I’m a 35-year-old married man with one child. While I’m already covered by a health insurance policy worth 5 lakhs through my current employer, I also purchased a personal family floater Mediclaim Insurance worth 5 lakhs last year. Recently, after reading various posts and blogs, I’ve come to realize that relying solely on a health insurance policy of 5 lakhs might not suffice. With escalating healthcare expenses and the costs associated with hospitalization and treatments, I believe it’s prudent to secure a health insurance coverage of 50-100 lakhs to safeguard my family and myself. However, upon checking the premiums for such extensive coverage, I found them to be prohibitively high. What options do I have in this scenario?
This is a common concern shared by many individuals. Are Super Top-up health insurance plans a viable solution? What are the currently available Super Top-up Health Insurance plans in India? Before delving, let’s clarify what is meant by a Super Top-up Health Insurance plan and what deductibles entail in such plans. Let’s address the frequently asked questions about super top-up health insurance step by step.
About the author: Ajay Pruthi is a fee-only SEBI registered investment advisor. He can be contacted via his website plnr.in. Ajay is part of the freefincal list of fee-only advisors and fee-only India.
What is a Super Top-up plan?
A Super Top-up plan is a health insurance plan that gives you additional coverage above a certain limit or deductible. The follow-up question would be what is a deductible?
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What is a deductible in Super Top-up plan?
A deductible is the base amount or the baseline limit above which your super top-up policy will come into force. Let me explain
You hold a family floater super top-up policy valued at 45 lakhs with a deductible of 5 lakhs. If you’re hospitalized due to illness, your super top-up policy won’t kick in until your medical expenses during your hospitalization surpass 5 lakhs. Essentially, the initial 5 lakhs of medical expenses will be covered either by your base policy, corporate policy, or out of your own pocket. Any expenses exceeding 5 lakhs will be covered by the Super Top-up policy.
Why should one opt for a Super Top-up policy?
The premium paid in super top-up policies are cheaper than your normal base health insurance policies, because of the deductible.
Suppose you are a family of 4 (2 adults and 2 children) (age of eldest member – 35)and you want to opt for a health insurance policy of 100 lakhs. You can consider the following options:
- Base health insurance cover of 100 lakhs – Rs. 57413
- Health insurance cover of 10 lakhs and a Super Top-up plan of 90 lakhs with 10 lakhs deductible- Base policy Rs. 25057, Super top-up policy – 1589 (Total -26646)
Which one do you think is better?
Why premium is low in super top-up policy?
Insurance operates on probabilities. The likelihood of a 2-3 Lakhs claim is significantly higher than that of a 10 Lakhs claim, hence super top-up policies are more economical. Additionally, the higher the deductible, the lower the cost for the same insured sum.
Does the deductible limit consist of a single claim or multiple claims?
The deductible limit must be surpassed, whether it’s a single claim or multiple claims, in order to claim from the super top-up policy.
Can I make multiple claims for self and family members??
Yes, after the deductible limit is met, you can make multiple claims for both yourself and any family members included in the policy.
What is the ideal amount of super top cover and deductible amount?
An ideal coverage amount is typically between 50-100 Lakhs with a 10 Lakhs deductible. Lower deductibles are an option, but they often come with higher premiums.
Do I have to buy base policy to purchase a super top-up policy?
No, it’s not necessary to purchase a base health insurance policy. The super top-up plan becomes effective only after the aggregate deductible is met. You can cover the deductible amount from your base policy, corporate policy, or even from your own pocket.
Can I buy a super top-up in addition to my company cover?
Yes, you can certainly purchase a super top-up plan in addition to your company cover. However, it’s generally advisable to also have a base cover in a personal capacity.
Should I purchase a base policy and super top-up policy from the same insurer?
Ideally, yes, purchasing both the base and super-top-up policy from the same insurer is recommended. While it may enhance the chances of settling cashless claims, it’s important to note that there’s no guarantee of cashless claim.
What if I purchase a base policy and super top-up policy from the different insurers?
The likelihood of cashless settlement claims is minimal. Typically, you’ll need to initially pay the bill out of your own pocket and then seek reimbursement from another insurer. Alternatively, you can opt to purchase a new super top-up policy upon renewal of your base policy, provided there are no changes in the health conditions of yourself and your family members.
Should I purchase a base policy and super top-up policy at the same time?
Yes, ideally, purchasing a super top-up policy at the same time as your base policy lowers the chances of claim rejection.
