Under base health insurance policies, the claims are paid upto the sum insured limit opted whereas under super top-up plans, the claims are paid only if the claim amount exceeds beyond the deductible option opted for.
Super top-up plans available in the market consider aggregate of the claims per policy year and not a single hospitalisation. It is beneficial to take super top-up health insurance given growing medical inflation and increasing healthcare cost. Also, selecting higher sum insured under base health policy may not be an affordable option for all, as premium for high sum insured will be on higher side for higher age. Hence, a good option is to buy a super top-up health insurance plan that can offer additional coverage which is beyond the threshold or maximum limit of existing health insurance policy. These policies are available with various deductible options ranging from Rs.1 lakh to Rs.10 lakh with sum insured limits of Rs.2 lakh to Rs.20 lakh or even more and also the premium charged is reasonable.
Ms. Keswani had a major operation for which she submitted claims worth Rs.9 lakhs. Her insurance policy had a threshold limit of Rs.6 lakhs and when her colleague asked how she would manage the rest of the expenses, Ms. Keswani said that she has a top-up plan.
A regular health insurance policy has a sum insured limit, beyond which it does not cover any expenses. This is when a top-up policy is useful, it becomes effective soon as the sum assured from a health plan is exhausted. Therefore, Ms. Keswani can claim the balance amount of Rs.3 lakhs from her top-up health cover. So essentially, she has a top up plan with a deductible of Rs.6 lakhs.
However, top up covers have restrictions on pre-existing diseases, pre and post hospitalization expenses, and some providers might exclude certain conditions from their plans.
A super top up comes to the rescue when a single claim does not cross the threshold limit of the regular policy, but multiple claims do. Thus, if Ms. Keswani submitted two different claims of Rs.4 lakhs and Rs.5 lakhs respectively, the top up plan would be useless since none of them exceed Rs.6 lakhs individually.
Her regular health plan would reimburse the first claim completely and give her Rs.2 lakhs for the second one. If Ms.Sood had a super top up plan, then all her claims would be reimbursed as it considers the total of all the bills submitted.
Even if Ms. Keswani submitted two claims of Rs.7 lakhs and Rs.2 lakhs each, the top up would not have covered the entire expense. It would have reimbursed Rs.1 lakh on the first claim and dismissed the next as it does not exceed the deductible. A super top up would be useful as it would take into account the total amount.