02 Oct 2017 16:34 IST

Get more health cover for less

A top up plan will get you the cover you desire for a reduced premium

It is very important that you have adequate health insurance cover. If you have a regular plan, you can consider topping it up for more cover. Even if you cannot afford the premium for a regular plan, you can look up for a standalone top-up or a super top-up plan which will help you get the cover you desire, but for a reduced premium. Here’s what you should know about these plans.

What is it?

A ‘top-up’ or a ‘super top-up’ health plan will cover you once hospitalisation expenses exceed a certain limit or what is called the ‘deductible.’ ‘Deductible’ is that portion of a hospital bill which has to be funded through a base hospitalisation plan or paid out of your pocket.

The top-up plan, however, may not be of use to you always. This is because, it requires that at each time of hospitalisation, the claim exceeds the threshold limit. For instance, assume you have a total cover for ₹2 lakh in your base health plan and a top-up plan of ₹5 lakh with ₹2 lakh deductible. If at the first time of admission in the hospital in a year, you spend ₹1 lakh, the base policy will pay ₹1 lakh. If you get hospitalised again in the same year and the bill is for ₹2 lakh, your base policy will pay the remaining ₹1 lakh. But the top-up plan will not be used because you didn’t cross the minimum threshold of ₹2 lakh. Thus you will have to pay the balance ₹1 lakh from your pocket.

But, if you have a super top-up plan, it will come in handy. Super top-up plans pay for the full bill up to the sum insured once cumulative expenses exceed the threshold. Taking the same case discussed above, if you have a super top-up cover for ₹5 lakh with ₹2 lakh deductible, and in your second claim, the bill is ₹2 lakh, the base plan will pay for ₹1 lakh and the super top-up plan will pay the remaining ₹1 lakh.

Today, there are both standalone super top-up plans such as those of Apollo Munich’s Optima Super, Religare’s Enhance and Liberty Videocon’s Supra, and standalone top-up plans such as HDFC ERGO’s Health Suraksha Top Up plan, Apollo Munich’s Optima Plus. There are also regular health plans with optional ‘deductibles’ that need to be exhausted on an aggregate basis making them essentially super top-up plans. This includes Cigna TTK’s Prohealth Protect and Prohealth Plus and Royal Sundaram’s Lifeline.

What suits whom

“If you are a youngster, you should consider a top up with ₹1/2 lakh deductible at the very least, says Vaidyanathan Ramani, Joint Head, Health Insurance at Policybazaar.com. The most competitive plans in terms of premium among super top up policies are – Liberty Videocon’s Supra and HDFC ERGO’s – my: Health Medisure Super Top Up but when it comes to features such as no restriction in the policy and conversion to a regular health plan then Apollo Munich- Optima Super and Royal Sundaram’ Life Line are best bet to buy, he adds.

If you are in your early 40s and looking for a back-up for your health plan, you can buy a no-condition ( i.e no sub-limits) super top-up plan and also ensure that the waiting period is less. Apollo’s Optima Super has no sub limits, but there is a four-year waiting period for pre-existing diseases. Bajaj Allianz’s recently launched – Extra Care Plus, comes with a 1-year waiting for pre-existing diseases and maternity expenses, but there are no limits on expenses. Royal Sundaram’s Lifeline too doesn’t have any limits.

If you are someone who has a cover under the corporate group health plan, and are looking for an added protection, you can look at Royal Sundaram’s Lifeline or Apollo Munich’s Optima Super (a super top-up policy). In Apollo Munich’s Optima Super, you can have the ‘deductible’ clause removed between the age of 55 and 60 years, provided you had renewed the policy without break and had enrolled before 50 years of age. There will be no requirement for medical tests. Royal Sundaram’s Lifeline turns into a super top-up plan if you opt for deductible but it can be converted back into a regular health plan, at the time of renewal in any year. This is available in Classic and Supreme options of the Lifeline plan.

(The article first appeared in The Hindu BusinessLine.)

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