Categories: Insurance Planning

Top Up Health Insurance Plan & Super Top Health Insurance Plan-What are they?

Many of us have employer-provided health insurance. But have you never thought of who will pay the claim amount in case it is more than the sum insured? In such situation, the cheapest options are buying Top Up Health Insurance Plan & Super Top Health Insurance Plan. Let us see how they will be handy in such situations.

Considering the current health cost in India, especially in big cities, it is hard to believe that health insurance coverage of around Rs.3 lakh to Rs.5 lakh is sufficient. Also, many of salaried completely depend on employer-provided health insurance.

#Let us first discuss Top Up Health Insurance Plan.

Top Up Health Insurance plan is a regular health insurance plan. But with certain threshold limit (deductible) to it. For example, if Top Up Health Insurance Plan offering you sum insurance of Rs.10 Lakh with threshold (deductible) limit of Rs.5 lakh. Then any health insurance claim arising more than Rs.5 lakh will be payable by this top up health insurance. Below Rs.5 lakh claim must be settled either by regular health insurance or we have to pay from our own pocket.

Let us say Mr.X has a regular health insurance of sum insured Rs.5 Lakh and a top up health insurance of Rs.10 lakh with a threshold limit of Rs.5 lakh. Suddenly one day due to health issues he got admitted to the hospital. The claim bill amount was Rs.6 lakh. His regular health insurance will pay Rs.5 lakh (as the maximum sum insured is Rs.5 lakh only). Who will pay the remaining Rs.1 lakh? As the claim amount is more than the threshold limit set by top-up health insurance, remaining Rs.1 lakh will be payable by this top up health insurance.

In the absence of any such top up health insurance, Mr.X might be forced to pay the remaining Rs.1 lakh claim amount from his own pocket. I explained the different scenarios of how the regular health insurance and top up health insurance will work in below image.

Now you got an idea of where the Top Up Health Insurance will be handy, apart from regular health insurance plans. If there is more than one claim in a single year, then such top up plan will not be useful, as these top up plans only applicable to one claim per year. If that particular single claim is above threshold limit, then you get the claim amount from top up plans. Otherwise, such top up plans will not be useful.

Here in such a situation, super top up health insurance plan will come in handy.

#Let us discuss Super Top Up Health Insurance Plan.

Super Top Up Health Insurance Plan works exactly like Top Up Health Insurance but with only one difference. In Top Up Health Insurance Plan, there is a limit for a claim in a year i.e. single claim in a year. However, in case of Super Top Up Health Insurance Plan, there is no such limit.

For example, in the last scenario of the above table, if Mr.X has Super Top Up Health Insurance, then the remaining Rs.3 lakh might be settled by this super top up health insurance but not from his own pocket.

Super Top Up Plans will consider the total claim amount in a year. Whatever the amount below threshold limit must be payable either by regular health insurance or from our own pocket. The remaining amount will be payable by super top up health insurance plans. I tried to explain the same in below image.

See from above table where I highlighted the last row with a different colour. Here Super Top Up Health Insurance Plan will come into handy than regular plans or Top Up Health Insurance Plan.

Features of Top Up Health Insurance Plan & Super Top Health Insurance Plan

  • No restriction to have Regular Health Insurance-There is no such restriction that you must have regular health insurance to buy either of these two. If you have regular health insurance, then below the threshold amount will be settled by the regular plans and above threshold claim amount by either of these two.
  • Can buy from different insurers-You can buy regular health insurance from one company and top up plans from a different company.
  • Cheaper than Regular Health Insurance Plans-Due to threshold limit or deductible clause, these plans are cheaper than regular health insurance plans.
  • Both Individual and Family Floater Plans Available-Exactly like typical regular health insurance products, such top up plans will offer you to an individual or to a whole family.
  • Come with regular exclusions-Regular exclusions also applicable to top up plans like existing diseases or dental care. Hence, check out for exclusions in detail.
  • Tax Benefit-Exactly like regular health insurance products, you can claim the tax deduction under Sec.80D of IT Act.
  • Works on reimbursement base-Before settling the claims under top up plans, insurers first check whether the below threshold limit amount of total claim bills paid from a policyholder or not. They will not bother whether below threshold amount is from the policyholder’s own pocket or from his regular health insurance. Then only any dues of above threshold limit settled by top up plans. Hence, you may say that getting cashless benefit from the top up plans is difficult.
  • No NCB (No Claim Bonus)-These plans usually not offer any NCB benefits.

Who can go for Top Up Health Insurance Plan & Super Top Health Insurance Plan?

If your health insurance is negligible and budget is your problem, then definitely you can this of buying Top Up Health Insurance Plan & Super Top Health Insurance Plan. Because they are cheap. But do remember that claim settlement may be cumbersome with Top Up Health Insurance Plan & Super Top Health Insurance Plan. Hence, it is better to increase your cover from the existing health insurance itself.

If you plan to increase your health insurance cover, then first try to compare the premium of top up plans with regular plans. Go for top up plans only in case you feel cheaper than going for regular plans.

Usually, minor claims are more frequent than the huge claims. Hence, you may end up in forgetting the features of such top plans. Hence, make sure that you know the details regularly and it’s applicability.

Few Top Up Health Insurance Plan & Super Top Health Insurance Plan available in market

You may also refer our earlier posts on Health Insurance.

BasuNivesh

View Comments

  • Dear Basuji,
    Can you write an article on various super top plans available as on 2020. This article is old.

