Top-up Health Insurance Plans provide an effective way to enhance your existing health insurance coverage without the need for buying an entirely new policy. Medical emergencies can result in substantial expenses, and even a comprehensive policy may fall short in covering all costs. Here, Top-up plans act as a financial cushion, offering additional coverage at an affordable cost once your base policy's limit is exhausted. In this article, we’ll explore how Top-up Health Insurance Plans work, what makes them valuable, and why they are a smart choice for expanding your health insurance coverage.
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There are two types of top-up health insurance policies in India. Here are the details.
The top-up insurance plan provides insurance coverage by replenishing the sum insured up to a certain amount. Once the medical expenses cross the deductible limit, the top-up plan gets activated.
Super top-up plan provides additional insurance coverage after the medical costs exceed the threshold limit. While the top-up plan considers the threshold limit/deductible for every claim, the super top-up plan considers all the claims put together in a policy period.
In both plans, if the illness relapses within 45 days of discharge from the hospital, it is usually considered a single illness. However, if the illness relapses after 45 days from discharge, it is generally considered a fresh illness.
A Top up Mediclaim Insurance Policy is an add-on policy that provides additional coverage once your existing health insurance or a pre-defined deductible limit is exhausted. Simply put, it kicks in when the total medical bills exceed a certain threshold.
For example, if you have a top-up plan with a ₹5 lakh deductible and your medical bills exceed this amount, the top-up plan will cover the expenses beyond ₹5 lakh.
A Super Top-Up Health Insurance Plan works similarly but with an added benefit. Unlike a regular top-up plan, which applies the deductible to each individual claim, a Super Top-Up Plan covers all claims in a policy year once the total claim amount exceeds the deductible limit.
This is particularly useful if you anticipate multiple claims in a year. For instance, if you have a ₹5 lakh deductible and make three claims of ₹3 lakh each, a regular top-up plan wouldn’t cover anything, but a Super Top-Up Plan would cover the amount above ₹5 lakh cumulatively.
| Factors | Super top-up plan + Base Plan | Without a top-up plan (Base plan) | Top-up plan + Base Plan |
| Base plan sum insured | Rs. 5 lakhs | Rs. 5 lakhs | Rs. 5 lakhs |
| Top-up/Super top-up plan sum insured | Rs. 10 lakhs | NA | Rs. 10 lakhs |
| Threshold/deductible limit | Rs. 5 lakhs | NA | Rs. 5 lakhs |
| 1st claim of the year | Rs. 8 lakhs | NA | NA |
| What the insurer pays | Rs. 5 lakhs (base policy) + Rs. 3 lakhs (super top-up policy) | Rs. 5 lakhs | Rs. 5 lakhs (base policy) + Rs. 3 lakhs (top-up policy) |
| What you pay | Nothing | Rs. 3 lakhs | Nothing |
| 2nd claim of the year | Rs. 4 lakhs | NA | NA |
| What the insurer pays | Rs. 4 lakhs | Nothing | Nothing |
| What you pay | Nothing | Rs. 4 lakhs | Rs. 4 lakhs |
Imagine you have a base health insurance policy of ₹3 lakh and a top-up plan with a deductible of ₹5 lakh. If your medical expenses amount to ₹6 lakh, the base policy will cover the first ₹3 lakh, and the top-up plan will cover ₹1 lakh (the amount above ₹5 lakh). You’ll need to pay the rest (₹2 lakh) out of pocket. Top-up plans are perfect when you expect medical expenses to exceed your base policy but don’t want to pay for a high sum insured on your base plan.
