Differences between top-up health insurance vs super top-up plans

A booster to your health insurance policy in the form of a top-up and super top-up health insurance plan comes to your rescue when the sum insured amount is comparatively low. Both these plans increase the sum insured over and above your primary health insurance plan. But, how are the top-up and super top-up health insurance different? Read on to find out.

There are two types of top-up health insurance policies in India. Here are the details.

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 health insurance plan enhances your existing health insurance policy’s sum insured amount. It provides financial coverage after you have utilised the maximum claim amount. When the set sum insured amount is exhausted, it acts as an additional layer of financial protection and backup to your primary health insurance plan.

For example, it was not until 1904 that a spare tyre was added to the car so that if the tyre got punctured, you have the backup in the form of a spare tyre. Top-up plans work in the same fashion as a spare tyre does to the car.

With advancements in healthcare infrastructure and technology, medical costs are always on the rise. Therefore it is essential to have a health insurance plan that comprehensively covers you against all types of medical emergencies. 

When your medical expenses exceed the limit of your base health plan, top-up plans act as a safety net.

The primary health insurance plan covers medical bills up to the sum insured, while a top-up plan provides coverage after the sum insured has exhausted as per policy. Please note, the mandatory deductible is payable as per the terms and conditions of the policy.

For example: Suppose you have opted for a health insurance plan with a sum insured of Rs. 5 lakhs and enhanced the existing plan with a top-up insurance plan of Rs. 10 lakhs. Thus, the total sum insured amount is Rs. 15 lakhs with a set threshold limit of Rs. 5 lakhs.

If your medical bill is Rs. 8 lakhs, your insurer will pay Rs. 5 lakhs from your base plan and Rs. 3 from your top-up plan. Here is the example in a table for your reference.

Note: The top-up plans work on a per claim basis. Hence, the deductible rule will apply for each claim and not the total medical expenses incurred during the policy year. Meaning, only if the claim amount exceeds the deductible limit, the top-up plan will be active. 

Super top-up plans are similar to top-up plans that enhance your health insurance sum insured. However, the difference is that super top-up plans work on the total medical expenses incurred during the policy year and not on a per claim basis. 

Unlike the regular top-up health insurance plan that only covers claims when a single claim surpasses the threshold limit, the super top-up plan covers claims when the overall claims during the policy period are above the threshold limit.

In the recent past, there has been a massive improvement in healthcare infrastructure and pharmaceuticals. This improvement has resulted in an increase in healthcare expenses. Therefore, you must be well-protected with a health insurance plan that has the benefit of a super top-up plan and avoids higher out-of-pocket expenses.

The base health insurance policy covers medical expenses up to the sum insured amount. In contrast, the super top-up health insurance plan provides financial cover after you exhaust the sum insured amount. Similar to the top-up plan, the super top-up plan covers expenses of the cumulative claim amount that exceeds the threshold limit.

For example: Suppose you have opted for a health insurance coverage of up to Rs. 5 lakhs and enhanced the existing plan with a super top-up insurance plan of Rs. 10 lakhs. Thus, the total sum insured amount is Rs. 15 lakhs with a threshold/deductible limit of Rs. 5 lakhs.

If your medical bill is Rs. 8 lakhs, your insurer will pay Rs. 5 lakhs from the base policy and Rs. 3 lakhs from the super top-up plan.

You need to note that the threshold limit is not considered for every claim in the super top-up plans but rather on the total hospitalisation bill during the policy period (cumulative claims). However, in the case of a top-up plan, the plan will only turn active if the medical bill crosses the threshold limit for each claim.

Here is the example in a table for your reference.

Here is why you should get a Super Top-up or a Top-up health insurance plan.

Similar to other health insurance plans, top-up health insurance plans also come with the same eligibility criteria. While the exact details differ between insurers, the following are the main eligibility parameters to buy the top-up and super top-up health insurance policy.

Following are the coverage details of top-up and super top-up health insurance plans depending upon specific coverage offered by an insurer.

Here are the non-coverage details of top-up and super top-up insurance plans depending upon specific coverage offered by an insurer.

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.

Both the plans provide financial support when the medical costs surpass the sum insured limit. While their primary aim is to offer additional financial protection, they differ in terms of coverage. In other words, a top-up health insurance plan will provide financial support for medical costs when your claim crosses the threshold limit. In contrast, a super top-up health insurance plan will provide for medical expenses when one or more claims (during the policy period), put together, crosses the threshold limit.

Here is an example of the differences between top-up and super top-up in health insurance.

The top-up and super top-up health insurance act as a shield that helps if you exceed the limit of the existing base plan. But, both have different benefits.

If you do not suffer from a chronic illness or run the risk of a terminal ailment, you should choose the top-up plan. However, if you have the risk of a chronic disease that may require you to be hospitalised more once, you should choose the super top-up plan.

ACKO is a digital-first insurance company, and most of the transactions are through the digital platform. Whether you want to buy, raise claims, or renew the plan, you can visit our website or mobile app to transact directly with us. Here are some of the key benefits of buying health insurance from ACKO.

Rising healthcare costs means you need to make sure your health policy has your back in times of need. Sometimes, even comprehensive health insurance policies may not be adequate to handle medical expenses. Stay on top of things with top-up or super top-up healthcare plans and ensure you and your family are taken care of during a medical emergency.