6 things that can go wrong with Super Top-up Health Insurance
The year 2020 made many of us realize that a 5 Lakhs family floater cover won't take us far. Being from the insurance industry, we faced maximum questions in social circles, forums, over webinars around the topic of upgrading health insurance. And, one of our most recommended ways to efficiently upgrade health insurance has of course, been - Super Top-ups.
Then, you've heard of the 1 Crore health insurance cover. Almost every insurance player is promoting the high cover at a surprisingly low cost (premium lower than a 25 lakh cover!) The secret to this 'too-good-to-be-true' cover lies in the fact that this is a Combo plan - two health insurance plans packaged as one - A regular base health insurance + a Super Top-up plan.
But is Super Top-up the right strategy to upgrade your health insurance cover? What are the pitfalls and things to look for when buying this category of insurance? Let's take you through this and more.
For people who came in late, a Super Top-up is an extension you can buy on your existing (or new) base health insurance cover. In effect, a Super Topup starts paying after you have exhausted your base-plan amount (called the deductible), in its Plan-year. This policy can be from the same insurance company where your base plan is bought or any other.
For example, say you have an Rs. 3 Lakhs cover, and want to upgrade your cover. You can buy a super top-up plan of Rs. 10 Lakhs with a deductible of Rs. 3 lakhs. In this case, in a given year your base cover will take care of expenses up to Rs. 3 Lakhs. Once your annual hospitalization bills in a year cross Rs. 3 Lakhs, the super top-up plan act as an extension and will cover you for another Rs. 10 Lakhs.
But you should be very careful while buying the Super Topup, as it could impact your claim drastically.
Since it's a separate health insurance cover- the Super Top-up comes with a different set of conditions and limitations. You should be very mindful of these - while you pick up such a Combo cover - as you could easily make wrong assumptions and decisions, that could end up costing you a lot of money as out-of-pocket payments at hospitalization.
1 . Financial Limits:
A Super Top-up plan might have room rent limits and fewer features compared to a full plan. Ensure you go through all features and benefits in detail, before signing up.
2. Two Policies - Two Claims:
Basically, you'll be having two different health policies. Meaning - two different application processes and two claims processes, every time you need a higher cover. You can buy the Super Top-up from the same insurer, or a different one. But, getting it from the same insurer will make things easier - as the processing of the claim will become slightly more seamless. You can read about making two claims here. Step by Step process for Health insurance Claims - Cashless & Reimbursement (beshak.org)
3. Waiting Periods can be different:
The pre-existing waiting period of your super top-up might be different from the base plan. Understand the differences carefully, so you’re not taken by surprise.
4. Cashless network can be different:
If the policy is from a different insurance company, the hospital network that offers cashless facilities might differ from your base-plan. Check the list of hospitals properly.
5. Super Top Vs. Upgrading the existing plan?
A Super Top-up will be extremely cheap compared to a normal upgrade of your existing health plan. If used appropriately, it can give you and your family fantastic health insurance coverage, at a decent cost - in the long term. In fact, we strongly recommend combining a Super Top-up with your base-plan as the go-to health insurance purchase strategy.
Having said that, it is important to have a good enough base-cover, to begin with, that will cover for all smaller hospitalization needs, without having to compromise because of room-rent limits, or quality of care. Say - at least 10 Lakhs per person in your family. Above that, use a low-cost Super Top-up to increase the cover drastically. You can get a +15 Lakhs, +25 Lakhs Super Top Up - to have insurance shoulder a majority of the costs, in case of a serious hospitalization, costing tens of lakhs.
6. The best time to buy Super Top-up: ⭐
The deductible in a Super Top-up plan is calculated on an annual basis. This means, for the super top-up policy to pay, the hospitalization expenses should cross the deductible amount during the year in question.
We, therefore, recommend that the best time to buy a Super Top-up would be the same month (even better, the same date) as your base-plan. If the months don't coincide the claim payments can get complicated. Let's explain with an example.
Say you have the following Combo plan.
Base plan of Rs. 2 Lakh (Plan year: January 2021 to December 2021)
Super Top-up of Rs. 5 Lakh with an annual deductible of Rs. 2 Lakhs (Plan year: April 2021 to March 2022). (This means for the Super Top-up to pay, the hospitalization expenses should cross Rs. 2 Lakhs in the policy period in question - which is April 2021 and March 2022.)
Now, say you undergo two hospitalizations in the year 2021.
The first one happens in January 2021, the bill amount is Rs. 2 Lakh. Now this is covered by your base-plan there is no confusion, and the claim amount is paid.
Next - you undergo a hospitalization in April 2021. And the bill comes to 1.5 Lakhs.
Now, take a guess on - who will pay for this?
A. Base-plan
B. Super Top-up
C. You
If you guessed A or B - then you'll be up for a BIG surprise! Here's how your two insurance plans will look at the second claim.
Your base plan will not pay: Because - you have already exhausted the cover amount available for the year (January 2021 - December 2021)
Your Super Top-up will not pay: Because the Super Top-up plan pays only when the hospitalization expenses during the policy period of April 2021 to March 2022 crosses the deductible of 2 Lakhs. In this case, the total hospitalization expenses during the period in question (Apr 21 to Mar 22) are only Rs. 1.5 Lakhs - hence the claim won't be payable.
We hope that you got a fair understanding of how the Super Top-up can boost your health insurance cover, dramatically - and strategies you should use to benefit the most from it.
Still, got a question about how you can customize the perfect Super Top-up plan for your family?
