What are top-up and super top health insurance plans?
A top-up in health insurance plans offer additional coverage over and above the current health insurance threshold limit that you have.
A super top-up also offers additional coverage in health insurance like the top up but it covers the total of your health treatment bills over and above the threshold limit. Whereas, a top-up only covers one claim above the threshold limit.
For instance, your hospital bill will be paid by your insurer up to a pre-decided sum insured limit. And if you have invested in a top-up, you can avail its benefits only after your hospital bill has crossed that pre-decided amount, say Rs 2 Lakh, so once your bill crosses 2 Lakhs, you can use your top-up health insurance benefits.
PS - A basic health insurance policy and the additional Top-up coverage can be purchased from two different health insurance providers. Although, it is recommended to stick with one insurer to avoid complications and delays in health claim processes.
Why do you need a Top-plan?
Sometimes standard health insurance plans are not sufficient enough to pay all your medical treatment bills, investing in an add on, a top-up, or super top allows you to enhance your coverage and increase your sum assured. Instead of purchasing another policy, additional coverage can be included in your existing plan that is not only cost-effective but also saves you from rising medical costs in india.
What do a top-up and super top-up plan cover?
- A family member, if they are dependant on you
- Hospital room rent expenses
- Pre and Post hospitalization treatments including 30 to 60 days of hospital
- In-patient treatment facility (at-home treatments)
- Expenses related to organ donations
Advantages of Top-up Health insurance plans
- Cost effective - It's usually cheaper than general health insurance policies.
- Tax deduction - A top-up health insurance coverage offers a tax deduction under section 80D
- Top-ups covers available include family and individual.
- Affordable premiums with higher coverage
FAQs on Top-up Health insurance plans
1. If someone uses alcohol 10 years earlier, but now since the last 10 years, he is not consuming it, what should he mention at the time of proposal? And after some years if a health problem occurs and the doctor says its because of alcohol, is the claim payable?
Answer - The claim would be applicable if the policyholder had informed it’s insurer about his/her previous or current lifestyle habits. If the insurer is completely unaware of the policyholders old drinking habits or previous lifestyle, the claim will be rejected
2. Health insurance rejected on the ground that the one single admission of a patient can't get the proceeds of two policies.
Answer - If you have 2 health insurance policies, you can only claim one policy at a time. Apply for a single health insurance policy claim to avoid claim rejections of both your policies.
3. Someone purchased a health insurance policy and that time he is a non-smoker and in future he starts smoking, Is it a Claim rejection cause?
Answer - A claim can get rejected if you have not updated your health insurance about your current lifestyle habits. Your insurer needs to be updated about all your previous and current lifestyle habits to validate the authenticity of your claim. Avoid hiding any information from your insurer and be completely honest.
4. In the top up plan whether we need to intimate both the companies at the time of claim?
Answer - Yes, you have to inform both the insurance companies if you have 2 different top-up health insurance policies.
5. If someone is aware of a pre-existing disease and still buys an insurance like cancer care or critical illness plan, later after 2 years, is the insured eligible for a claim if it is established that he was having the illness at the time of buying insurance?
Answer - The claim will be applicable provided your insurer has been informed about the policyholder’s illness while purchasing the policy.
6. Documents in cashless treatment of top-up health insurance plan
- A pre-authorization form
- If the policyholder is being hospitalised for a pre-planned treatment, the pre-authorization form should be filled and submitted with the insurance company at least 3-4 days prior..
- In case of an emergency hospitalisation, the form should be filled and submitted within 24 hours of hospitalisation.
- If the policyholder is seeking treatment in another medical facility which is not a hospital, it would qualify for a reimbursement claim and a pre-authorization form would not be required.
- Discharge Summary issued by the hospital
- In case of an accident, a police FIR should be filed and the same should be submitted to your insurer.
- Original hospital bills should be submitted which should show the detailed bifurcation of the different costs incurred on treatments
- Prescriptions of the doctors who were consulted for the treatment would be required
7. Any other limitations of top up plans?
Answer - Other limitations or sub limitations in a top up health insurance plan includes surgeries, treatments and room rents.
There is another sub limit which is basically a co-payment clause, it is a fixed percentage of the bill which you have to pay during the claim settlement process.
8. What if i was hospitalized twice in a year, will my top-up health insurance plan work?
Answer - A basic top-up policy will apply the threshold deductible to every claim, that is, every hospitalisation.
We at Insurance Samadhan, are here to help you with all your health insurance related complaints, if you are facing issues with health claim rejections or facing issues with fraudulent misselling of health insurance plans, Register with us and our experts will be happy to assist you to retrieve your all claims/money.
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