Topups or Super Topups - Which is better to boost health insurance coverage?

Will your current health insurance cover be enough ten years down? What about twenty? Surely not. And given you’ll not be able to upgrade your policy once you make your first claim, it is necessary that you buy sufficient cover for your long-term future, today. 

But direct health insurance upgrades can be very costly, and many families settle for a low sum insured, just because they can’t afford them. But, there are options to get around this.

Topups and Super Topups. 

Topups and Super Topups are extensions to your base health insurance plan that can help you get a higher sum insured at a reasonably low cost. Each extension comes with a ‘deductible’ - which is the amount after which these plans start paying. Usually, you match the deductible to your base-plan amount, so, as soon as the base-plan is exhausted, (or the deductible is crossed) the extension comes into play. These plans can be bought from the same insurance company where your base plan is bought or any other. 

While they sound similar, Topups and Super Topups can be very different in terms of how they pay. Let’s go through them one-by-one. 

First - Topups. 

A Topup’s deductible is calculated based on every single hospitalisation. Meaning, a topup plan becomes active and starts paying only if the expenditure on one, single hospitalisation crosses the deductible limit. 

Let’s take an example and explain this better. Consider this combination. 

• Base-plan INR 5 Lakhs. 
• Topup health insurance plan INR 10 Lakhs (with a deductible of 5 Lakhs)

Consider these hospitalisations over the period of a year. 

1️⃣ Hospitalisation 1: Claim amount = 3 Lakhs 

This is paid entirely by the base plan. 

2️⃣ Hospitalisation 2: Claim amount = 3 Lakhs

Of this, the base plan pays the available 2 lakhs. 

But, since this particular hospitalisation’s cost is not beyond the Topup’s deductible of 5 lakhs, the remaining amount of 1 Lakh will need to be paid out of your pocket. 

3️⃣ Hospitalisation 3: Claim amount 7 Lakhs

Of this, the first 5 Lakhs will need to be paid out of your pocket.

With that, the deductible is met - and the Topup will pay the remaining 2 Lakhs. 

Summing up in this table. 

 Total claims made in the year = 13 Lakhs

Paid by you = 6 Lakhs 

So you see, a Topup helps you out in cases of large hospitalisations - but, you might end up paying a large sum of money out of your own pocket, in most cases. 

So - we come to the next option - Super Topups.

A Super Topup’s deductible is calculated based on the sum total of all hospitalisation expenses incurred during the entire plan-year. Once the sum of costs paid across admissions crosses the deductible - your Super Topup starts paying. 

Let’s understand from the same example above, if you had bought a Super Topup instead. 

• Base-plan INR 5 Lakhs. 
• Super Topup INR 10 Lakhs (with a deductible of 5 Lakhs)

Consider these hospitalisations over the period of a year. 

1️⃣ Hospitalisation 1: Claim amount = 3 Lakhs 

This is paid entirely by the base plan. 

2️⃣ Hospitalisation 2: Claim amount = 3 Lakhs

Of this, the base plan pays the remaining 2 lakhs. 

Now - note the difference. 

The total deductible of 5 Lakhs is achieved across two hospitalisations, hence the Super Topup kicks in and pays the remaining 1 lakh.

3️⃣ Hospitalisation 3: Claim amount 7 Lakhs

Since the deductible has already been met during the plan-year, the Super Topup pays all the 7 lakhs in this admission. 

Summing up in this table. 

 Total claims made in the year = 13 Lakhs

Paid by you = 0

Topup or Super Topup - Which one should you pick?

Generally, advisors suggest a Topup if they see that you do not have any major health issues, or don’t expect to have them in the future. And Super Topups if you’re at a higher risk of chronic illnesses, requiring multiple hospitalisations in the future. Topups are considerably cheaper than Super Topups - so that’s seen as a way to save some money. 

But honestly, given our lifestyles, stress and poor eating habits - this is very difficult to predict. Plus - there’s always the risk of accident-related hospitalisations which can happen to anyone at any time! 

One thing to note is that when you have hospitalisations with large bills in each of them, both Super Topups and Topups work in the same way. The major difference comes in when you have several, smaller bills - where Topups can become pretty useless. 

On the other hand, with a Super Topup - it doesn’t matter whether you undergo a single or multiple hospitalisations, it will pay as long as the deductible is paid for - and hence it is a better option. 

Summing up, without having to directly upgrade your health insurance, you can use Topups and Super Topups to extend the cover amount. These start paying as soon as the base-plan is exhausted - and can provide a considerably large cover for an affordable cost. 

Now that you have a basic understanding of how Topups and Super Topups work - you should read this article - with a detailed insight into the nuances that come into play with these extension plans - including waiting periods, cover restrictions such as room rent limits, complex claim procedures, etc. Make sure you’re aware of all these limitations before you buy a plan. 

Got a question you’d like to get clarified? 

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