All about Top Up Health Cover Products

Written by Vidya Kumar

July 9, 2014

Policy Name

HDFC Ergo Health Surakhsa Top Up

Apollo Munich Optima Plus

Bajaj Allianz Extra Care


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Medical Costs are rising in our country. It is imperative to have a health insurance plan. You should review it and decide whether it is enough. If it is not, you can consider Top Up and Super Top Up plans which provide cover above a certain threshold level. We have compared some of these health plans here.

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You already have health insurance for yourself and your family. That is good but have you thought whether it is enough? Medical costs in India are on a rising trend be it medicines, hospitalization or specialized doctor visits. Moreover as you grow older, health insurance becomes more expensive.
How can you increase your medical cover in this scenario? Buying Top Up health covers and Super Top Up plans are ways to improve your medical cover. Let us see what these products are all about –

1. Top Up Health Insurance Plans –  Top Up Insurance plan covers medical costs beyond a threshold point known as deductible. For example if you have a top-up insurance plan of Rs. 3,00,000 with a deductible of Rs.1,00,000, the insured will have to pay Rs. 1,00,000 either from his own pocket or use an existing medical cover. The rest of the amount up to the maximum cover will be covered by the top-up plan. So if your existing medical cover is less, you can supplement it with a top-up plan which might work out cheaper as their prices are lower. The price is lower because of the deductible. Number of claims is lesser and these plans do not have to cover claim amounts below the threshold level set. 
Here is a comparison of some Top Up Insurance Plans –


Age Eligibility

91 days to 65 Years. No limit on age for renewability
91 days to 65 Years. No limit on age for renewability
90 days to 70 years. No limit on age for renewability

Sum Assured

Rs. 2,00,000 to Rs. 10,00,000
Rs. 5,00,000

Rs. 10,00,000, Rs. 12,00,000 and Rs. 15,00,000

Premium for 1 year.

Rs 3,037 for a Rs 5 lakh sum insured and deductible of Rs 2 lakh  
Rs. 1049 for a Rs 5 lakh sum insured and deductible of Rs 2 lakh
Rs. 2500 for sum assured of Rs. 10,00,00 and deductible of Rs. 3,00,000

Family Floater Option Available

Yes
Yes
Yes

Pre and Post Hospitalization

Coverage for medical costs incurred 60 days before hospitalization.

Coverage for medical costs incurred 90 days after hospitalization.
Coverage for medical costs incurred 60 days before hospitalization.

Coverage for medical costs incurred 180 days after hospitalization.  

Coverage for medical costs incurred 60 days before hospitalization.

Coverage for medical costs incurred 90 days after hospitalization. 

Special Features

You can avail a family discount if 3 or more family members are covered under individual plans.
Waiver for deductible between the ages of 58 and 60.
If medical test is required, 50% of expenses will be reimbursed.

Pre-existing Medical Conditions

There are waiting periods depending on illness, number of times policy is renewed etc.
The pre existing diseases will be covered after waiting period of 3 years 
The pre existing diseases will be covered after waiting period of 4 years 

Comments

It is a good top up plan to have especially if you have a regular health plan from HDFC Ergo but it is expensive compared to other top up plans.
It is only for a fixed sum. The waiting period can be adjusted accordingly if you have a regular health policy. But it is not helpful if you want a higher cover.
The sum assured is on the higher side and the deductible starts at Rs. 3,00,000. So you should consider this policy only if the probability of  major hospitalization expenses is high.

Top Up plans cover one claim at a time.  If you have a top up plan with a deductible of Rs. 2,00,000 and you get hospitalized twice in a year and each time you spent less than Rs. 2,00,000, the top up plan will not get activated as each time the expenses were within the threshold. The medical expenses cannot be combined to take advantage of the Top Up plan.

There are Family Floater versions of Top Up plans as well. Here again, the total of all hospitalization expenses is not taken into consideration for the Top Up plan claim to get triggered. For example if a person has taken a Family Floater Top Up Plan with a deductible of Rs. 3,00,000 for him and his wife and both get hospitalized with each bill coming to Rs. 2,00,000, the claim cannot be processed. Even though the total is higher than the threshold, the individual expenses are within the deductible. Here is where Super top up plans play a role.

2. Super Top Up Health Insurance Plans – They consider the aggregate bill amount.  So in the earlier example of the family floater insurance plan, the Super Top Up plan with a deductible of Rs. 3,00,000 would have covered the total amount of the two bills which comes to Rs. 4,00,000  (higher than the deductible).
Here is a comparison of Super Top Up Insurance Plans

Policy Name
L&T Medisure Super Top Up
United India Super Top Up
Apollo Optima Super
Age Eligibility
18 years to 65 years and  can be renewed lifelong.
18 years to 80 years and can be renewed lifelong.
5 years to 65 years. If the parent is covered under the policy,dependent child will be covered from the age of 91 days. There is no maximum age limit on renewals.
Sum Assured
Rs. 3,00,000 – Rs. 20,00,000
Rs. 3700 per year for policy of Rs. 5,00,000 with Rs. 2,00,000 deductible-Rs. 3258
It is available for a sum assured of Rs. 5 lakh, Rs. 7 lakh and Rs.10 lakh.
Premium for Rs. 10,00,000 for an individual of 35 years with deductible of Rs. 5,00,000 for 1 year.
Rs. 1236
Rs. 4157
Rs. 2781
Family Floater Option Available
Yes
No
Yes
Special Features
An assurance of service response within 6 hours for a cashless facility is given if intimation is received during working hours on a working day and within 8 hours on a holiday or non-working hours. A fixed compensation of Rs 1000 will be given if they fail.  
Relapse of medical condition leading to re-hospitalization within 45 days of previous hospitalization is considered as part of first hospitalization.
It can be converted to a normal health plan with almost zero deductible between the ages of 55 and 60 if needed. Apollo Munich offers health related counselling sessions for those covered under this plan.
Pre-existing Medical Conditions
They will be covered after 3 continuous years of renewals.
They will be covered after 4 continuous years of renewals.
They will be covered after 4 years of buying the policy. Some conditions like cataract, joint replacement surgery, hernia are covered after 2 years.
Comments
It is a good plan to have if you  think your health cover is inadequate or that the top-up plan will not satisfy all your claims. There are some discounts available as well. 
It is slightly expensive and the customer service in United India leaves a lot to be  deserved.
The Optima Super Plan is cost effective. The customer can convert it to a normal health plan during a certain phase. It is good plan to buy if one wants increased  health coverage.


Top Up and Super Top Up plans are useful only if your health insurance is inadequate or you think you will incur huge hospitalization expenses. If your health plan is very negligible, then it is better to increase the cover of the regular health plan. If feasible, it is better to buy a top-up plan from your regular health insurance provider as claims processing will have to be done only with 1 provider.

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