A top-up cover becomes effective after you have exhausted the sum insured on your basic mediclaim
policy. You need to choose a deductible for your top-up policy - the amount that you will have to pay out of your own pocket, or which your basic policy will pay for. The top-up policy will only pay for an amount above the deductible limit.
Super top-up plans offer a better deal than top-up plans. A top-up plan gets activated only when a single claim amount exceeds the deductible amount. Suppose that you have a top-up cover with a deductible of Rs 200,000. You fall ill twice during the year, and each time your hospitalisation bill comes to Rs 150,000. In such a scenario, your top-up plan will not get activated. If the hospital were to present you with a single bill of Rs 225,000, then your top-up plan would get activated and you would be reimbursed for Rs 25,000.
You can take care of this gap in a top-up policy by opting for a super top-up plan. With this plan, even if you were to get two separate bills of Rs 150,000 (so that the total during a year comes to Rs 300,000), the super top-up policy would reimburse you for Rs 100,000.
A top-up plan has limited cover for pre and post-hospitalisation expenses. But super top-up plans provide coverage of pre- and post-hospitalisation expenses, day care procedures, and pre-existing diseases after a waiting period of three years, just like basic insurance plans.
To opt for a super top-up plan, you do not need to have a basic health insurance policy. You can pay the deductible amount out of your own pocket.
Instead of buying a top-up or super top-up plan, you can also enhance the cover of your basic policy. But this is an expensive approach. "Premiums of top-up and super top-up plans are much lower than those of basic health covers since they come with a higher deductibility, and hence insurance companies consider them to be less risky," says Anand Roy, executive director and CMO, Star Health and Allied Insurance.
For a 40-year-old, HDFC's Health Suraksha, a basic insurance plan, with a sum insured of Rs 750,000 charges a yearly premium of Rs 9,172. On the other hand, HDFC's super top-up plan with a sum insured of Rs 700,000, and having a deductible of Rs 300,000 charges a yearly premium of Rs 2,207. "Buying a basic health cover and supplementing it with a top plan is the prudent way to combat rising health care costs in a cost-effective way and avoid out-of-pocket expenses," says Harjot Singh Narula, founder & CEO, ComparePolicy.
When buying a super top-up plan, you need to undergo a medical check-up only if you are above 55. "People who are about to enter the senior citizen category and have a limited sum insured in their basic mediclaim
policy should opt for super top-up plans to get higher protection," says Rakesh Jain, executive director and CEO, Reliance General Insurance. Premiums paid for super top-up plans are eligible for income tax deduction under Section 80D.