In response to our article – How do I combine base and super top-up health insurance policies? – Two readers sent us identical stories on what our base policy and super top-up policy should have the same renewal date.
Case 1: Shared by Mr. Srinivasan Sundarajan. The person had a base (10L) and a super top-up (50L) from the same insurer. The person was involved in an accident, say on Feb 1st. There was an initial hospitalisation. The claim was 8L. It was for the period ending Feb 15th. The insurer paid it out.
After 15 days, the doctor could further diagnose, and the boy needed surgery. This was determined on Mar 1st. The super top-up policy was renewed on Feb 20th. The base policy was due for renewal on Mar 10th. This is when it became tricky.
The surgery would cost an additional 12 L. If they decided to undergo the surgery on Mar 2nd, the base policy would only cover 2 L, the super top-up would not cover the first 10 L, and the final 2 L would be covered. So they would go out of pocket for 8L.
Luckily, the renewal of the base was only 10 days away, and they could wait (which was acceptable due to the health situation). So they scheduled it for Mar 12th – to get the base to pay 10L and the 2L from the super top-up.
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This was a real close call. Lesson learnt: Align the policy renewal dates on both policies to avoid getting into a trap. If the base policy renewal had been another 20 days later, they would have had no choice but to pay the 8L, despite all the coverage.
Also read by the same author:
- Health Insurance: Switching out of my current job – My experiences
- Experience: After porting from group health insurance to a family floater
Case 2: Shared by Mr. Harpreet Gandhi. My acquaintance purchased a 10 lakh base policy from Company A, along with a 40 lac super top-up, with a deductible of 10 lac from Company B. In theory, they had coverage up to 50 lac. However, they bought these policies on different dates. The base policy was purchased on 1st January and the Super Top-up on 1st April of the same year.
It so happened that they were diagnosed with cancer, and the chemotherapy expenses exhausted the base cover by 1st March. So while the base policy was exhausted, the super top-up policy kicked in and provided cover till 31st March. However, as we know, cancer treatment goes on for a long duration. The top-up policy was renewed in April, and Company B then again asked for the deductible condition of 10 lac to be met before the super top-up policy kicks in. This is where it shocked them. They were unaware of this peculiarity of the way the super top-up policy works.
Had the policies been bought on the same date, this situation would not have happened and would have saved 10 lac expense from their pocket.
More than the money, it is also about the distress that the patient’s family had to go through. They were under the impression that they were very well covered. However, it turned out to be untrue due to this small detail.
Editor’s note. What can you do? In my experience, if the top-up is purchased from the same insurer as that of the base policy and via an agent, this issue usually does not arise, as the renewal dates usually match. Buying it online can be tricky, so it’s best to purchase close to the renewal date of the existing policy and ensure the dates match.
Care should be taken when the top-up insurance is from a different insurer. An exact date match is not always possible, but as long as the gap is as short as possible (a few days), it should be okay. But even here, you can request a date match. They may or may not agree.