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Insurance Article

Face Off: Health Insurance Super Top-Up vs Top-Up

August 26 2016

There are some key differences that make super top-ups highly beneficial.

Inflation and demand for specialty healthcare have led to a rise in basic medical expenses. In case of hospitalisation and a claim, one often realises that while having a complete health insurance policy was a great financial decision, the sum assured was a constrain. It is often noted that rising healthcare costs render the cover insufficient.

Thankfully, you can avoid such a situation by opting for either a top-up plan or a super top-up plan. In some cases, a third alternative is to opt for an additional policy. However, for most cases, a top-up is the ideal way ahead as it enhances the sum assured of your base plan to cover the shortfall. Let us learn more about Top-Ups and Super Top-Ups:

Top-Up Plans

The Top-Up allows you to make a claim that exceeds the deductible value & the sum assured of the base policy during a single hospitalisation. All claims are treated individually in this cover and multiple claims under the same policy period are not aggregated. The deductible is the limit set in your policy schedule.

Super Top-Ups

A Super Top-Up pays claims for cumulative medical expenses within a policy year once it exceeds the deductible and the sum assured of the base policy. It offers coverage not payable by your top-up or base plan. Such a plan can be availed from any insurer and is not limited to your base policy insurer.

While both top-ups kick in only after the claim amount exceeds the deductible and the sum assured of the base policy, the difference lies in its working. The illustration below will help you better understand how both these plans are beneficial.

Situations Top-Up Cover Super Top-Up Cover
Policies Mr. Sharma has a base health insurance of ₹5 lakhs sum assured.
In case he buys a Top-up plan of ₹10 lakhs with ₹5 lakhs as the deductible In case he buys a Super top-up of ₹10 lakhs with ₹5 lakhs as the deductible
Case 1: Single claim of ₹12 lakhs Health Insurance plan will cover ₹5 lakhs. Top-up plan will cover the remaining ₹7 lakhs as it exceeds deductible. Health Insurance will pay ₹5 lakhs. Super Top-up will cover the remaining ₹7 lakhs as it exceeds deductible.
Case 2: Two claims of ₹4 lakhs each Health Insurance will cover for the ₹4 lakhs of first claim and ₹1 lakh of second claim. There will be no claim pay-out from Top-up Plan, as the individual amount of the claim does not exceed ₹5 lakhs. Health Insurance will cover for the ₹4 lakhs of first claim and ₹1 lakh of second claim. Super Top-up will cover the remaining ₹3 lakhs.
Case 3: Claim of ₹7 lakhs and ₹4 lakhs Health Insurance will pay ₹5 lakh from first claim Top-up Plan will pay the remaining ₹2 lakhs for the first claim. No claim is payable for second claim as it does not exceed the deductible limit. Health Insurance will pay ₹5 lakh from first claim Super Top-up will cover the remaining ₹2 lakhs for the first claim and ₹4 lakhs for the second claim.

How to decide?

Both of these plans have their own benefits. In the long run, a super top-up plan is a cost-saver and offers coverage for wide range of illnesses. It is especially beneficial for senior citizens who have frequent medical expenses that can be covered due to cumulative coverage. However, factors such as your premium outgo, budget and medical history should be considered before opting for either plan.

ICICI Lombard offers Super Top-Up called Health Booster for your medical needs. Click here to learn more about its features.

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