limitations to cap the amount may apply to all the benefits.


With the availability & transparency of information, one should study various aspects of the plans & make informed choices. 


Things to note:

  1. Always study the exclusions of any add-on cover
  2. Always be clear about the coverage & the lack of, for various family members in the Top-up insurance plan.
  3. Always check the deductible criteria related to different illnesses
  4. Always verify the waiting period in various scenarios of hospitalization (pre & post) & pre-existing health conditions 
  5. Always be aware of the benefits of the existing health insurance policy & the proposed top-up plan to avoid overlapping of benefits.