    Regards,
    A Bandyopadhyay

  • Dear Sir,

    I have finalised hdfc ergo optima restore for base plan after reading your article on health insurance.

    I was going through super top article and finalised on Apollo munich optima super top up (now hdfc ergo) and Hdfc ergo health surkasha super top up( medicare) .

    I saw that for apollo they are charging around 5300 for 4 lakh deductible and 10 lakhs Sum insured. ( 30 years age bracket floater)
    But in Hdfc ergo health surkasha they are charging 2860 for 4 lakh deductible and 16 lakhs Sum insured.

    This difference is huge if you select age bracket of 60 plus.

    where is catch ?.. i tried to find some but was not successful … can you please tell atleast one major difference for such huge premium difference which is surprising because now they are under same parent company (HDFC Ergo).

    Is it just like they (HDFC Ergo) have just done acquisition and have not revised their underwriting policies for apollo product …

    are the offering by Apollo and hdfc ergo super top plan same or there is any difference.

    Please suggest

    • Dear Vinay,
      We can't question the premium rate. However, both Apollo and HDFC now a same company, you can choose the one.

  • Dear Basavaraj,
    I have basic sum assured 4 lakh from Star Health. Now, I want to top-up for 10 lakh from Star Health, have only 3 option of min. deductible amount of 3 or 5 or 10 Lakhs.
    Now, should I opt for a min. deductible for 3 lakhs or it is better to increase my basic sum assured to 5 lakhs and opt for a min. deductible for 5 itself? Kindly suggest your views. Thanks

  • Hi,
    Kindly clarify my doubt? I have Star Family Health Optima plan for 2A +1C. In that,
    Basic Sum Insured: 4.0 lac
    NCB: 1.35 lac
    Limit of Coverage: 5.35 Lac
    Recharge Benefit: 1.0 Lac
    In this senario should I opt for a super top-up plan with the deductible amount 5.35 Lac or 6.35 Lac?

  • Hello Basavaraj,
    Will the Super top-up plan continue to exist even if the base group insurance plan expires for whatever reason? I have a group health insurance of a 3 lac family floater cover. I am now in a dilemma weather to pick up a fresh new individual policy of around 7 to 10 lacs or should I just go and get a super top plan for the same amount. Any guidance on the same would be greatly appreciated. Thanks in advance.

    • Dear Kevin,
      The co-payment clause in Super Top Up plans in no way related to how you afford your part of co-payment. You can compensate from the base plan or from your own pocket. Better to have one base plan and then a super top up.

  • There is something strange about SUPRA SUPER TOPUP from Liberty Videocon Insurance where their premiums are very low like 60% less on comparing plans (comparing the quote is from policybazaar.com) ? Is there any catch ?

    • Dear Raja,
      They may be reduced the premium just to garner more business. Check for exclusions cautiously.

  • Can I stack up Super Top-Up Plan to reduce the premium ? For (eg) I have my office primary group health plan for 5lakhs and I stack up with first Super Top Up Plan for 10 Lakh sum Insured with 5 Lakh deductible for Rs.7000 and another Super Top Up Plan ( Liberty Videocon Supra Super) for 1Cr with 10 lakh deductible for Rs.1600 which gives a saving of 35% (Rs.5000) premium if I had to take just one 30 lakh sum insured plan with 5 lakh deductible Super Top-Up Plan ?

    • Dear Raja,
      Yes, you can do so. But in case of higher claim amount, then you have to knock different insurers to get the claim settled.

  • Adding to the post below I have also seen in many super top up policies about the deduction amount (which we have to pay from our pocket before the policy comes into effect).
    Example if I am hospitalized and the expenses are 5L.
    My base health insurance would cover me for 3L.
    Apollo super top up says 2L deductible for 5L cover so does that mean I end up not utilizing the super top up policy benefits?
    please help me understand..

    • Dear Shiva,
      Co-Payment is nothing but the amount you pay from the claim bill (either from health insurance or from your own pocket). Hence, in your case buy super top up with co-payment of Rs.3 lakh.

  • Simple yet very effective post.. Thanks..
    I have couple of Questions Sir..
    -Me and my wife are covered under employee health insurance (5L each in individual companies plus spouse cover is also there within the same sum assured)
    -I have take Apollo Optima restore Family floater-3L

    I really feel that this health insurance is not enough and I am thinking about taking a super top up from Apollo again for around 5L(me,spouse and kid).

    First Question-My kid is not covered in the base Apollo Optima restore Family floater,would she be covered under the super top up? (I am thinking negative).
    Second Question-Would it make more sense if I invest to create wealth good enough to negate health insurance super top up or top up?

    • Dear Shiva,
      Base plan is in no way connected to super top-up plan. Hence, you can include your kid in super top up plan. Is it not wise to transfer the risk to someone else (Insurance company) than taking that risk on our head? However, it does not mean that you must not consider to keep aside some amount for emergency corpus (even though you have Health Insurance). Because you will not get 100% of the claim get reimbursed.

  • I want to take a health insurance of Rs.20 lakh. Is it better to take 5 lakh of health insurance or 10 lakh of health insurance with remaining amount in top up? Any better option than this is also welcome.

    • Dear Giriraj,
      You can choose so like Rs.10 lakh base plan and then another Rs.10 lakh super top up with co-payment of Rs.10 lakh.

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BasuNivesh

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