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What Should My Policy Cover If I Purchase Top-Up Health Insurance?

Health insurance is a great way to protect yourself from unexpected and long medical bills. It thus covers your needs during a health emergency. As much as having a health policy is essential, it is equally vital to have sufficient coverage. Although you might take measures to opt for an adequate sum insured that suits your needs and budget, there may be times that you still run short.

When hospital bills exceed your health insurance coverage, you may have to pay the overhead costs from your pockets. However, there are a few ways to solve this situation.

First, opt for a higher sum insured, which means you pay a huge premium. Second, look for comprehensive health insurance policy that may cover various illnesses and procedures like dental insurance, LASIK coverage, vaccination coverage, etc. Lastly, opt for top-up or super top-up plans.

The article below will discuss health insurance top-up policies in detail.

 What is a Medical Top-up Policy?

A top-up plan is additional coverage over and above your base health insurance plan. If you exhaust the sum insured of your base policy, you can get additional coverage with a top-up health policy. A health insurance top-up policy works almost the same as your regular policy, except it comes with a lower premium.

For example, you buy a health policy of ₹5 lakhs for an annual premium of ₹8,000. However, later you feel that the coverage isn’t adequate. Now, if you consider increasing the existing ₹8 lakhs, the premium amount would also increase to around ₹12,000. Instead, if you opt for a top-up plan, with a premium of ₹1,000 for every 1 lakh of top-up, you would get the extra ₹2 lakh cover for ₹2,000, that is, an annual premium of ₹10,000.

 Health Insurance Top-up Policy v/s Super Top-up Policy

To understand the difference between top-up and super top-up plans, let us look at the below table:

Situation Policyholder A (base plan of ₹3 lakh + ₹5 lakh top-up plan) Policyholder B (base plan of ₹3 lakh + ₹5 lakh super top-up plan)
Claim 1: ₹3 lakh Covered by the base health plan Covered by the base health plan
Claim 2: ₹1 lakh Policyholder has to pay the entire amount as the claim does not exceed the cover amount of the health insurance plan. Hence, top-plan will not be applicable. Super top-up plan will cover the claim. In case of multiple claims in a year, super-top up plan covers for the additional amount once the base plan is exhausted.
Claim 3: ₹4 lakh The top-up plan will cover ₹1 lakh since the amount is ₹1 lakh over the base plan. The super top-up plan will cover the entire amount.

 Which Medical Expenses Are Covered under Medical Top-up Policy?

Top-up plans may vary from one insurance provider to another. Here are a few health expenses covered under most top-up insurance plans.

  • Pre and post-hospitalisation expenses
  • In-patient hospitalisation expenses
  • Room rent expenses
  • Organ donor expenses
  • Emergency ambulance charges
  • Daycare procedures
  • Domiciliary treatment expenses

 Things to Remember While Purchasing a Health Insurance Top-up Policy

Now that you know this plan’s importance, consider the points below before purchasing a health insurance top-up online.

  1. Know the benefits available: Since you buy a top-up plan to expand your coverage, ensure it covers the illnesses or benefits you seek.
  2. Deductible limit: Health insurance top-up plans come with a deductible limit, an amount a policyholder must pay at the time of claim. The higher the deductible, the lower the premium. Ensure you choose a wise deductible amount.
  3. Waiting period: Top-up plans have a certain period during which you cannot initiate a claim. This period would vary based on the insurer and the plan.
  4. Co-payments and sub-limits: Your policy may have a sub-limit to specific illnesses and treatments; ensure your top-up plan does not include a sub-limit. Even if it does, make sure it is minimum. Similarly, check for co-payment clauses too.
  5. No-claim bonus: You are eligible for a premium discount on your regular health insurance policy for every claim-free year. This is called a No-Claim Bonus (NCB). However, this benefit does not apply to top-up plans.

 Wrapping Up

Top-up plans in health insurance are a great way to expand your insurance coverage. Apart from enhanced coverage, they are affordable and can also be easily convertible into a regular insurance plan at the time of renewal. However, it would be best to buy a health insurance top-up online after understanding its coverage, exclusions and terms and conditions to avoid any disappointment at the time of the claim.

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