Top-Up Vs.Super Top-Up


Rakhi recently bought a Rs. 5 lakh health insurance cover for herself, despite her financial advisor's recommendation that she opt for a higher cover. A few months later, Rakhi was hospitalised and had to undergo a heart surgery. The cost of hospitalisation came to Rs. 8 Lakhs. Rakhi was forced to dip into her savings, something she might have prevented if she had purchased adequate health cover in the first place.

If, like Rakhi, you too have insufficient health insurance cover, it is important that you extend it so that there are no hassles in the future - in case you’re hospitalised. One of the simplest and cost-effective ways to extend your health insurance cover is by buying a Top-up or a Super Top-up plan.

Top-Ups And Super Top-Ups

Top-ups and Super Top-ups are like extensions to your base health policy that help you get a higher sum insured at a relatively low price. Both these plans come with a ‘deductible’ - the amount after which these plans begin to pay. So, as soon as your hospitalisation expenses exceed this deductible, these plans become active and start paying. Now, while both these plans may seem similar, they work very differently.

In this article, let's learn how both Top-up and Super Top-up plans work, how one differs from the other, and which one should you buy.

Let’s dive right in!

How Does A Top-Up Work?

The deductible for a Top-up is calculated on the basis of each and every hospitalisation. This means that a top-up plan becomes active and begins to pay only if the cost of a single hospitalisation exceeds the deductible threshold.

Let’s understand how a Top-up works with the help of Roshni’s example.

Roshni has a base health plan with a sum insured of Rs. 10 Lakhs. She also has a top-up plan of Rs. 20 Lakhs with a deductible of Rs. 10 Lakhs. Let’s say she undergoes multiple hospitalisation in a year, where the expenses incurred are as follows -

Hospitalisation 1: 6 Lakhs

Hospitalisation 2: 8 Lakhs

Hospitalisation 3: 12 Lakhs

Hospitalisation 4: 4 Lakhs

Let’s see how these claims will be paid to Roshni by the insurance company.

Hospitalisation Claim Amount Who Will Pay?
Hospitalisation 1 6 Lakhs Base Plan will pay the entire Rs. 6 Lakhs.
Hospitalisation 2 8 Lakhs

Base Plan will pay the available Rs. 4 Lakhs.

Roshni will have to pay the remaining Rs. 4 Lakhs from her pocket.

(Top-up will not pay anything because the claim does not exceed the deductible limit, i.e., 10 Lakhs.)

Hospitalisation 3 12 Lakhs

Roshni will have to pay Rs. 10 Lakhs from her pocket.

Top-up will pay the remaining Rs. 2 Lakhs - because the deductible is surpassed.

Hospitalisation 4 4 Lakhs

Roshni will have to pay the entire Rs. 4 Lakhs from her pocket.

(Top-up will not pay anything because the claim does not exceed the deductible, i.e., 10 Lakhs.)

So, total claims made by Roshni = Rs. 30 Lakhs.

Out of this, the amount she had to pay from her pocket = Rs. 18 Lakhs.

Top-up Vs. Super Top-up: What’s The Difference?

Top-up Plan Super Top-up Plan
When Does It Start Paying? It will begin to pay when a single claim exceeds the deductible. It will start paying when the sum of all claims in a year crosses the deductible.
Premium The premiums of a top-up plan are relatively cheaper than a super top-up plan. The premiums are comparatively higher.
Out-Of-Pocket Expenses Here, the out-of-pocket expenses will be higher. Because, the deductible is calculated for every single hospitalisation. The out-of-pocket expenses will be less. Because, here, the deductible is calculated based on the sum of all claims during a year.

Which One Should You Buy?

You must always opt for a Super Top-Up plan, as it covers all the risks covered under a Top-Up plan and more. Top-Up plans can be very restrictive, and the use cases where they will work (one hospital bill above the deductible amount) are very few, even in the long term.

Always look for a policy that has an “annual deductible” or mentions “AOY”, which is short for “Any One Year”, instead of policies which have a claim level deductible or mention AOA - which is short for “Any One Accident”.

Wrapping Up!

So, this is how Top-up and Super top-up health insurance plans work. Both these plans help in enhancing your health insurance coverage at a reasonable price. So, if you think your existing health insurance cover will be inadequate in the future, you can extend it by buying a Top-up or a Super top-up plan.

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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. These two instances speak very high of sincere advice and timely help rendered by the SMC Staff, Ms. Neha Khanna which helped us a lot in time of need.Show More

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