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Insurance Article

5 Things to Look for in Your Health Top-Up Plans

August 08 2016

A health top-up plan provides the financial backup you needed after your base plan is exhausted. For example, if your incur medical expenses of ₹7 lakhs, and your base plan covers only ₹4 lakhs, the remaining ₹3 lakhs will be covered by your top-up plan.

When opting for enhanced health coverage, consider if you want to opt for a top-up or a super top-up plan. Post carrying a cost-benefit analysis of both types of plans, you also need to consider the following factors before opting for a supplementary top-up.

1. Sufficient Benefits

Check whether the benefits in the plan provide sufficient coverage for various types of treatments you foresee. There is no point paying higher premiums if the plan won't cover you enough for the treatments when you need it the most. Reset Benefit is one of the crucial features that will provide enhanced coverage.

2. Deductibles

Deductibles are the most important aspect of any top-up plan. These plans come into effect after the medical expenses exceed the deductible limit, hence choose your limit wisely. Insurers follow the rule of 'higher the deductible lower the premium'. However, it doesn't make sense choosing a high deductible that will never kick in. The deductible of the top-up or super top-up should be close to the sum insured of your primary health insurance policy.

Another important thing to look for is the structure of your plan.

Example:

If your single medical claim is for ₹6 lakhs with a ₹3 lakh deductible, you will have to pay the deductible amount while the difference will be paid by the standard top up cover. But if you have two claims of ₹2 lakhs and ₹3 lakhs in a year, they won't be payable under a standard top-up plan as each of these claim amounts don't exceed the deductible limit. This is where a super top-up plan is beneficial, as it covers the aggregate claims in a policy year. In the above case you will have to pay the first claim of ₹2 lakhs from your pocket since the amount is less than the deductible amount. For the second claim, you will have to pay just ₹1 lakh and the super top up plan will cover the remaining amount. Therefore, you need to decide whether cumulative deductible (super top-up) or single incidence (standard top-up) plan is suitable for your needs.

3. Coverage

You can purchase an individual plan if you don't have any dependents. Family floater plan is ideal for married individuals with kids. A separate senior citizen plan can be taken for your parents, if they have crossed 60 years of age. It reduces the outgo as floater plans consider the maximum age of a person, which can significantly increase costs. Ultimately, the city you live in also determines the coverage for these plans.

4. Pre-existing Disease Cover

Your base plan might not cover for pre-existing diseases; hence it makes sense if your supplementing top-up plan has pre-existing disease cover. This cover is beneficial if you are prone to certain illness due to family history. It usually has a waiting period, or is dependent on renewal.

5. Sub-limits

Sub-limits can restrict the extent of coverage of your policy. It can limit claim amounts with respect to room rent, donor expenses, doctors' and operation theatre charges. There are various sub-limits on specific types of surgeries and treatments. Make sure your super top-up plan does not have any sub-limits, if it has, make sure it is as least as possible.

Co-payment is another type of sub-limit in the plans. It is a fixed percentage of bill you will have to pay while claiming. This percentage usually varies around 10-20%.

Be clear about these aspects before purchasing a top-up. Check for words like co-pay, limits and deductible in your policy wordings. A free-look in period provided by insurers will also help clarify some of the inclusions and exclusions in the policy.

Additionally, features like Daily Hospital Cash, Domiciliary Expenses, Emergency Ambulance and other benefits, which are secondary in usage, can also be considered.

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