Top-up health insurance is an additional cover that increases your existing health insurance plan. It comes into play when your base policy’s sum insured is exhausted due to medical expenses. Simply put, it acts as a financial backup for high medical costs. With a Top-up Health Insurance plan, you can easily increase your coverage without paying a high premium, ensuring you stay protected even during unexpected hospital bills.
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A top-up health insurance plan gives you extra medical coverage on top of your existing health policy or employer mediclaim. It kicks in when the sum insured under your regular policy is used up. However, it comes with a deductible, which means the plan will start covering expenses only after you’ve paid a certain amount out of pocket.
Health insurance top up plans are usually more affordable than buying a higher-cover basic policy. They work well alongside your employer’s health insurance and ensure you have additional protection for unexpected medical expenses when your regular cover isn’t enough.
A top-up health insurance plan with ACKO gives you extra protection once your regular health cover runs out. It comes with a deductible, the part of the medical bill you agree to pay first. Once that amount is crossed in a single hospitalisation, your ACKO top-up plan kicks in to cover the rest.
You can use your base health policy or pay out of pocket to meet the deductible. Just keep in mind that the deductible applies to every claim, and your hospital bill must exceed it in one go for the top-up plan to activate.
Example: Suppose you have a ₹3 lakh base policy and a ₹7 lakh top-up with a ₹2 lakh deductible. If your hospital bill is ₹5 lakh, the base policy pays ₹3 lakh, and ACKO’s top-up covers the remaining ₹2 lakh. But if you have two separate bills of ₹1.5 lakh each, the top-up won’t apply since neither bill crosses the ₹2 lakh deductible.
With ACKO, top-up plans are an affordable way to increase your health cover without spending too much on a higher base policy.
Here are the benefits of a Top-up Health Insurance Plan.
Health insurance top up plans boost your coverage, so you’re protected even if your base health policy runs out.
Since you pay a deductible first, premiums are much lower than regular health plans.
Most top-up plans don’t come with limits on room rent, doctor fees, or other hospital charges.
You can easily convert a top-up into a regular health plan at renewal if you need more comprehensive cover.
In most cases, you don’t need a pre-policy medical screening, unless you’re above a certain age.
Premiums paid for top-up plans qualify for deductions under Section 80D of the Income Tax Act.
Even if your base plan is exhausted, your top-up plan steps in, ensuring you’re not left worried about big hospital bills.
Most top-up plans cover a wide range of medical expenses, including:
If you’re comparing a basic health insurance plan with a top-up plan, it’s important to understand how each works. Here’s a quick comparison to help you make the right choice.
| Category | Basic Health Insurance | Top-up Health Insurance |
| Meaning | Covers medical expenses up to the chosen sum insured for hospitalisation, surgeries, and other eligible treatments. | Offers additional coverage once the claim amount crosses a specific limit (known as a deductible) under your base health policy. |
| Mandatory Deductible | No mandatory deductible applies. | Has a mandatory deductible for every claim, coverage kicks in after you pay or your base policy covers this amount. |
| Policy Activation | The plan is active from day one (for accidental claims). | Becomes active only after your base plan limit is exhausted and the deductible is paid. |
| Premiums | Premiums are usually higher as the insurer covers expenses from the first rupee onwards. | Premiums are more affordable since the deductible reduces the insurer’s upfront liability. |
| Pre-medical Screening | At ACKO, medical tests are required for everyone above 18 years. | Most top-up plans don’t require medical tests. |
| Sub-limits | Sub-limits may apply for room rent, treatments, or procedures. | Generally, no sub-limits apply under top-up plans. |
Top-up and super top-up health insurance plans might sound similar, but they work differently when it comes to covering medical expenses once your base policy limit is used up.
A top-up plan gives you extra coverage, but it only comes into play if a single hospital bill goes beyond the deductible amount. In contrast, a super top-up plan offers wider protection because it considers your total medical expenses in a policy year, not just one bill.
Example: Suppose your deductible limit is ₹5 lakh. If you have two hospitalisations in a year with bills of ₹2 lakh and ₹3 lakh, your top-up plan won’t activate because neither bill crosses ₹5 lakh on its own. But with a super top-up plan, both bills are added together, so once your combined expenses cross ₹5 lakh, the plan will start covering the remaining costs.
