Super Top up Mediclaim – Do You Need It?

Medical expenses are increasing day by day. Healthcare inflation is 20% which is much more than the overall inflation. You have to be prepared for the medical emergency and hospitalization. Though a large chunk of investors rely on the health insurance provided by their employer, you need to have separate health insurance to cover those expenses.

Even if the medical expenses are increasing day by day the people who have health insurance are of average cover of Rs 2 lakhs. This cover certainly to be increased and the best way of increasing the cover is to buy a top up/ super top up health insurance policy.

Top up Policy:

A top up health insurance plan is an additional health insurance plan to a regular or existing individual health insurance. It is applicable for single hospitalisation. If the limit of regular existing health insurance exceeds top up plan triggers for a single time. It is not applicable for multiple claims under the same policy period.

Super Top up Policy:

Super top up mediclaim is applicable for more than one hospitalization. When the threshold limit or maximum limit of a health insurance exceeds in a particular year, this super top up health insurance triggers and pay you up to the maximum coverage under this policy.

Top up vs Super Top up:

The basic difference between a top up medicaliam and super top up mediclaim are that the top up mediclaim is applicable for single hospitalization case whereas super top up one is applicable for multiple cases. Hence, super top up mediclaim is more flexible compare to the other one.

Let’s discuss the difference between a top up and a super top up health insurance in the following table. Consider the regular health insurance as Rs 3 lakhs and Rs 5 lakhs as top up and super top up as the respective cases.

Description Top Up Plan Super Top Up Plan

Remarks

Scenario:1

A single bill of Rs 2 lakhs

Rs 2 lakhs shall be paid by basic health insurance Rs 2 lakhs shall be paid by basic health insurance Here, bill is not more than the threshold limit of Rs 3 lakhs. Hence, the entire bill is paid by basic health insurance.
Scenario:2

A single bill of Rs 6 lakhs

Rs 3 lakhs shall be paid by basic health insurance

Balance Rs 3 lakhs will be paid by top up plan

Rs 3 lakhs shall be paid by basic health insurance

Rs 3 lakhs will be paid by super top up plan

Here, bill is more than the threshold limit of Rs 3 lakhs in a single case.
Scenario:3

A bill of Rs 4 lakhs and Rs 3 lakhs twice in a year

Rs 3 lakhs will be paid by basic health insurance

Balance Rs 1lakh will be paid by top up health insurance.

In the second case, Rs 3 lakhs will not be paid by top up mediclaim

Rs 3 lakhs will be paid by basic health insurance

Balance Rs 1lakh will be paid by super top up health insurance.

In the second case, Rs 3 lakhs will be paid by super top up mediclaim

In the first case, the second claim i.e. Rs 3 lakhs is generated after the exhaustion of threshold limit at the second time
Scenario:4

A bill of Rs 2 lakhs and Rs 2 lakhs twice in a year

Rs 2 lakhs shall be paid by basic health insurance

Next Rs 2 lakhs will not be paid by top up plan

Rs 2 lakhs shall be paid by basic health insurance

Next Rs 2 lakhs will be paid by super top up plan

In the first case, the second claim of Rs 2 lakhs does not cross the threshold limit hence the top up plan is not applicable.
Now, the question is whether you should consider the super top up mediclaim or not. The followings points to be remembered in this regard.
  1. A top up plan is cost effective and very less cost than the basic or regular health insurance.
  2. The top up policy is applicable for individual as well as family floater mediclaim policy.
  3. The top up policy normally excludes the pre and post hospitalization claim which is generally covered by basic health insurance.
  4. Irrespective of the basic health insurance provider, the top up policy can be bought. As an example, you have bought a regular health insurance from National Insurance and you can buy top up cover from New India Assurance.
  5. The pre-existing diseases are not applicable for the top up cover also in line with the basic cover which generally excludes the pre-existing diseases. Though some insurance providers insist for a check-up before issuing a top up cover.
  6. You can get the tax benefit also under section 80D for taking top up cover.
Should I take the super top up cover?

As I said earlier, the medical cost is increasing day by day at an exponential rate. Hence, it is inevitable to have higher health insurance cover for all of us. Now, there are two ways of increasing the cover. One is to increase the cover under regular health insurance and another is to buy a super top up health insurance.

Super top up cover is obviously a cheaper one but it has some disadvantages also. You have to claim from more than one provider and hence, dealing with two insurers may not be easy for you. The super top up does not give you the advantages of cashless facility in all the cases.

If don’t want to pay higher premium and still want the higher cover for yourself and family, go for a super top up mediclaim.

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