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Customize Your Health Insurance With Top Up Plans

Team AckoMay 24, 2024

In the event of a medical emergency, insurance provides much-needed financial assistance. Life is unpredictable, and health problems are unavoidable. While we may not be able to predict illness, we can prepare financially for it. Investing in health insurance is a prudent way to mitigate financial risks associated with unexpected health emergencies.

But, the rising healthcare costs and the increasing prevalence of health issues can make your basic policies seem inadequate. That’s where a top-up health insurance plan becomes beneficial. What exactly is it, and how does it work? Read on to gather more insights about top-up health insurance plans and why you should invest in them. 



Basics of Top-up Health Insurance 

Top-up health insurance is a type of additional coverage that goes beyond the limit set by a basic insurance plan. This extra insurance is meant to offer added protection to those who may need medical care that exceeds what is covered by their primary insurance policy. 

Having top-up medical insurance is beneficial because it provides higher coverage at a reasonable cost. It offers financial assistance in case of unexpected medical emergencies or illnesses that require costly treatment. With the increasing cost of healthcare, investing in supplementary insurance is a smart choice to ensure adequate coverage for yourself and your family. 

In India, supplementary medical insurance plans are becoming more popular due to their affordability and comprehensive coverage. Insurance companies provide a variety of supplementary plans with different features and benefits, allowing individuals to choose the one that best fits their healthcare needs and budget. It is important to research and compare different top-up medical insurance plans before making a decision.

How Do Top-up Health Insurance Plans Function?

Top-up health insurance supplements an existing health insurance policy by providing coverage above a specified limit. For instance, you have a base insurance policy of Rs 3 lakh. You have purchased a top-up plan of Rs 5 lakh. 

Now, maybe you have incurred medical expenses of Rs 4 lakh in a policy year. Your base insurance policy will cover you for Rs 3 lakh because that’s the sum insured amount. 

Your top-up insurance policy will start working after that. So, the remaining Rs 1 lakh will be covered by your top-up health insurance plan. 

Types of Top-Up Health Insurance Plans

Policyholders can choose from the following types of top-up health insurance plans:

  • Deductible-based top-up plans: In this plan, the individual sets a deductible amount. Up to this amount, their primary health insurance covers expenses. Once medical costs surpass the deductible, the top-up plan provides extra coverage.

  • Aggregate-based top-up plans: These plans will look into all of the medical expenses you have during the policy year. If the total expenses go beyond the pre-selected limit, the top-up coverage becomes active.

  • Disease-specific top-up plans: Certain medical insurance add-on plans are designed for specific illnesses or conditions. Some examples include top-up plans that focus on critical illnesses such as cancer, heart disease, or organ transplants. These plans offer additional coverage for select medical concerns and are particularly valuable for those with a higher risk of experiencing these illnesses.

  • Super top-up plans: Super top-up plans cover multiple claims within a policy year. For instance, if the policy has a limit of Rs 5 lakh and the policyholder has expenses of Rs 3 lakh and Rs 2 lakh in separate claims, the super top-up plan will cover both amounts.

Inclusions and Exclusions

Before buying top-up health insurance plans, you must carefully evaluate the inclusions and exclusions. Some common inclusions in these plans include:

  • All necessary medical expenses

  • Room rent in the event of hospitalisation

  • Pre and post hospitalisation charges of up to 30 to 60 days

  • Organ donor expenses during a transplant

  • Daycare procedures requiring you to stay in the hospital for less than 24 hours

  • Ambulance charges

Some common exclusions within these plans are as follows:

  • Undeclared pre-existing illnesses

  • Treatments for STDs

  • Cosmetic surgeries

  • Treatment for self-inflicted harm

Features of a Top-up Health Insurance Plan

Glance over the points mentioned below to get a better understanding of how a top-up health plan actually works and how you can get the best value out of it:

Acts as a backup:

Let us assume you have a health cover of Rs 5 Lacs. After a serious road accident, you are left in a state of coma and require various surgeries. Thankfully, you make a recovery, but your hospital bill stands at Rs 8 lacs when you get discharged. Where are you going to get the extra Rs 3 lacs from? This is why you need the top up health insurance plans. Such a plan offers a sum Insured over and above the sum insured of the base health plan. So you can make a claim on your top up plan for the remaining amount after you clear a part of the bill with the claim from your base plan.

Also, read: Top-up vs Super Top-up plans in health insurance

Available only beyond a limit:

As mentioned above, the top-up health insurance plans are only used as a backup and not as the primary cover. You, therefore, need to note here that you can only make a claim when the bill is above a certain amount. This is the deductible component, which is normally the sum insured of your base plan. So if your deductible is Rs 2 lacs, you can only make a claim if the bill is above Rs 2 Lacs. If the bill is Rs 1,80,000 then the base plan will take care of the expenses and you cannot raise a claim against the top-up plan.

Cheaper than a new plan: Many people wonder why they need to buy the top up health insurance plans and not go for a higher limit on their base plan. Well, the biggest reason for choosing a top-up health insurance policy is its cost. These plans are available at very low prices. You can get a top-up cover for Rs 10 lacs for a premium of just about Rs 3000. This is very cheap and it makes it affordable for most people.

Can be from a different insurer:

There is no compulsion that you have to buy the plan from the same insurer who sells you the base policy. The medical insurance in India rules, permit you to get a top-up cover from a different insurance provider. If you are not happy with your existing health insurer’s service, you can get the top up cover from some other company. You must do your research and look for the best top-up plan from the best possible insurance provider out there.

These are some of the most fascinating features of top-up medical insurance India. As you can see, there are some very handy benefits that these plans have on offer.

Learn more about what is super top-up health insurance?

In conclusion

Explore your options and find the most suitable health insurance coverage. You should ideally have a good base plan and a handy top-up plan along with it. Keep all the points mentioned above in mind and make a careful selection. You should never be underinsured or over-insured. So assess your requirements properly and then choose the covers you feel are apt for you.

Frequently Asked Questions:

Here are some of the frequently asked questions related to top-up health insurance plans


Who can buy top-up health insurance plans?

Individuals within the age range of 18 to 80 are eligible to acquire a top-up health insurance policy. This policy becomes active when the coverage limit of your primary health insurance plan is fully utilized.

Is it possible to purchase a top-up health insurance policy without a base plan?

No, this is not possible. You must have an existing base policy with coverage limits that are exhausted before you can activate a top-up health insurance policy. The top-up policy supplements the coverage provided by the base policy, enhancing your overall protection.

When is it important to buy a top-up health insurance plan?

Top-up health insurance plans provide additional coverage when the coverage limit of your primary health insurance policy runs out. If you're concerned that your current policy provides insufficient coverage, you can consider purchasing a top-up plan for a relatively low additional premium.

Can I get tax benefits for top-up health insurance plans?

Similar to conventional health insurance, payments made towards top-up medical insurance policies can reduce your tax liability. Under Section 80D of the Income Tax Act, these premiums are eligible for tax deductions.

Are top-up health insurance plans expensive?

Top-up plans are often more budget-friendly than purchasing a primary health insurance policy with a larger coverage limit. They offer extra protection for a smaller charge, making them a practical way to boost your medical insurance coverage without breaking the bank.

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