Drop a question on the Beshak Insurance Forum - and get an answer from an expert in 6-8 hours - for free!
- Super Top-ups are one of the most cost-effective ways to get a large sum assured, for your health insurance plan
- But, you should carefully evaluate all the benefits and limitations before purchasing this extension
- With this, you'll essentially have two health plans - so be mindful of the additional documentation and processes you'll have to go through
- Ensure you buy the Super Topup Plan in the same month you are renewing your base plan.
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Hi Team Beshak, In point no. 6, what if the claim happens in 2nd year of buying a super top up . I think this point is valid only in the case of Year 1 of super top up Plan Am I right?
No. Point 6 is applicable for every year, if you don't buy top-up in the same month.
Hi Team Beshak , Loved the website , was going through the Super Topup article above and i found that the "restore" option has not been considered for point no .6 i.e The best time to buy Super Top-up. I believe with the Restore Option or with unlimited restore as is being offered by Companies post Covid such an "issue" will not arise...please do check the same as per your expert opinion and incorporate it in a change or a new article on the subject . Regards,
Hey Vivek, Hope you are doing well, and thanks a lot for pointing this out. We'll look into this and make the desired changes in the article. Regards,
Hey. Great article. I have one doubt. If I have base policy with Room Cap Limit as 1% of Sum Assured, then can I take Super Top Up Policy without Room Cap Limit?? How this situation will affect in future?? Thank you in advance.
Hey Poojan, Hope you are doing well! We request you to kindly post this question on our community forum. Sharing the link of the same with you for your ready reference - beshak.org/forum. Thanks!
Hi, With regard to 6. The best time to buy Super Top-up, If I don't buy Super top up now while buying only the base cover. After that suppose I want to buy super top up. Then would it be okay if I buy super top up in the same month when the policy is up for renewal.
Yes, you are right. Whenever you buy your super top-up, try buying in the renewal month of your base policy.
1 Recent IRDA guidelines says that no mediclaim can be rejected on any grounds after completion of 8byrs of continuous policy. Is it so? If some one has not disclosed prevexisting disease even then this guide line will apply ? 2. Preexisting disease is defined as one for which symptoms / treatment was there in the previous 4 years. Does it mean that if some had some disease prior to 4 years but if no symptom / treatment was taken in previous 4 yrs it need not be disclosed as per existing disease?
Hello Dipak, you need to ask these questions on Beshak Forum - Please click on Community link on the top right of this page, or copy this URL - www.beshak.org/forum. Thank you.
Great article Team Beshak!!! I have taken Maxbupa ‘ReAssure’ policy for base 10L + 25L super top-up (with 10L deductible). This plan provides unlimited times reinstatement of Sum Insured for all members and same or different illness every year; in-short base plan SI 10L will not be exhausted. Will there be an issue still in the claim as suggested in point “6. The best time to buy Super Top-up” if policy issue/renewal dates are not in the same month? If yes, then in which scenario? Thank you in advance.
Thanks a lot for your reply.
This is an excellent question, HemanthKumar. In the scenario you have suggested, not having a topup policy overlapping the renewal month of the base policy, won't make any difference to the claim.
this is with reference to your reply dated 27th apl 2021. Thanks for the same. I would like you to clarify and confirm that u have taken into consideration that there is a time gap of 4 months between 1st and 2nd claims and hence spilled over amount from claim no1 will not get time barred.
Hello Dipak, a super top-up policy only calculates the hospitalization expenses you have incurred during a policy year and pays after deducting the deductible amount. There is no requirement or condition regarding the time between two claims. Hope this clarifies.
I have been unable to get an answer from mediclaim companies or their agents including coverfox etc. If u can help. Underlying issue is if certain amount is denied in base policy claim because of sub limits like room rent can it be recovered from supertop up subkec to cum deduction condition being met. Illustration is as under 1 sum insured 15,00,000 2 deductible 3,00,000 3 hospital bill-1st illness 2,20,000 4 admissible amount on a/c sub limits 2,00,000 5 paid by base policy 2,00,000 6 NO PAYMENT FROM SUPER TOP UP 7 2ND ILL NESS-HOSPITAL BILL 3,00,000--after 4 months but in policy year 8 admissible amount on a/c sub limits 2,50,000 9 paid by base policy 1,00,000 9A TOTAL AGGREGATE DEDUCTION 3,00,000 10 BALANCE PAYMENT FROM 1ST CLAIM less SR NO3-SR NO2 20,000 11 BALANCE CLAIM FROM 2ND ILLNESS-SR NO7 less SR NO9 2,00,000 12 PAYMENT BY SUPER TOP UP 2,20,000 pl do reply. dipak jambusaria
Hello Dipak, The Super Topup policy will pay claims against their own policy conditions. If the base policy has room rent limit, but the super topup doesn't then the super topup policy can pay the difference. Your total spent in the example is 5.20 Lakhs. The Super Topup policy will take this entire expense, apply its own limits, make the 3 Lakh deduction for deductibles and pay. Say there are no limits in the super topup policy, the Super Topup should pay the entire Rs. 2.20 Lakhs. Hope this helps.
Thanks for guiding us through the Maize called Health Insurance. Learning every day from your forum.
Thank you, Ganesh 🙏🏻. Glad we are of help. Our goal is to help nurture a community of informed insurance buyers, help people make better decisions in insurance Do help spread the word, share with others who you think can benefit😊.
Great article from Beshak!
Hey, thank you Nisarg! 😊