When it comes to buying a top-up plan along with a comprehensive health policy, there is a lot of confusion regarding what is a top-up and a super top-up plan. Let us help you decode the differences between the two plans.
Top-up means coverage beyond a certain amount. So, in a top-up policy, if ₹2 lakh is deductible, the top-up policy will start paying after ₹2 lakh, i.e., beyond a certain limit.
For instance, if a company is offering ₹3 lakh cover as a group health policy to its employees, the employee can generally take a top-up plan wherein the deductible is ₹3 lakh because the first claim amount up to ₹3 lakh will be paid by the group policy.
However, there are two types of top-up plans available. One is the basic or regular top-up plan and the other is a super top-up plan.
Basic top-up plan
When you buy a basic top-up plan, the deductible is applied on single hospitalization or per claim basis in a year, i.e., the plan will cover a single claim above the deductible limit. In other words, it means that the deductible is applied to each health insurance claim separately. This way, if any of your first, second, third or any subsequent hospitalization bills do not exceed the deductible limit within a year, the top-up plan will not become active and hence, it won’t help you settle your claim.
Super top-up plan
A super top-up plan covers the total of all hospitalization bills once the deductible is paid. In other words, when the total admissible claims surpass the deductible limit, this plan becomes active for subsequent claims. The deductible is applied to the total admissible claims in one year.
“For instance, assume you have both a super top-up plan and a basic top-up plan with a maximum sum insured of ₹5 lakh (assuming a deductible of ₹3 lakh). Now, say, two claims arise in a year; the first one of ₹1.5 lakh and the second one of ₹2.5 lakh. The basic top-up plan will not help settle both claims because in both cases your health claim did not exceed the deductible limit of ₹3 lakh. However, in the case of super top-up plan, the total of both admissible claims will be considered for the deductible and hence the second claim of ₹1 lakh (claim of ₹1.5 lakh + ₹2.5 lakh) – ( ₹3 lakh deductible) will be paid out to you,” said Sheenu Sehgal, vice president and national head – general insurance, Bajaj Capital Insurance Broking.
The best option
According to financial experts, if you think the risk of being hospitalized is more than once in a year, then you must go for a super top-up plan to cover chronic ailments, etc. The premium amount is very low for basic plus super top-up plans as compared to going for a policy with a higher sum insured.
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