Super Top Up Policy – 6 Factors to be considered while buying

On May 5,2021 Gujarati Midday a daily newspaper by Jagaran group has published my article on Super Top Up Policy under Health Insurance. The article image is here for the ones who can read Gujarati and translation of the same in English is after the image for the readers, clients, friends and family.


Super Top-Up Health Insurance Policy


In the times of rising medical costs there are Super Top Up policy by most of the insurance companies which acts as an additional cover to your existing health insurance and provides wider health protection for you and your family. In case of higher expenses due to illness or accidents, Super Top Up policy takes care of the additional expenses. It is important to consider the fact that with rising inflation the health insurance cover may not be adequate, at the same time buying a large insurance cover may not be affordable.


A Super Top-up is an extension you can buy on your existing (or new) base health insurance cover. A Super Top up starts paying after you have exhausted your base-plan amount (called the deductible).This policy can be from the same insurance company where your base plan is bought or other.


For example, say you have an Rs. 3 Lakhs cover, and want to increase your cover. You can buy a super top-up plan of Rs. 10 Lakhs with a deductible of Rs. 3 lakhs. In this case, in a given year your base cover will take care of expenses up to Rs. 3 Lakhs. Once your hospitalization bills in a year cross Rs. 3 Lakhs, the super top-up plan acts as an extension and will cover you for another Rs. 10 Lakhs.


Six factors to consider while buying a Super Top – up Policy :


1) Room Rent Limits – Under a Super top – up policy there would always be specified capping’s which would differ from your base policy. The billing under each hospitalisation is based on the room rent opted for. Most of the super top up plans provide Single Ac room which would be different in each hospital. As there would be category of single Ac room too. The insurer specifies clearly in the policy wordings that they shall only pay reasonable and customary charges, so its important to know exactly how much would we be paid incase of claim.


2) Waiting Period – The pre-existing waiting period of your super top-up policy might be different from the base policy. These are to be kept in mind for covering of pre-existing diseases and also treatment for kidney stone,cataract or any other surgeries.


3) Minimum and Maximum Entry Age – Under a Super top up policy most of the insurer allows entry from 91 days till 80 yrs of age whereas your base health policy shall have a restriction of age in entry. This needs to keep in mind while opting for a super top up policy.


4) Claims on Two Policies – 
When there are two policies in picture Base + Super top up, claim is explained as under with 2 examples-


Situation 1 – We take the above example. Base and Super top Up Policy with same insurer –  Claim of Rs. 5 lacs.
Since the Insurance company is same the full claim of Rs. 5 lacs will be payable under cashless i.e 3 lacs from the base policy and 2 lacs from the super top up.


Situation 2 – We take the above example. Base and Super top Up Policy with different insurer –  Claim of Rs. 5 lacs.
In this situation the claim shall be payable under anyone policy as insurance companies are different. In case the insured opts for availing from base policy then 3 lacs shall be paid from the base policy and the balance Rs.2 lacs shall be paid from the super top-up as reimbursement after the discharge by submitting required documents for claiming under Super top up policy.


5) Network Hospital – If the policy is from a different insurance company, the hospital network that offers cashless facilities might differ from your base-plan. list of hospitals needs to be checked properly.


6) Buying at same time –It is always preferred to have bought your base policy and Super top-up policy at the same date /month so that it would not create any hassles while application processing and at the time of claims too. The deductible in a Super Top-up plan is calculated on a yearly basis. This means, for the super top-up policy to pay claim, the hospitalization expenses should cross the deductible amount during the year.


7) Optional Covers – There are various optional covers like Air Ambulance, Critical Illness, Reduction of waiting period for pre-existing diseases etc. These features would be covered as a standard under your base policy but won’t be covered under super top up policy as they might have to be availed as Optional or a rider cover by paying additional premium.


Top up plans are cheaper as compared to Super top up plans where the features are compromised. So one needs to be aware of feature and process difference between the both before availing them.


Questions – 


Do I need to have a health insurance policy to opt for Super Top Up policy?


Answer – No, you need not. If you don’t have a health policy, you can still purchase a Super Top Up policy. However, in this case you will end up paying the expenses out-of-pocket until you exceed your deductible limit and the Super Top Up sum insured kicks in. Hence, it is ideal to have a basic health insurance policy, however not mandatory.
Can I cover self and my family member under this policy?


Answer – Yes, you can cover self, spouse & children on individual & family floater basis.