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Top Up health Insurance and Mediclaim Policy Cover

Just like you carry a spare tire or a Stepney in your car as a stand-by, you can buy a top-up health insurance plan. It will offer you the desired protection in case the sum assured amount of your current medical insurance policy gets exhausted.  To help you extend your threshold limit without affecting your budget, many insurance providers have come up with health insurance top up plans like- Apollo Munich, Bajaj Allianz, HDFC ERGO, etc.

It is a kind of an additional coverage offered by health insurance providers to aid you while you are out of your maximum insurance limit. Let’s take an example and understand–

If your current policy has a sum assured limit of 5 Lakh and you get a top-up plan of Rs. 7 Lakh. Once your existing sum assured is exhausted then you can use your top-up plan. So, if you have registered a claim of Rs. 8 Lakh then your basic sum assured of Rs. 5 Lakh will be used and the remaining Rs.3 Lakh will be used from your top-up plan. And if the claim you file is more than 12 Lakh then the remaining amount shall be paid from your own pocket.

Top up medical insurance plans are affordable and more economical than the basic health insurance. These can also be taken along with the health coverage provided by your employer. A lot of individuals get confused considering top-up and the riders as the same. Actually, health insurance companies top up plans are only the indemnity schemes with a regular cover.

If you feel that your existing medical policy may not suffice, then you can buy a top-up plan. It will offer additional sum insured to help you cope up with unforeseen medical emergencies.

Advantages of Top-up Health Insurance Plan

  • Even if your current health insurance policy gets exhausted while filing a claim, you can still feel and enjoy your peace of mind as you are covered for the remaining duration.
  • Option to enhance your policy coverage while renewing your current policy.
  • You can buy a Top-Up Plan even if you don’t have a basic medical policy

However, it is suggested that you get a health insurance plan with a sum insured amount equal to the deductibles.

Features and Benefits of Top-up Health Insurance Plan              

  • Easily convertible to a basic health plan
  • If both the parents are covered then you can include your children in the same plan
  • No restrictions and sub-limits are applicable on hospitalization expenses like fees charged by the medical practitioner, room rents, doctor fees etc.
  • A family discount is also provided in some plans. This includes the policyholder, spouse, dependent parents and children up to a specified limit. Parents will be covered in a separate family floater plan
  • Avail cumulative bonus on the sum insured for every claim-free year ( up to a specified percentage )
  • There is a free-look period of 15 days from the date of policy purchase
  • Policy can be issued for a period of 1 to 2 years (depending on the insurer)
  • No pre-medical screening required up to a specified age
  • Lifelong renewability option is provided
  • Tax Benefits on the insurance premium paid under section 80/D of the Income Tax Act

What is covered in a Top-up Health Insurance Plan?

The coverage varies from one insurance provider to another. But usually, you can avail the following benefits:

  • Compensation for in-patient hospitalization expenses including nursing and boarding charges s, room rent charges, doctors’ fees, OT charges, cost of oxygen, prosthetic devices or implantation of any other equipment during surgery, blood, diagnostic procedures, and other similar expenses
  • Pre-hospitalization expenses 60 days prior to hospitalization
  • Post-hospitalization expenses to be covered 90 days immediately after hospitalization
  • Daycare procedures that do not require hospitalization for more than a day
  • Organ donor expenses cover in some plans
  • Emergency ambulance expenses to be covered up to a specified limit
  • Some insurers also provide a cumulative bonus at the time of policy renewal
  • Domiciliary treatment expenses, as suggested by the doctor

What Does a Top-Up Health Insurance Plan Offer?

Health insurance top-up plans cover almost all the hospitalization expenses. But do not mix them with a rider benefit.  Rider benefits like personal accident cover, hospital cash, critical illness etc. cover only a few major illnesses. You can purchase a rider plan only with a base plan; however, you can buy a top-up plan irrespective of the base plan.

Basically, top-up health insurance is like an indemnity plan, which provides the same benefits as a basic reimbursement health insurance plan.

The only difference is the cost of deductibles that make these plans easy-on pocket. Moreover, in a top-up plan, pre-medical screening is not required up to the age of 55 years. And, in most of the other basic health insurance policies, it becomes mandatory after 45 years of age.

If your basic plan reaches the threshold, the claim for both top-up and individual health plan can be filed together. And you can easily both of them simultaneously from different insurance providers, who will be liable to pay off the part of their claims.

When Should You Use a Top-up Health Insurance Plan?

Usually, a single hospitalization cover is provided in top-up health insurance plans.  Your top-up plan comes in to play when your hospital bill exceeds the deductible limit (during the hospitalization).

So, if you make two claims in a year of Rs. 1 Lakh and 2 Lakh, and your top-up plan have a threshold limit of Rs. 3 Lakh, then it will not be triggered and same is the case in a family floater plan where two members are hospitalized and the hospital bill comes out to be Rs. 2 Lakh each.

In case the illness is relapsed within 45 days of discharge then it will be considered as a single illness. And if there is re-hospitalization after 45 days of discharge; then it will be counted as a fresh illness.  Simply put, you can only avail the benefits of a top-up health plan if the deductible limit is crossed.

How to Select a Top-Up Health Insurance Plan?

If you are looking for an affordable plan, then you can opt for higher deductibles. You need to consider that while buying extra coverage, there is no duplication of the actual benefits.

And, exclusions like daily cash allowance and the dental cover shall not make a huge difference as they may be covered by your regular health insurance policy.

However, do not forget to check the waiting period in regard to the pre-existing health conditions, coverage for pre- and post-hospitalization expenses; deductible criteria pertaining to single illness, maternity cover etc.

Also, check if the plan offers coverage to your family members including parents, spouse, and children. At times, it can be discouraging to know it when you are actually filing a claim.

To Conclude!

Definitely, top-up medical insurance plans will help in filling the gap between actual hospitalization and your ongoing policies.  And a top-up medical policy is a feasible option for people who are covered under an individual health insurance policy or a group health insurance policy.

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