Aarti Khanna, 33, a Gurgaon-based software developer, had a medical insurance cover worth Rs 1.5 lakh from her employer. She met with an accident a few months ago and had to be hospitalized. The treatment for her recovery cost the same, around Rs 1.5 lakh, but she had to pay Rs 50,000 from her own pocket, despite having a corporate health insurance cover.
What most employees don’t realise is that corporate medical insurances generally do not cover the entire expense in case of a major disease or accident. This leaves them partially without an insurance policy. To get full coverage, one should buy additional coverage on their own, apart from the one provided by their employer. Instead of opting for a basic health plan, depending on your requirements, you can alternatively opt for a top-up or a super top-up plan.
Top-ups and super top-ups are like supplementary health plans that complement an employer’s existing group health policy or individual policy. Top-ups and super top-ups are available for both individual and family floater health plans. According to industry experts, enhancing a basic policy is an expensive approach as compared to buying a top-up plan. As these top-up plans come with higher deductibility, the premiums are also lower than basic health covers.
Here is how both top-ups and super top-up plans differ;
With limitations such as co-payments, exclusions of a certain disease, corporate health covers (the one provided by the employer) come with various restrictions. Their coverage also varies from year to year.
According to experts, opting for a basic health cover and combining it with a top-up, or just opting for a top plan along with a corporate cover is an ideal way to avoid the rising health care costs and paying from your own pocket.
This way once you have exhausted the sum insured of your basic health cover, the top-up cover can come into play. With the top-up cover, you need to choose a deductible for it while buying the policy. This is the amount that you have to pay either from their own pocket or using your basic health policy before the top-up cover activates. The amount that goes above the deductible limit, is paid through the top-up plan.
Comparatively, super top-up plans offer a better deal in contrast to top-up plans. A top-up plan gets activated when a single claim amount exceeds the deductible amount. However, in the case of the super top-up plan, a single claim amount need not exceed the deductible amount, two or more separate bills are also considered as one expense.
For instance, if your top-up cover has a deductible of Rs 1 lakh, and in a year, you produce two hospitalization bills of Rs 70,000 and Rs 80,000, the top-up plan will not get activated. For the top-up plan to get activated, you would need to produce a single bill of Rs 1.5 lakh, to activate the top-up plan. Only with a combined bill, you will be reimbursed the extra Rs 50,000.
On the other hand, in case of a super top-up plan, produce two separate hospitalization bills of Rs 70,000 and Rs 80,000, a total of Rs 1.5 lakh in a year will get the policyholder the reimbursement of Rs 50,000.
Additionally, with top-up plans, policyholders get limited cover in terms of pre and post-hospitalization expenses. With the super top-up plan, both pre and post-hospitalization expenses, daycare procedures, and pre-existing diseases (with a waiting period) are all covered. With super top-up plans, the premiums paid are also eligible for income tax deduction under section 80D.