Top Up Plans: An Additional Benefit For Health Insurance Coverage

An Additional Benefit For Health Insurance Coverage

It is often seen people worry about their health insurance plans whether they are enough to cover some serious emergencies, critical illnesses, or family health insurance plans as medical emergencies can never be predicted and medical inflation is at a continuous surge. Either people spend on separate policies for each member or prefer buying multiple policies but in both scenarios, the cost of health insurance comes relatively higher and unaffordable. Therefore, Top-Up plans play a pivotal role to get sufficient coverages for health and affordability.

Top-Up plans are designed as a helping tool to manage unexpected excessive medical expenses ensuring there is a sufficient budget for the emergency in case the existing policy is exhausted or becomes insufficient and there is enough money to take care of the medical needs of each family member in case of family floater plan.

The Top-Up plans can be availed along with the existing insurance plan and also with group insurance plan as they tend to be limited for an individual and families. Such plans play a pivotal role of additional add-on cover but perform to be more than just a rider as they are limited in roles. Instead of ensuring coverage for a particular thing such as accidents, hospital bills, or critical illness, the benefit of the Top-Up plan is that it takes care of all expenses almost all the hospitalization expenses, unlike riders which cover only a few major illnesses. Moreover, a rider plan can only be availed with a base plan; however, a top-up plan works regardless of the base plan.

The premium of a top-up plan is decided based on the sum insured, deductible and age of the insured which means the higher the deductible, the lower the premium or vice versa. These plans can be availed with any nature of health policy by just providing basic required details. Plus, in a top-up plan, various health insurance service providers don’t have a mandatory health screening up to the age of 55 years which makes it quite convenient to buy for seniors as well.

Multiple features & benefits of Top-Up Plans such as

  • No cap on the restrictions and sub-limits applicable on hospitalization expenses, for instance, room rent, doctor fees, etc.
  • Family concessions are available in some plans which involve policyholder, spouse, dependent, parents, and kids but only up to a specified limit.
  • Free-look period for 15 days from the date of policy issued.
  • If both parents are covered in the same plan then children can also become a part
  • A life-long renewability option is available
  • Tax benefit on the insurance premium paid under section 80/D of the income tax.

Top-Up Plans generally come with deductibles which makes them affordable. Deductibles are the cost-sharing requirement by the health insurance company. Simply, deductibles are the fixed amount borne by the insurance company regardless of hospitalization claims within the policy period.

Deductibles help the health insurance companies share the cost with the policyholder. When a policyholder buys the super top-up health insurance plan, he has the option of choosing a specific deductible amount.

There are two types of Top-Up Plans:

  • Regular Top-Up Plans
  • Super Top-Up Plans

While the regular Top-Up plans’ benefits are the same as above but with deductibles as where it is calculated on each hospitalization.  

Super Top Up health plans is those where the threshold limit is applied to the total expenses spent during the policy tenure. It allows the policyholder to claim multiple times in a financial year despite the base sum insured is exhausted and with paying deductible amount only one time. It also covers pandemic-led diseases. 

Thumb Rules to buy Top-Up Plans

In the presence of a standard health policy, a top-up is required to be affordable and economical, hence always go for a higher deductible to have a cheaper top-up plan. The logic behind this is to take off the extra cover without duplicating the actual benefits at an affordable price.

It is highly suggested to check the waiting period clause of pre-existing illnesses, deductible criteria in case of a single illness, maternity cover, coverage for pre & post-hospitalization expenses and others.

Last but not least, it is required to check if the top-up policy provides coverage for family members such as spouse, children, parents and etc.

There are various companies offering top-up or super top-up plans but there are very few which are providing good plans of these sorts. Aditya Birla Health Insurance has one innovative plan named Aditya Birla Activ Assure Diamond+ Super Top-Up Health Plan is a super health plan plus top-up plan which adequately covers the policyholder and its insured family members during any critical health emergency with medical expenses up to 1 crore.

This includes daycare procedures, in-patient hospitalization expense, emergency assistance services domestically and internationally, and man more.

Another is Care Enhance Health Super Top-up Plan by Care health insurance that offers extra safety net coverage to the basic health insurance plan. This gives the freedom to choose the deductible along with the desired sum insured to enhance their basic coverage during emergency health conditions.

Care Enhance Health Super Top-Up doesn’t ask for a pre-policy medical check-up (for deductible amount and sum insured amount) less than 40 lakhs, till the age of 50 years. This plan offers an add-on cover of “Expert Opinion”, wherein the policyholder is eligible to get a second opinion from the specialist medical professional.