Voluntary Top-up In Group Health Insurance

Group health insurance policies that a company provides to its employees come with many additional options. One of those additional options is a voluntary top-up. It is an option that an employer offers to the employees so that they can enhance their group health insurance coverage in case they are not satisfied with the existing one.

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The Aspect of Voluntary Top-up

Companies purchase group health insurance plans for their employees with a particular set of coverage at a particular amount of sum insured. The insurer also put a disease-wise capping that put a limit on the coverage amount for any particular disease and its treatment.

In this case, if the billing amount exceeds the capping amount then the employee has to pay the rest of the amount out of pocket. In order to provide a solution for this problem, the employer offers an option of voluntary top-up where the employee can extend the sum insured amount and widen the coverage for a better facility.

Need Of Voluntary Top-up Option

The standard coverage base amount provided by the company in a group health insurance is usually Rs 2-3 lakh and the top-up provided by the insurer is Rs 2 lakh. There are times when companies offer critical illness cover as add-ons

However, witnessing the rise in inflation every year that is 12-18% the coverage of Rs 3 lakh with a Rs 2 lakh top-up does not seem adequate. With the top-up option provided to the employees get a hold of their group health insurance plan and opt for the top-up so that they do not have to pay for the exceeded billing amount at the time of claim.

Case Scenario

Rahul is an employee of a big organization that offers a group health plan with a sum insured of Rs 5 lakh. The organization gives him an option of a top-up policy with the same amount of sum insured and a deductible of Rs 5 lakh.

This would make the total sum insured Rs 10 lakh and the policy will only trigger when the claim amount is greater than the deductible amount which is Rs 5 lakh. So if Rahul raised a claim for any specified treatment in the policy and the claim amount exceeds Rs. 5 lakh, the top-up policy will come in handy and provide the additional coverage required and Rahul will not have to pay out of pocket.

Sample Program for a Company

Management Level

Base GMC SI

Top up Policy SI

Voluntary Deductible

Total Coverage Amount

Junior Management

2 Lac

5 Lac

2 Lac

7 Lac

3 Lac

5 Lac

3 Lac

8 Lac

5 Lac

10 Lac

Middle Management

7 Lac

10 Lac

7 Lac

17 Lac

8 Lac

10 Lac

8 Lac

18 Lac

10 Lac

20 Lac

Senior Management

12 Lac

15 Lac

12 Lac

17 Lac

13 Lac

15 Lac

13 Lac

18 Lac

15 Lac

30 Lac

*Data mentioned in the above table is for reference purposes only. It can vary from company to company.