Here is a table explaining top-up plans in detail:
| Factors | Top-up plan | Without a top-up plan (Base plan) |
| Base plan (Sum insured of the base health policy) | Rs. 5 lakhs | Rs. 5 lakhs |
| Top-up plan | Rs. 10 lakhs | NA |
| Total sum insured (Base plan + top-up plan) | Rs. 15 lakhs | Rs. 5 lakhs |
| Threshold limit | Rs. 5 lakhs | NA |
| 1st claim of the year | Rs. 8 lakhs | NA |
| What the insurer pays | Rs. 8 lakhs (Rs. 5 lakhs from the base plan and Rs. 3 lakhs from the top-up plan) | Rs. 5 lakhs |
| What you pay | Nothing | Rs. 3 lakhs |
Here are a few reasons why buying a Top-up plan is a good idea.
Top up plans offer higher coverage at a much lower premium than buying a new health policy.
Instead of increasing your base policy sum insured (which increases your premium), you can simply buy a top-up plan.
In case of severe medical emergencies or hospitalisation, top-up plans ensure that you aren’t left with out-of-pocket expenses.
A Super Top-Up Plan is ideal for the following people:
Individuals with an existing health insurance plan who want extra coverage for unforeseen large medical bills.
Families with multiple members, as the plan covers multiple claims in a year.
Senior citizens or those with pre-existing health conditions who may require frequent hospitalisation. A dedicated top up health insurance for senior citizens can cater to their needs in a timely manner.
Best Features of a Top-up Health Insurance Plan are mentioned below to get a better understanding of how a top-up health plan actually works and how you can get the best value out of it:
Let us assume you have a health cover of Rs 5 Lacs. After a serious road accident, you are left in a state of coma and require various surgeries. Thankfully, you make a recovery, but your hospital bill stands at Rs 8 lacs when you get discharged. Where are you going to get the extra Rs 3 lacs from? This is why you need the top up health insurance plans. Such a plan offers a sum Insured over and above the sum insured of the base health plan. So you can make a claim on your top up plan for the remaining amount after you clear a part of the bill with the claim from your base plan.
As mentioned above, the top-up health insurance plans are only used as a backup and not as the primary cover. You, therefore, need to note here that you can only make a claim when the bill is above a certain amount. This is the deductible component, which is normally the sum insured of your base plan. So if your deductible is Rs 2 lacs, you can only make a claim if the bill is above Rs 2 Lacs. If the bill is Rs 1,80,000 then the base plan will take care of the expenses and you cannot raise a claim against the top-up plan.
Cheaper than a new plan: Many people wonder why they need to buy the top up health insurance plans and not go for a higher limit on their base plan. Well, the biggest reason for choosing a top-up health insurance policy is its cost. These plans are available at very low prices. You can get a top-up cover for Rs 10 lacs for a premium of just about Rs 3000. This is very cheap and it makes it affordable for most people.
There is no compulsion that you have to buy the plan from the same insurer who sells you the base policy. The medical insurance in India rules, permit you to get a top-up cover from a different insurance provider. If you are not happy with your existing health insurer’s service, you can get the top up cover from some other company. You must do your research and look for the best top-up plan from the best possible insurance provider out there.
These are some of the most fascinating features of top-up medical insurance India. As you can see, there are some very handy benefits that these plans have on offer.
Most Top up Health Insurance Plans cover the following.
Expenses for room rent, doctor’s fees, surgery, etc.
For a specified period before and after hospitalisation.
Treatments that don’t require an overnight stay.
Expenses for ambulance services during emergencies.
While top-up plans offer great benefits, they also have exclusions. Here are some common ones.
These may have waiting periods before coverage kicks in.
Non-medical procedures like cosmetic surgery are not covered, unless medically recommended because of an injury.
Most top-up plans don’t cover maternity costs.
Items like consumables and registration fees are generally excluded.
Selecting the ideal top-up health insurance plan requires careful consideration of various factors to ensure that it complements your existing health insurance effectively and provides adequate financial protection in times of need. Here are key aspects to consider when choosing a top-up plan:
Before choosing a top-up plan, evaluate your current health coverage to identify any gaps. Consider factors like your family's medical history, potential health risks, and the existing sum insured. The top-up should adequately cover these gaps without duplicating what your primary insurance already provides.
