6 Important Tips To Keep In Mind When You Buy A Super Top-Up
Medical Inflation has been outpacing retail inflation in recent years. Affording expensive treatments, surgeries etc. has become close to impossible. If you believe a 5 lakh cover is sufficient enough to protect you financially, we are sorry to say you’ll probably be underfunded in the next 5 to 10 years. Hence, there is a constant need to upgrade your health insurance policy.
Let’s take a scenario - Raghu, a 35-year-old, requires a kidney transplant. The procedure costs around Rs 10 lakhs. But, he has health insurance with Rs 5 lakhs coverage. The remaining Rs 5 lakhs will still be outstanding. How will he arrange such a large sum in this dire situation?
Such circumstances can create a financial crisis. It is essential that you prepare ahead of time. You may think of purchasing additional policies to enhance your coverage, but that requires a lot of paperwork and will cost you a fortune.
Then, what is the effective solution?
You can boost your health insurance cover efficiently by getting a Super Top-Up plan. It is an extension to your existing plan that you can buy at a relatively low price.
What is a Super Top-Up Plan? What should you look for when buying this type of plan? Let’s see.
What Is A Super Top-Up?
A Super Top-Up is essentially an extension that you add to your existing base health insurance plan to expand its coverage. It kicks in after your base plan cover amount, also known as the deductible, is exhausted in a policy year.
You can purchase a Super Top-Up through the same company as your base policy or from a different company.
Taking Raghu’s example again. He owns a health insurance plan with a cover amount of Rs 5 lakhs. He can expand its coverage by buying a super top-up plan of Rs 10 lakhs with a deductible of Rs 5 lakhs. As seen before, he requires a kidney transplant that costs Rs 10 lakhs. So, his base cover will take care of expenses up to Rs 5 lakhs, and then, the super top-up plan will cover the remaining Rs 5 lakhs.
Super Top-Ups - Some Handy Tips!
A Super Top-Up is a separate health cover with its own limitations and conditions.
Avoid any hassles in the future by staying aware of the following factors -
Once you buy a super top up, you will now own two health insurance policies - your base plan and a super-top up. Enter two different application processes and different claim processes.
Check our article on from 2 different health insurance policies.
A Super Top-up can be purchased from either the same insurer or a different insurer. Getting it from the same insurer will simplify the process as the claim will be processed seamlessly.
Different Cashless Networks
There's a chance that if you have bought a Super Top-up Plan from a different insurance company, network hospitals that allow cashless payment may be completely different from the one offered by your base plan. Make sure you examine the hospital list carefully.
The features of a Super Top-up plan may be limited as compared to a standard health insurance plan. Super Top-ups also have a room rent limit - a limit up to which your insurance company will bear the hospital room rent, or Super Top up may not cover say Organ donor expenses or Day care treatments. Take the time to carefully review all features and benefits before you commit to the plan.
Different Waiting Periods
There might be a difference in the pre-existing waiting period of your super top-up and the base plan. A waiting period is a time period during which some specified conditions are not covered by the policy. Generally, the waiting period for pre-existing diseases is 2-4 years. Be aware of the differences, so you don't get caught off guard.
Super Top-Up v/s Upgrading Your Existing Plan - Which Is Better?
While having one plan with a large cover can be extremely convenient, super Top-ups are extremely affordable when compared to normal health plan upgrades and hence make a compelling proposition. In the long run, they can provide you with quality health insurance coverage at a reasonable cost. A Super Top-up coupled with your base plan is the most effective way to purchase health insurance.
The first step is to have a sufficient base cover to take care of smaller hospitalisation expenses without having to worry about room rent limits or quality of medical treatment. As a result, you should allocate Rs 10 lakhs for your family. You can extend your coverage by adding a super top-up plan that is affordable.
It is possible to choose from a variety of top-up options, such as 10 lakhs, 15 lakhs and 25 lakhs etc. In case a serious hospitalisation is needed, this extended coverage helps bear a large portion of the cost.
When To Buy A Super Top-Up?
As discussed before, Super Top-Ups come with a deductible, i.e., they activate when a certain amount is crossed. The deductible is calculated on a yearly basis.
In other words, your hospitalisation expenses should exceed the deductible amount during the year in question for the Super Top-Up to pay.
In order to get the most out of your Super Top-Up, it is best if you can purchase it in the same month as your base-plan, or on the same day. Claim payments can be complex if the months do not line up.
Here's an example to understand the above point -
Bharat has a combo plan - A Base Health Insurance Plan and a Super Top-up Plan
The base plan of Rs 5 Lakhs with plan year - January 2022 to December 2022.
Super Top-Up of Rs 10 Lakh with an annual deductible of Rs 5 Lakh for the period March 2022 to February 2023.
To qualify for the Super Top-Up, the hospitalisation expenses must exceed Rs 5 lakhs during the policy period, March 2022 to February 2023.
Let’s Assume Bharat Undergoes Two Hospitalizations In 2022.
| First Hospitalisation
|| Second Hospitalisation
|Heart surgery in February 2022, costing Rs 5 lakhs.This will be covered by his base plan.
||Knee surgery in May 2021. The cost is Rs 2.5 Lakhs.
What Happens During The Second Claim?
Base Plan (January 2022 - December 2022)
Since Barat has exhausted the cover amount available for the year for his first surgery, he can't claim for the second one.
Super Top-Up Plan (March 2022 - February 2023)
Barat can’t use his Super Top-up cover because it only pays when the hospitalisation expenses between March 2022 and February 2023 cross the deductible of Rs 5 lakhs. Since the first hospitalisation happened in February 2022, it doesn't fall under the Super top-Up term. Hence, the first hospitalisation expense, i.e., Rs 5 lakhs shall not be considered a deductible.
According to this claim, the total hospitalisation expenses during the particular period of April 21 to March 22 are only Rs 2.5 lakhs (below Rs 5 Lakhs). Thus, the claim will be denied.
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What Is The Best Course Of Action?
The answer is pretty easy. Buy your Super Top-Up on the same day as your base plan or as close as possible to that date. In this way, your deductible will be calculated concurrently with your base plan calculation - ensuring you have ample coverage.
A Super Top-up keeps you prepared and saves you from financial straits, when your health insurance policy doesn’t cover you adequately - especially in emergencies! Make sure you go through these conditions carefully and read the plan thoroughly, so you’re in for no surprises down the road.
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We were fortunate enough to have selected SMC as our Health Insurance Broker for they have been very helpful in resolving our queries related to health insurance. I would like to cite two examples where SMC's role has been very crucial.
One was when payment for cashless hospitalization was not coming through as the insurance company was taking undue longer time to approve the Hospital Bill. It was then I talked to Neha and it was she who through her contacts in the Insurance co. facilitated and expedited the approval for payment of hospital bill.
Second was very recently when the Insurance co. had proposed a top up "Enhancer" policy for our existing policy. When I talked to Neha she immediately told me not to take this policy being offered without any medical test as it will not be beneficial to us and may create problem later on account of recent hospitalization. If I had I not consulted Neha, I would have into a big trouble with the insurance co.
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