you bought one Health Insurance Scheme A few years ago, it was expected that it would provide adequate health insurance coverage. However, over the past few years, medical inflation has increased faster than the average inflation rate. As a result, you feel that the health insurance cover you purchased a few years ago is inadequate today. In such a scenario, you can purchase additional coverage in the form of a top-up or super top-up health insurance plan. In this article, we will understand what is a top-up and super top-up health insurance plan, what is the difference between them and which one you should take.
What is Top-up Health Insurance Plan?
A top-up health insurance plan pays out when hospitalization claims are above a specified limit, called the deductible. For example, suppose you buy a top-up plan with a sum assured of Rs. 10 lakh and a deductible of Rs. 3 lakh. In this case, the top-up plan will pay only if the claim amount exceeds Rs. 3 lakh.
If claim amount is Rs. 4 million, For top-up policy Rs. Will have to pay. 1 lakh after considering Rs. Deductible of Rs 3 lakh. If the next claim amount is Rs. 2 lakh, top-up policy will not be payable as it is below Rs. Deductible of Rs 3 lakh.
How to link top-up health insurance plan with your Aadhaar plan?
If you feel that your base health insurance policy coverage is inadequate, you can purchase a top-up policy with the deductible amount being the same as the base health insurance policy amount. For example, suppose you have a base health insurance policy with a sum assured of Rs. 5 lakh. In this case, you can buy a top-up policy of Rs. 10 lakh with a deduction of Rs. 5 lakh.
If the claim amount is up to Rs. 5 lakh, base The health insurance policy will pay. If the claim amount exceeds Rs. 5 lakh, Aadhaar health insurance policy will pay Rs. 5 lakh, and the top-up policy will pay incremental amounts up to the top-up policy sum assured (since the deductible is Rs 5 lakh).
It is important to note that in a top-up policy, the deductible amount applies to each claim separately, and only the incremental amount above the deductible amount is paid. For example, if there are 3 claims in a policy year, the deductible amount for each claim will be applied first, and The incremental amount, if any, will be paid up to the Sum Assured as per the terms and conditions of the policy.
What is Super Top-up Health Insurance Scheme?
A super top-up health insurance plan pays out when hospitalization claims exceed the deductible amount. The deductible amount is calculated by taking the sum of all claims made during the policy year. Therefore, if there are multiple claims in a policy year, the total of all claims is added. Once the sum of all claims made so far exceeds the deductible amount, incremental claims will be paid (total up to the sum insured) as per the terms and conditions of the policy.
For example, suppose you buy a super top-up plan with a sum assured of Rs. 10 lakh and a deductible of Rs. 3 lakh. In this case, the super top-up plan will pay out when the sum total of all claims in the policy year exceeds Rs. 3 lakh.
If the first claim during the policy year is Rs. 2 lakh, Super Top-up policy will not pay out as the claim amount is less than Rs. Deductible of Rs 3 lakh. If the second claim during the policy year is Rs. 1.5 lakh, the total sum of two claims during the policy year is Rs. 3.5 lakh. In this case, the total claim amount (Rs 3.5 lakh) exceeds the deductible by Rs. 3 lakh. The insurance company will pay an incremental amount of Rs. 50,000, which is more than the deductible of Rs. 3 lakh.
If the third claim during the policy year is Rs. 2 lakh, the total sum of three claims during the policy year is Rs. 5.5 lakh. In this case, the insurance company will pay the entire Rs. Claim amount of Rs 2 lakh. There was a deduction of Rs 3 lakh in the second claim itself.
|
Super Top-up Cover = Rs. With Rs 10 lakh. Deductible of Rs 3 lakh |
Total claim amount during the policy year |
claim paid |
|
First claim = Rs. 2 lakhs |
Rupee. 2 lakhs |
Zero |
|
Second claim = Rs. 1.5 lakh |
Rupee. 3.5 lakh |
Rupee. Rs 50,000 (incremental amount over deductible amount) |
|
Third claim = Rs. 2 lakhs |
Rupee. 5.5 lakh |
Rupee. 2 lakhs |
Difference between top-up and super top-up policies
The main difference between both the policies is that the top-up plan works on a per-claim basis, with the deductible amount being applied to each claim separately. For each claim, only the incremental amount above the deductible amount as per the terms and conditions of the policy will be paid.
In a super top-up plan, all the claims made in a policy year are added. If the cumulative claim amount exceeds the deductible, the incremental amount above the deductible amount will be paid as per the terms and conditions of the policy. Once the deductible amount is exceeded, all subsequent claims during the policy year will be paid (up to the total sum insured), subject to the terms and conditions of the policy.
Which policy should a person take?
In India, most people with health insurance cover are underinsured. Therefore, they need additional health insurance cover. With a top-up or super top-up plan, one can significantly increase their health insurance cover without any significant increase in Premium amount.
If the individual is healthy and needs coverage against a major claim or critical illness, he or she can consider a top-up plan. If the individual is at risk of being hospitalized multiple times during the policy year, they can consider a super top-up plan.
The premium of a super top-up plan is higher than that of a top-up plan. However, a super top-up plan offers better value for the policyholder.