What if I do not purchase a base policy and super top-up policy at the same time?
No problem. You have the option to purchase a new super top-up policy at the time of renewing your base policy, provided there are no changes in the health conditions of yourself or your family members. Alternatively, you can choose to continue with the same policy and retain a small level of risk
What if my insurer does not offer a higher amount of super top-up policy?
You can check with the insurer if it’s possible to purchase multiple super top-up policies from the same insurer. Another option is to purchase from a different insurer, if there is no change in health conditions of any of the family member.
Is there any co-payment in super top-up health insurance policy?
It’s important to review your policy document for this information. Some companies may have co-payment options once you reach a certain age.
Will I get any tax benefits?
Yes, you do get tax benefits under Section 80D.
Should I use no claim bonus or super top up policy first?
No claim bonus. Opting for the no claim bonus saves you from additional documentation hassles and ensures cashless claims.
Is the claim cashless or on a reimbursement basis?
Both scenarios are correct. If both the base policy and super top-up policies are from the same insurer, it often increases the likelihood of cashless claims being accepted.
What documents are required to claim from super top policies?
All previous reports and expenses incurred during hospitalization up to the deductible level should be retained. Ensure to keep your records safe for reference
Does super top-up policy cover pre-existing diseases?
Yes, however, there might be a waiting period to cover pre-existing diseases
Are modern treatments covered in super top-up policies?
Please check your policy document for specific details as this can vary from insurer to insurer.
Should I directly purchase it from website or third-party apps?
Better to directly purchase it from the website.
Do third party apps help in claim settlement?
Yes, they can help you if the claim is genuine. If the claim is not genuine, no one can help in the settlement of claims.
Do I need to have health emergency fund even if I buy super top-up policy of higher amount?
Yes, it’s advisable to maintain a health emergency fund even if you purchase a super top-up policy for two main reasons:
- The health insurance company may reject your claim, so having a fund ensures you can cover expenses if needed.
- If you plan to seek reimbursement for hospitalization expenses, you should have the necessary funds available to pay the bills upfront
Do I get no claim bonus in super top policy too?
No, in most of the policies.
Do I need to undergo any medical test to buy the policy?
Depending on factors such as age, pre-existing conditions, sum assured, and deductibles, you may be required to undergo medical tests.
Is it mandatory to inform change in health conditions in writing while renewing the super top-up policy?
No in most of the policies. But it is always advisable to inform the company.
Can I buy it for my parents and in-laws?
Yes, you can certainly purchase these plans for your parents and in-laws, although there may be an upper age limit when purchasing the policy.
Which Super Top-up health insurance plans are currently available in India?
Here is a list of several Super Top-up health insurance plans currently offered in India.
Niva Bupa – Health Recharge
HDFC Ergo – my:health Medisure Super Top-up
ICICI Lombard – Health Booster
Star Health – Star Super Surplus (Floater) – Gold Plan
Care Insurance – Care Enhance
Liberty Insurance – Health Connect Supra
New India – New India Top Up Mediclaim
Oriental Insurance – Oriental Super Health Top UP
United India – super top up plan
Best Super Top-up Health Insurance Plans in India
What constitutes the best Super Top-up health insurance plan in India varies depending on individual needs. While Liberty Health Connect Supra and Niva Bupa Health Recharge may offer attractive premiums, other factors beyond low premiums should be considered before making a decision. Here are some key factors to consider:
- Consider purchasing the Super Top-up policy from the same insurer as your base policy, provided the difference in premium (around Rs. 3000-4000) is acceptable to you. This can simplify the claims process and prevent potential complications.
- Many Public Sector Undertaking (PSU) health insurance policies come with room rent sub-limits. While this might be adequate for smaller cities and towns, it may not suffice for treatment costs in metro cities where treatment expenses often correspond to room rent limits.
- Check the waiting period for covering pre-existing diseases.
- Ensure there are no conditions such as co-pay and co-deductible attached to the policy.
Do let me know if you have any additional queries regarding super top-up health insurance policy.
*Disclaimer- Nothing contained in the article is a solicitation, recommendation, endorsement, or offer by me. If you have any doubts as to the merits of the article, you should seek advice from an independent financial advisor. Registration granted by SEBI, membership of BASL, and certification from NISM in no way guarantee performance of the intermediary or provide any assurance of returns to investors. Investment in securities market is subject to market risks. Read all the related documents carefully before investing.
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