Top Up Health Insurance Policy: Inclusions Under Health Insurance Top Up Plans & Their Types
A top-up health insurance policy provides additional financial coverage over someone’s existing health insurance plan or employer mediclaim policy. People buy top up health insurance to get additional coverage after exhausting the sum insured of their regular policy.
This reduces the insurer’s risk factor, making health insurance top-up plans a cost-effective way to increase health insurance coverage.
Let’s dive into the details of various features, benefits, inclusions and exclusions of top up medical insurance plans in India.
How Do Top Up Health Insurance Plans Work?
As mentioned above, a top-up health insurance plan works as an additional medical coverage over an already existing policy. However, note that a top-up features voluntary deductibles. Meaning, you will get coverage only upon paying the voluntary deductibles.
Let us understand the working of top up plans with an example:
Suppose your existing health insurance plan comes with a sum insured of Rs. 5 lakh. On top of that, you purchase a top up health insurance policy worth Rs. 10 lakh. Now, if you register a claim of Rs. 12 lakh with your insurer, then the basic sum insured amount of Rs. 5 lakh will be initially used. Following this, you will receive the remaining Rs. 7 lakh from your top up plan.
However, in case you raise a claim of more than Rs.15 lakh, note that you will have to pay the excess amount from your own pocket.
Also read: Deductible in Health Insurance: What Is It and How Does It Work?
Features and Benefits of a Top Up Health Insurance Plan
- The policy term can be one year to two years, depending on the insurer’s terms and conditions.
- Top up medical insurance policies provide financial backup over the threshold limit, keeping your expenses low.
- Insurance providers could offer high coverage with health insurance top up plans at low premium costs subject to terms and conditions.
- Some of these policies provide discounts when more family members are added.
- You can get increasing bonuses for every claim-free year, according to the terms and conditions of the chosen policy.
- Top up medical insurance plans can offer cover against pre-existing illnesses if you have a standard insurance policy covering the same.
Also read: Should you buy health insurance on EMI?
What Expenses are Included and Excluded in a Health Insurance Top Up Plan (Updated 2022)?
Inclusions of health insurance top-up plans
Hospital bills
This can include doctors’ fees, diagnostic tests, nursing and boarding charges, implants, prosthetic devices, OT (operation theatre) fees, etc. among other eligible expenses.
Pre and post hospitalisation expenses
Top up health insurance policies could cover eligible medical expenses around 30 days prior to getting admitted to a hospital. Depending on the insurer, these plans could also cover expenses for up to 60 days after discharge.
Daycare procedure
Some insurers provide coverage for daycare procedures that do not require patients to get admitted.
Health check-ups
With some policies, one can avail of free yearly health check-ups for themselves and covered family members.
Ambulance charges
Emergency ambulance coverage is provided up to a certain limit by some insurers under top-up plans.
Organ donor
Some plans also cover organ donor expenses.
Home treatment
Some top-up policies also cover home treatment expenses suggested by a doctor.
Exclusions under Top Up Health Insurance Plans
- Top up medical insurance plans do not cover medical expenses until they cross a certain deductible. For example, let’s assume a policyholder has a standard insurance plan with a coverage limit of Rs.4 lakh and a top up health plan of up to Rs.8 lakh with Rs.4 lakh deductible. If he/she makes a claim of Rs.6 lakh, the top up plan will provide compensation of Rs.2 lakh. However, if the expenses are at, say, Rs.3 lakh, the insurer will not be able to use the top-up plan as that is below the deductible limit (of Rs.4 lakh) and can be claimed against the standard health policy.
- Top up health insurance policies cover only a single hospitalization incident, not multiple cases.
- Many health insurance top up plans do not cover medical treatment arising out of adventure sports, cosmetic surgeries, war and self-inflicted injuries.
Also read: All you need to know about dental insurance coverage and benefits in India
Types of Top Up Health Insurance Plans
Typically, there are two types of top up health insurance plans. Both these plans vary depending upon the applicability of deductibles. Find details about them below:
- Regular top up plans
This plan offers additional coverage by applying a deductible on each insurance claim. The deductible in this plan is kept equal to that of your existing health insurance policy. In this type of top-up plan, the deductible applies on individual hospitalization or a per claim basis. In simple words, the plan only covers a single claim that falls above the threshold limit.
Thus, if your hospitalization bill does not exceed the deductible, you will not receive a claim settlement.
