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Differences between top-up health insurance vs super top-up plans

Team AckoOct 20, 2021

A booster to your health insurance policy in the form of a top-up and super top-up health insurance plan comes to your rescue when the sum insured amount is comparatively low. Both these plans increase the sum insured over and above your primary health insurance plan. But, how are the top-up and super top-up health insurance different? Read on to find out.

Differences between top-up health insurance vs super top-up plans

Types of top-up health insurance plans in India

There are two types of top-up health insurance policies in India. Here are the details.

  • Top-up plan: The top-up insurance plan provides insurance coverage by replenishing the sum insured up to a certain amount. Once the medical expenses cross the deductible limit, the top-up plan gets activated.

  • Super top-up plan: This top-up plan provides additional insurance coverage after the medical costs exceed the threshold limit. While the top-up plan considers the threshold limit/deductible for every claim, the super top-up plan considers all the claims put together in a policy period.

In both plans, if the illness relapses within 45 days of discharge from the hospital, it is usually considered a single illness. However, if the illness relapses after 45 days from discharge, it is generally considered a fresh illness.

What is top-up health insurance?

A top-up health insurance plan enhances your existing health insurance policy’s sum insured amount. It provides financial coverage after you have utilised the maximum claim amount. When the set sum insured amount is exhausted, it acts as an additional layer of financial protection and backup to your primary health insurance plan.

For example, it was not until 1904 that a spare tyre was added to the car so that if the tyre got punctured, you have the backup in the form of a spare tyre. Top-up plans work in the same fashion as a spare tyre does to the car.

With advancements in healthcare infrastructure and technology, medical costs are always on the rise. Therefore it is essential to have a health insurance plan that comprehensively covers you against all types of medical emergencies.

When your medical expenses exceed the limit of your base health plan, top-up plans act as a safety net.

How does top-up health insurance work?

The primary health insurance plan covers medical bills up to the sum insured, while a top-up plan provides coverage after the sum insured has exhausted as per policy. Please note, the mandatory deductible is payable as per the terms and conditions of the policy.

For example: Suppose you have opted for a health insurance plan with a sum insured of Rs. 5 lakhs and enhanced the existing plan with a top-up insurance plan of Rs. 10 lakhs. Thus, the total sum insured amount is Rs. 15 lakhs with a set threshold limit of Rs. 5 lakhs.

If your medical bill is Rs. 8 lakhs, your insurer will pay Rs. 5 lakhs from your base plan and Rs. 3 from your top-up plan. Here is the example in a table for your reference.

Factors Top-up plan Without a top-up plan (Base plan)
Base plan (Sum insured of the base health policy) Rs. 5 lakhs Rs. 5 lakhs
Top-up plan Rs. 10 lakhs NA
Total sum insured (Base plan + top-up plan) Rs. 15 lakhs Rs. 15 lakhs
Threshold limit Rs. 5 lakhs NA
1st claim of the year Rs. 8 lakhs Rs. 8 lakhs
What the insurer pays Rs. 8 lakhs (Rs. 5 lakhs from the base plan and Rs. 3 lakhs from the top-up plan) Rs. 5 lakhs
What you pay Nothing Rs. 3 lakhs

Note: The top-up plans work on a per claim basis. Hence, the deductible rule will apply for each claim and not the total medical expenses incurred during the policy year. Meaning, only if the claim amount exceeds the deductible limit, the top-up plan will be active. 

Super top-up plans in health insurance

Super top-up plans are similar to top-up plans that enhance your health insurance sum insured. However, the difference is that super top-up plans work on the total medical expenses incurred during the policy year and not on a per claim basis.

Unlike the regular top-up health insurance plan that only covers claims when a single claim surpasses the threshold limit, the super top-up plan covers claims when the overall claims during the policy period are above the threshold limit.

In the recent past, there has been a massive improvement in healthcare infrastructure and pharmaceuticals. This improvement has resulted in an increase in healthcare expenses. Therefore, you must be well-protected with a health insurance plan that has the benefit of a super top-up plan and avoids higher out-of-pocket expenses.

How does super top-up health insurance work?

The base health insurance policy covers medical expenses up to the sum insured amount. In contrast, the super top-up health insurance plan provides financial cover after you exhaust the sum insured amount. Similar to the top-up plan, the super top-up plan covers expenses of the cumulative claim amount that exceeds the threshold limit.

For example: Suppose you have opted for a health insurance coverage of up to Rs. 5 lakhs and enhanced the existing plan with a super top-up insurance plan of Rs. 10 lakhs. Thus, the total sum insured amount is Rs. 15 lakhs with a threshold/deductible limit of Rs. 5 lakhs.

If your medical bill is Rs. 8 lakhs, your insurer will pay Rs. 5 lakhs from the base policy and Rs. 3 lakhs from the super top-up plan.

You need to note that the threshold limit is not considered for every claim in the super top-up plans but rather on the total hospitalisation bill during the policy period (cumulative claims). However, in the case of a top-up plan, the plan will only turn active if the medical bill crosses the threshold limit for each claim.

Here is the example in a table for your reference.