Research the insurer's market reputation for trustworthiness and reliability. Look for reviews and ratings from current policyholders, and consider how long the company has been in business. A reputable insurer will have a track record of prompt and fair claim settlements.
The top-up plan's coverage limit should be high enough to cover significant medical expenses beyond your base policy. Also, assess the deductible amount—the portion of the claim you need to pay before the insurer pays—to ensure it's financially feasible for you. The deductible should ideally match or exceed the sum insured of your base policy.
Compare the cost of the top-up plan with the additional coverage it provides. Top-up plans are generally more affordable than increasing the sum insured under a primary health policy, but prices can vary significantly between insurers.
Check if the top-up plan offers flexibility in terms of increasing the insured amount or including additional family members later. Also, consider if the policy is portable, allowing you to switch insurers without losing the benefits if you are dissatisfied with your current provider.
Effective customer support is essential, especially when dealing with health insurance claims. Evaluate the insurer's customer service efficiency and availability. Customer support should be accessible, responsive, and helpful, particularly during emergencies.
Carefully review the exclusions and the waiting periods for pre-existing conditions or specific treatments. Understanding these can help you avoid surprises during a claim.
Some top-up plans offer extra benefits like maternity coverage, vaccination coverage, or international treatment for critical illnesses. Consider these additional benefits if they align with your personal or family health care needs.
Here are some popular top up plans to consider:
Allows the benefit of getting the entire claim amount (after the set deductible) without deducting non-medical expenses and registration costs, etc. This plan also includes coverage for pre-existing diseases from day 01.
Offers a higher sum insured and better coverage options for individuals and families.
Provides a cashless facility at network hospitals and covers major medical expenses.
Comes with attractive features like a wide network of hospitals, no pre-medical tests up to a certain age, and coverage for AYUSH treatments.
Includes high coverage, OPD consultations, and cashless treatment at over 6,000 hospitals.
Here is why you should get a Super Top-up or a Top-up health insurance plan.
There is no denying that healthcare costs are rising daily. This means you need a comprehensive health insurance plan that offers a higher sum insured amount than a regular health insurance plan. The plan should also have the option to include a Top-up or Super Top-up plan that gives you an advantage when the sum insured amount has been exhausted.
Top-up plans (regular or Super Top-up) would not exist if there was no need for a higher sum insured amount. These plans offer you coverage over and above the base policy or a corporate health insurance policy at a much lower premium than individual health plans.
You get extensive coverage at a much lower health insurance premium with a Top-up plan.
Compared to the regular health insurance plans, Top-up and Super Top-up plans provide additional coverage during unforeseen emergencies.
Similar to other types of health insurance plans, Top-up and Super Top-up plans come with tax-saving benefits.
A top-up or super top-up is an excellent cost-effective method to ensure you are covered during uncertainties.
Eligibility criteria vary between insurers, but generally the following people are eligible.
Most plans are available for individuals aged 18 to 70. Some plans may extend beyond 70 years.
Depending on your age and health, some insurers may require a pre-policy medical test.
Top-up plans offer that extra edge at a lower premium when the sum insured is exhausted. Here is the role that top-up plans play in senior citizen health insurance policies.
Buying health insurance top up online is easy, here are the steps.
When you need to make a claim during or after a medical emergency (depending upon the type of claim you choose) follow these steps.
Notify your insurer about the claim as soon as possible.
Provide necessary documents like hospital bills, discharge summaries, and diagnostic reports.
First, claim from your base health policy. Once the deductible is crossed, you can claim from your top-up plan.
Follow up with the insurer to ensure a smooth process.
Top up health insurance plans are a cost-effective way to enhance your health coverage, especially when you anticipate high medical costs. Whether you're looking for extra protection or want to avoid paying a higher premium on your base policy, a top-up or super top-up plan can be a smart financial move for you and your family.
Here are some commonly asked questions about top-health insurance.
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