The following table summarizes the working of regular top-up plans:
| Factors | Without a top up plan | With a top up plan |
| Sum insured of the base plan | Rs. 5 lakh | Rs. 5 lakh |
| Top up amount | Nil | Rs. 10 lakh |
| Overall sum insured | Rs. 5 lakh | Rs. 15 lakh |
| Threshold limit | Nil | Rs. 5 lakh |
| 1st claim during a year | Rs. 9 lakh | Rs. 9 lakh |
| Amount the insurer pays | Rs. 5 lakh | Rs. 9 lakh (Rs. 5 lakh from base plan and Rs. 4 lakh from the top up plan) |
| Amount you pay | Rs. 4 lakh | Nil |
Note that a regular top-up plan works on a per claim basis. Thus, the deductible limit will be applicable for each claim and not the overall medical expenses during a policy year. In simple words, the top up plan will become active only when your medical expenses cross the threshold limit.
- Super top up plans
The only difference between regular top up plans and super top up plans is that the latter works on the total medical expenses that a policyholder incurs during a year rather than on a per claim basis.
Specifically, regular top up plans only provide coverage for a single claim which surpasses the threshold limit. Meanwhile, super top up plans cover the overall medical claims during a policy year which exceed the threshold limit.
Refer to the table below for a detailed explanation of super top up health insurance plans:
| Factor | Without a top up plan | Regular top up + base plan | Super top up + base plan |
| Sum insured of basic plan | Rs. 5 lakh | Rs. 5 lakh | Rs. 5 lakh |
| Sum insured of top up or super top up plan | Nil | Rs. 10 lakh | Rs. 10 lakh |
| Threshold limit | Nil | Rs. 5 lakh | Rs. 5 lakh |
| 1st claim during a policy year | Rs. 9 lakh | Rs. 9 lakh | Rs. 9 lakh |
| Amount that the insurer pays | Rs. 5 lakh | Rs. 9 lakh (Rs. 5 lakh from base policy and Rs. 4 lakh from regular top up plan) | Rs. 9 lakh (Rs. 5 lakh from base policy and Rs. 4 lakh from super top up plan) |
| Amount you pay | Rs. 4 lakh | Nil | Nil |
| 2nd claim during the policy year | Rs. 5 lakh | Rs. 5 lakh | Rs. 5 lakh |
| Amount the insurer pays | Nil | Nil | Rs. 5 lakh |
| Amount you pay | Rs. 5 lakh | Rs. 5 lakh | Nil |
Thus, a super top up for health insurance plan offers extensive coverage and enhances your policy’s sum insured amount.
What Does a Top Up Mediclaim Offer?
Mediclaim top-up plans cover almost every medical expense covered by one’s standard health insurance plan. Its facilities can include hospital-related expenses, health check-ups, medicine bills, cashless medical claims and more, depending on the features of the chosen policy and the terms and conditions of the chosen insurer
However, higher deductibles could make a top up insurance plan a low-cost method to increase insurance coverage. Deductibles refer to a portion of the claim that has to be paid by the insured person before the insurance policy takes effect. Since the primary insurance products take up most of the claims, companies can provide additional benefits at affordable costs for health insurance top up plans
Also, you may not need to undergo check-ups for up to 55 years of age to apply for these policies, depending on the terms of the policy. Policyholders can also claim both their individual health policy and top-up plan at the same time from different insurance providers.
Also read: What Is Third Party Administrator’s (TPA) Role in Health Insurance?
When Should People Opt for Top Up Health Insurance Plans?
You can buy top up health insurance policies to increase your insurance protection coverage up and over your existing health policy. Such a policy would provide a single hospitalisation cover once medical expenses cross the deductible limit up to the maximum sum insured.
These types of plans are also recommended for senior citizens, as regular health policies are likely to charge a relatively higher premium for plans with a high sum insured due to the increased risks. People with a family floater plan or pre-existing medical conditions can also opt for health insurance top ups for increased coverage at affordable premiums.
Tax Benefits under Top Up Health Insurance Plans
When you purchase a top up for a health insurance policy, you become eligible to obtain tax benefits. Specifically, under Section 80D of the Income Tax Act, you can claim a tax deduction of up to Rs. 25,000 each financial year on payment towards health insurance premiums. This limit is applicable for health insurance plans purchased for yourself, your spouse, children or parents.
Moreover, if you, your spouse or parents are above the age of 60, the deduction limit goes up to Rs. 50,000.
In addition, this section also mentions the scope of availing tax benefits for preventive health checkups. The deduction limit under such circumstances is Rs. 5,000 per financial year.
How To Select the Best Medical Insurance Top Up Plans In 2022?
