super top-up policy facts

Everything you need to know about a super top-up policy

Health insurance is a product that protects one from any financial strain due to medical emergencies. Such a product covers all the medical expenses incurred by a person in case of hospitalization. For purchasing a health insurance policy, one needs to pay a certain sum of money. The premium is payable in lump-sum or in installments. The premium amount once paid offers protection and coverage to the insured. Such a plan will help protect them from any challenge that a person might face due to their health condition.

In today’s time, a single health insurance plan is not enough for an individual. You might be thinking- So why not purchase another similar policy?

The answer to that is, the policies are expensive and, so many people hardly cope up to pay the premiums for one such plan. And so, it is not possible to buy many health insurances for securing one person or family.

For such a financially challenging situation, the other two important items to be aware of:

  • Top-up Plans
  • Super Top-up Plans

Before delving into these topics, one shall know the meaning of the term “Deductible.”

Usually, the deductible amount means the sum chosen by the insured that is committed to be contributed by the insured in case of any medical emergency. If the total expense is below the deductible cost selected by the insured, there will be no claim made by the insured.

For example, D has taken a policy of Rs.100,000. He chooses the deductible amount as Rs.20,000. After a gap of 10 months, he falls ill. Due to frequent fevers, D feels the need to go to a hospital and get admitted. D was cured within two days as there was nothing serious. The hospitalization bill received is Rs.18,000 that is lesser than the deductible amount. In the case, D cannot claim any reimbursement from the insurance company and the entire cost will have to be borne by him.

A top-up plan is an instrument that protects a person or rescues a person when the medical insurance of that person crosses a deductible amount or will be completely exhausted. A top-up insurance plan covers only one claim for the same disease/illness for which the patient has bought admission earlier. This policy applies to a single hospitalization. While purchasing such a plan, the person has to choose a deductible amount.

For example, A person is admitted three times in a hospital for more than 24 hours but, the hospitalization bill is lesser than the deductible amount chosen by oneself, later it will not be allowed to claim for coverage from the top-up health insurer.

Super top-up insurance plans

Super top-up insurance policy adds coverage to one’s existing insurance plan. This addition is done only after paying an additional premium. Such insurance provides additional coverage above the hospitalization policy. Unlike Top-up insurance plans, Super-top up grant claims on more than one or multiple hospitalizations in one year.

Who needs super top-up insurance plan?

  1. Senior citizens need super top-up plans because the older they get, the greater the health risks.
  2. A corporate providing group health insurance purchases such an offer as they are well aware that the plain vanilla coverage offered cannot be sufficient for an employee.
  3. An individual who cannot afford an expensive policy or more than one health insurance purchases such a plan.

Why do you need such a plan?

  1. Enjoy the benefits of tax exemption according to the value of one’s plan.
  2. Get extra coverage by paying a low premium.
  3. Secure oneself from future medical inflation
  4. Extend other benefits such as health check-ups, no claim bonus, and more.

Premium and coverage:

The Premium charged for a super top-up insurance plan is low compared to the amount one needs to pay for a separate health insurance plan. The insurance plan allows a person to pay the premium for such a policy in installments or lump-sum.

A super top-up policy comes into the picture only when the deductible amount chosen by the insured is exhausted. The coverage of this plan expires only when the base policy is exhausted. Health insurance and top-up insurance covers only one claim of a disease/illness caused. However, in super top-up health insurance, one can file numerous claims as long as the overall amount covered is exhausted.

What is covered under super top-up health insurance?

Covered: 

  1. Pre and post-hospitalization.
  2. Room rent capping.
  3. Annual health check-ups.
  4. Ambulance charges.
  5. Cashless facilities.
  6. Day care procedures.
  7. Pandemic situations.

What is excluded?

  1. Self-harm inflicted
  2. War-like situations.
  3. Sexually transmitted diseases.
  4. Injuries caused due to participation in adventurous or risky sports/activities.
  5. An individual helping to defend the country.

Important points to be covered while purchasing a super top-up insurance policy.

  • Doctor’s recommendation – If a person is suffering from a particular illness/disease and the doctor recommends him/her to take rest for 15 days. But instead of that, the person gets himself admitted to a hospital. In such a case, the insurance company has the full right to reject the claim.
  • Congenital abnormality expenses – They are also called birth defects that have been in the person’s body since birth. An insurer does not incur any cost unless the insured is hospitalized.
  • Base plan – Even though a super top-up plan is purchasable directly without existing health insurance. It is preferred to have a base plan as it helps cover the deductible amount.
  • Benefits – To purchase such a policy, an individual does not need to pay high premiums as this offer is affordable. An individual can get treated at any hospital, as most of the super top-up plan providers have a hospital network with almost all hospitals, helping one enjoy the benefit of cashless hospitalization.
  • Eligibility – the insured can claim if he/she has been hospitalized for a minimum period of 24 hours. There is no maximum entry age. An individual of a minimum of 6 years of age can be eligible for such a plan. A newborn can receive coverage under a floater plan after 91 days of birth. A person purchasing such a policy after 45 years of age needs to undergo a medical check-up.
  • Insurer – The insured has an option to buy a super top-up insurance plan from any such policy provider. It is not mandatory to purchase the same from the existing insurance company. Although the insured is open for advice to take the additional coverage from the same insurer as the waiting period for receiving a super top-up plan can be adjusted with the waiting period of the base plan.

Deductibles

And finally, while choosing the deductible amount, one shall be very careful while making such a decision and only make the decision under proper guidance. If a person has a base plan, this amount is deductible from the same. If a person does not have a base plan, then the chosen deductible amount will have to be paid by the insured. The amount of deductible varies as per the plans. It is determined based on single or multiple claims.

FAQs: Facts About Super Top-Up Insurance Policies

How does super top-up health insurance work?

Super top-up insurance plan is the additional coverage an individual can receive at a lower premium. A super top-up insurance plan is cheaper than purchasing additional health insurance cover.

For example, you have a base plan of INR 5 lakhs (which is also the deductible amount) and have purchased a super top-up plan for additional INR 8 lakhs. In a medical situation, you are admitted to a hospital. While discharging, you received a bill of INR 7 lakhs. In such a case, the base plan will be entirely exhausted after paying INR 5 lakhs, the balance amount will be paid by the super top-up insurer of INR 3 lakhs. If you are admitted to a hospital for the second time and as your base plan has exhausted, the bill amount for the second time hospitalization will be payable by the super top-up insurer.

What’s the catch with super top-up insurance plans?

The only catch with super top-up insurance plans is the deductible amount chosen by the insured. To select the deductible amount, one shall calculate it correctly. An individual shall also take professional advice to decide the right deductible amount. To understand what the exact catch is; let’s consider an illustration.

You have purchased a base plan of INR 3.5 lakhs (that is also the deductible amount) and a super top-up plan of INR 5 lakhs. Due to a medical emergency, you are admitted to a hospital. After getting cured, while being discharged, you receive a bill of INR 2.5 lakhs. The insurance company grants the claim amount of INR 2 lakhs, on the grounds of sub-limit. In such a case, with the bill not being charged above the deductible amount, the insured cannot claim for the super top-up insurer to pay the balance of Rs. 50 lakhs.

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