In short, a top-up plan helps during one major medical event, while a super top-up plan protects you from multiple hospitalisations throughout the year.
At ACKO, our super top-up plans are built to make healthcare more affordable and stress-free, ensuring you stay protected no matter how medical costs add up.
If your base health insurance plan hits its sum insured limit, you can still get coverage through your top-up plan. You can file claims under both your base policy and top-up policy together to make sure all your medical expenses are covered.
Even if your base health plan and top-up plan are from different insurers, that’s not a problem. You can raise claims with both companies at the same time, each insurer will settle their part of the claim independently.
At ACKO, we make this process smooth and hassle-free, so you can focus on recovery while we take care of the paperwork.
Selecting the ideal top-up health insurance plan requires careful consideration of various factors to ensure that it complements your existing health insurance effectively and provides adequate financial protection in times of need. Here are key aspects to consider when choosing a top-up plan:
Before choosing a top-up plan, evaluate your current health coverage to identify any gaps. Consider factors like your family's medical history, potential health risks, and the existing sum insured. The top-up should adequately cover these gaps without duplicating what your primary insurance already provides.
Research the insurer's market reputation for trustworthiness and reliability. Look for reviews and ratings from current policyholders, and consider how long the company has been in business. A reputable insurer will have a track record of prompt and fair claim settlements.
The top-up plan's coverage limit should be high enough to cover significant medical expenses beyond your base policy. Also, assess the deductible amount—the portion of the claim you need to pay before the insurer pays—to ensure it's financially feasible for you. The deductible should ideally match or exceed the sum insured of your base policy.
Compare the cost of the top-up plan with the additional coverage it provides. Top-up plans are generally more affordable than increasing the sum insured under a primary health policy, but prices can vary significantly between insurers.
Check if the top-up plan offers flexibility in terms of increasing the insured amount or including additional family members later. Also, consider if the policy is portable, allowing you to switch insurers without losing the benefits if you are dissatisfied with your current provider.
Effective customer support is essential, especially when dealing with health insurance claims. Evaluate the insurer's customer service efficiency and availability. Customer support should be accessible, responsive, and helpful, particularly during emergencies.
Carefully review the exclusions and the waiting periods for pre-existing conditions or specific treatments. Understanding these can help you avoid surprises during a claim.
Some top-up plans offer extra benefits like maternity coverage, vaccination coverage, or international treatment for critical illnesses. Consider these additional benefits if they align with your personal or family health care needs.
A deductible is a specified amount that the insured must pay out-of-pocket before the insurance provider begins to cover the excess costs. In the context of top-up plans, this amount is generally the coverage limit of the base policy. For example, if a top-up plan has a deductible of Rs 5 lakhs, and your base health insurance policy covers up to Rs 5 lakhs, the top-up plan will only be utilised for claims that exceed this amount.
Top-up plans are designed to enhance existing health insurance by covering costs that exceed the base plan's limit. For instance, if your hospital bill amounts to Rs 8 lakhs and your base plan covers up to Rs 5 lakhs, a top-up plan with a Rs 5 lakh deductible would cover the remaining Rs 3 lakhs. This setup ensures that your financial exposure is minimised beyond the deductible amount.
One of the most significant advantages of top-up plans is that they offer additional coverage at a fraction of the cost of increasing the limit on the base policy. This is primarily because the risk to the insurer starts only after the deductible is exceeded, reducing the likelihood of frequent small claims.
Deductibles allow policyholders to choose a deductible amount based on their existing base plan and personal financial ability to pay out-of-pocket expenses. This means you can tailor your insurance coverage to your needs and risk tolerance.
With deductibles, individuals can better manage their finances by setting aside the deductible amount in savings, thus preparing for potential health-related expenditures without the pressure of high premium costs.
By having to cover the deductible amount, policyholders are typically more mindful about when and how they use their insurance, potentially reducing unnecessary medical expenses and focusing on necessary treatments.
Understanding and selecting the right deductible is key to maximising the effectiveness of a top-up health insurance plan. It balances the need for sufficient coverage while keeping premiums affordable, making it a strategic choice for those looking to comprehensively extend their health insurance coverage.
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.
Here are some commonly asked questions about top-health insurance.
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