Before buying a top up for health insurance, consider the following factors:
Plan type
There are two types of top up health plans- i) regular top up and ii) super top up plans. The former is applicable only on a single claim basis. For the latter, the deductible applies for multiple eligible claims in a policy year.
Deductible
Experts generally recommend people to buy a top up plan having a deductible amount equal to or lower than the coverage amount of a base insurance policy. Meaning, if your base health plan has a coverage of Rs.5 lakh, your top up plan should ideally have a deductible equal to or lower than Rs. 5 lakh.
Waiting period
Check the waiting period with regards to pre-existing health conditions to ensure you can avail the benefits.
Family floater coverage
Some health insurance top up plans provide coverage to family members, including spouses, parents and children. This is a very cost-effective way to increase your health insurance policy’s coverage.
Steps to Raise a Top Up Health Insurance Claim
Raising a claim for your top up medical insurance online is extremely convenient. You simply need to follow these steps:
For cashless claims:
Step 1: Search a network hospital where you want to seek treatment
Step 2: Inform your insurer within 48 hours, in case of emergency hospitalisation and before 3 days, in case of planned hospitalisation
Step 3: Show the health insurance documents at the hospital
Step 4: Fill up the pre-authorisation request and submit it at the hospital
Step 5: Wait for approval from your insurer, which usually takes a few hours
Following this, your claim will be processed depending on the terms and conditions of the policy.
For reimbursement claims:
Step 1: Inform your insurer about the hospitalisation and pay the medical bills at a hospital of your choice
Step 2: Submit the required documents to your insurer within 15 days of discharge from the hospital
Step 3: Upon reviewing your documents, your insurer will either approve it or reject it
Upon approval, you will receive the reimbursement in your bank account. If your request is rejected, you will be informed about the same.
Download the Navi Health Insurance app to get a flexible policy that covers you and your family up to Rs. 1 crore. Given are some more reasons to buy top up health insurance from Navi.
Convenient cashless facility
Our cashless facility can be claimed in just 20 minutes and is available in over 10,000 hospitals in more than 400 locations in India.
Completely digital process
There’s no need for tedious paperwork or lengthy inspections. You can get a health card or raise claims with a click of a few buttons.
Fully transparent policies
We ensure 100% transparency with no hidden clauses.
Comprehensive coverage
Besides your hospital fees, our insurance policies also cover pre and post-hospitalization expenses up to a certain number of days.
Also read: A Quick Guide to Employees’ State Insurance Scheme
Steps to Buy a Top Up Health Insurance Plan
A top up health insurance plan indeed provides added coverage benefits to policyholders. The steps to buy top up health insurance are extremely simple and convenient. Simply follow these steps:
Step 1: Visit the health insurance section of your preferred insurer and navigate to the top up health insurance section
Step 2: Click on apply now and fill in the application form with the necessary details
Step 3: A representative will get in touch with you regarding the policy details and required documents
Upon this, you will receive your top up health insurance policy.
Final Word
People buy top up health insurance to cover expensive medical bills over the amount paid by regular policies. This keeps them financially secured for emergencies, especially if they have a history of medical conditions. Top up plans offer the much-required financial safety net in times of need in a cost-effective manner.
FAQs on Top Up Health Insurance Policy
Ans. Yes, a top up health insurance plan will cover pre-existing diseases if your base insurance policy also provides coverage for the same. Moreover, some insurance companies also drop the waiting period on pre-existing diseases if you purchase a top up health insurance over your base plan.
Ans. The primary point of difference between top up plans and super top up plans is that the former provides coverage benefits only till the threshold/deductible limit. On the other hand, the latter provides coverage benefits beyond the threshold limit.
Ans. Top up health insurance policies come into play when someone makes a claim over his/her base policies. It only covers the claim amount above a threshold limit, called the deductible.
Ans. Yes. As the insurer carries fewer risks due to the deductible clause, top up plans could have lower premiums compared to base policies with a high coverage amount.
Ans. Yes. Just like other health insurance policies, you can get tax deduction benefits under Section 80D of the Income Tax Act, 1961, for the premiums paid towards a top up health plan in a policy year. People below 60 years of age can get deduction benefits of up to Rs. 25,000 while senior citizens can get rebates up to Rs.50,000.
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Disclaimer: This article has been prepared on the basis of internal data, publicly available information and other sources believed to be reliable. The information contained in this article is for general purposes only and not a complete disclosure of every material fact. It should not be construed as investment advice to any party. The article does not warrant the completeness or accuracy of the information, and disclaims all liabilities, losses and damages arising out of the use of this information. Readers shall be fully liable/responsible for any decision taken on the basis of this article.
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