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Query on super top up

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15 May, 2021 by  Abhishek Mudiganti

Hi Experts,


If I have a base cover of Rs. 10 lakhs and super top up of 20 lakhs (same insurer and deductible of 5 lacs), and the hospital bill comes to Rs. 30 lakhs, can I use the base cover of Rs. 10 lacs and then super top of Rs. 20 lacs? Or will the insurance limit it to Rs. 20 lakhs + 5 lakhs (deductible amount)?


Also, I get confused when an insurer says "total sum insured" of Rs. 20 lakhs (read it while checking HDFC ergo super top up). So will they restrict claims to Rs. 20 lakhs irrespective of hospital bill amount?


Regards,

Abhishek

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Health Insurance
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Basics of Insurance

2 Answer

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17 May, 2021

Hi Abhishek,


Glad you put across this question with amounts. It makes it easy for everyone to understand how a super top up works.


Let us all be clear, you have 2 different policies even though from same insurer, one a comprehensive base policy of Rs. 10 Lakhs and a Super Top-up cover of Rs. 20 Lakhs with Rs. 5 Lakhs deductible. Now that the claim is for Rs. 30 Lakhs this is how the claim would be settled


Base plan Rs. 10 Lakhs

Super Top-up Rs. 15 Lakhs (20 Lakhs minus 4 Lakhs deductible)

Total claim settled Rs. 25 Lakhs.


Hope the above calculation addresses your question. If you still have any further questions please post here.


Stay Safe


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17 May, 2021
Rakshit
Dear Sir, Thank you for the answer but as per my understanding, The whole claim of 30 Lakhs will be paid in the above scenario. It will be as below: Base plan - 10 Lakhs Top up - 20 Lakhs (since deductible is 5 lakhs, the claim has already surpassed that amount, hence the insured is eligible for the whole amount) Request to kindly correct if I understanding is wrong
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17 May, 2021

Dear Rakshit


The way the super top up works is that the claim would be paid up to Sum Assured after deducting the deductible.


Considering the scenario shared by Abhishek total settlement would be 25 Lakhs.


Your understanding about how a super top up works is incorrect

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17 May, 2021
Rakshit
Dear Sathish, I had gone through a few super top up policy wordings wherein they have mentioned that the aggregate deductible does not reduce the sum insured. PFB the wordings of Bajaj Allianz Xtra Care Plus (Super top up policy of Bajaj) "Aggregate deductible is a cost sharing requirement under this policy that provides that the company will not be liable for a specified rupee amount of the covered expenses, which will apply before any benefits are payable by the company. A deductible does not reduce the sum insured. The deductible is applicable in aggregate towards hospitalisation expenses incurred during the policy period" Hence I had built up the understanding Regards, Rakshit
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