Factors Super top-up plan + Base Plan Without a top-up plan (Base plan) Top-up plan + Base Plan
Base plan sum insured Rs. 5 lakhs Rs. 5 lakhs Rs. 5 lakhs
Top-up/Super top-up plan sum insured Rs. 10 lakhs NA Rs. 10 lakhs
Threshold/deductible limit Rs. 5 lakhs NA Rs. 5 lakhs
1st claim of the year Rs. 8 lakhs Rs. 8 lakhs Rs. 8 lakhs
What the insurer pays Rs. 5 lakhs (base policy) + Rs. 3 lakhs (super top-up policy) Rs. 5 lakhs Rs. 5 lakhs (base policy) + Rs. 3 lakhs (top-up policy)
What you pay Nothing Rs. 3 lakhs Nothing
2nd claim of the year Rs. 4 lakhs Rs. 4 lakhs Rs. 4 lakhs
What the insurer pays Rs. 4 lakhs Nothing Nothing
What you pay Nothing Rs. 4 lakhs Rs. 4 lakhs

Importance of buying super top-up and top-up health insurance - Additional cushioning at lower costs

Here is why you should get a super top-up or a top-up health insurance plan.

  • Increasing healthcare costs: There is no denying that healthcare costs are rising daily. This means you need to get a comprehensive health insurance plan that offers a higher sum insured amount than a regular health insurance plan. The plan should also have the option to include a top-up or super top-up plan that gives you an advantage when the sum insured amount has been exhausted.

  • Higher sum insured: Top-up plans would not exist if there were no need for a higher sum insured amount, whether regular or super top-up. These plans offer you insurance coverage over and above the base or a corporate health insurance policy at a much lower premium as compared to individual health plans.

  • Higher coverage for senior citizens: You get extensive coverage at a much lower health insurance premium with a top-up plan.

  • An additional benefit to the existing plan: Compared to the regular health insurance plans, top-up and super top-up plans provide additional coverage during unforeseen emergencies.

  • Additional tax savings: Similar to other types of health insurance plans, top-up and super top-up plans come with tax-saving benefits.

  • Beneficial during rainy days: A top-up or super top-up is an excellent cost-effective method to ensure you are covered during uncertainties.

Eligibility criteria for top-up and super top-up medical insurance plan

Similar to other health insurance plans, top-up health insurance plans also come with the same eligibility criteria. While the exact details differ between insurers, the following are the main eligibility parameters to buy the top-up and super top-up health insurance policy.

  • Minimum entry age

  • Maximum entry age

Who should opt for the top-up/super top-up health insurance?

With uncertainties such as the COVID-19 pandemic and rising healthcare expenses, it is apparent that you should have higher health insurance coverage. If you fall under the following categories, you must opt for the top-up or super top-up plan.

  • Corporate employees: You may be covered by the corporate health insurance plan offered by your employer. However, the sum insured may not be enough. You can increase your sum insured by including add-ons to the base health insurance plan.

  • Parents and senior citizens: The medical expenses for senior citizens or parents are undoubtedly higher. Hence, the premium is higher as people grow older. The coverage increases with a top-up or super top-up plan and is relatively affordable compared to a regular health insurance plan.

  • Policyholders with low sum insured: If the sum insured amount of your health insurance is inadequate and does not have many benefits, you can opt for the top-up plans for a smaller premium compared to buying a new health insurance plan.

Inclusions in super and top-up health insurance plans

Following are the coverage details of top-up and super top-up health insurance plans depending upon specific coverage offered by an insurer.

Exclusions in super and top-up health insurance plans

Here are the non-coverage details of top-up and super top-up insurance plans depending upon specific coverage offered by an insurer.

  • Pre-existing diseases

  • Medical expenses during the waiting period

  • Self-inflicted injury

  • Pre and post-natal medical expenses, unless hospitalisation is required

  • No claim until you have exhausted the deductible

  • Infertility treatment

  • Plastic or cosmetic surgeries

  • Hospitalisation without doctor’s recommendation

Role of top-up and super top-up plans in senior citizen health insurance plans

Top-up plans offer that extra edge at a lower premium when the sum insured is exhausted. Here is the role that top-up plans play in senior citizen health insurance policies.

  • It acts as a shield against rising and higher health care costs for senior citizens.

  • It offers higher coverage at an affordable premium compared to regular health insurance plans.

  • It secures against risks of illnesses and diseases that may be common in senior citizens.

  • It helps save you money since it offers tax-saving benefits.

Difference between top-up plan and super top-up plan in health insurance

Both the plans provide financial support when the medical costs surpass the sum insured limit. While their primary aim is to offer additional financial protection, they differ in terms of coverage. In other words, a top-up health insurance plan will provide financial support for medical costs when your claim crosses the threshold limit. In contrast, a super top-up health insurance plan will provide for medical expenses when one or more claims (during the policy period), put together, crosses the threshold limit.

Here is an example of the differences between top-up and super top-up in health insurance.

Factors Top-up plan Super top-up plan
Base plan sum insured amount Rs. 5 lakhs Rs. 5 lakhs
Top-up sum insured amount Rs. 5 lakhs Rs. 5 lakhs
Threshold/deductible limit Rs. 3 lakhs Rs. 3 lakhs
1st claim of the year Rs. 8 lakhs Rs. 8 lakhs
What the insurer pays Rs. 8 lakhs Rs. 8 lakhs
What you pay Nothing NA
2nd claim of the year Rs. 2 lakhs Rs. 2 lakhs
What the insurer pays Nothing Rs. 2 lakhs
What you pay Rs. 2 lakhs Nothing

Which one to choose?

The top-up and super top-up health insurance act as a shield that helps if you exceed the limit of the existing base plan. But, both have different benefits.

If you do not suffer from a chronic illness or run the risk of a terminal ailment, you should choose the top-up plan. However, if you have the risk of a chronic disease that may require you to be hospitalised more once, you should choose the super top-up plan.

Benefits of buying a health insurance plan from ACKO

ACKO is a digital-first insurance company, and most of the transactions are through the digital platform. Whether you want to buy, raise claims, or renew the plan, you can visit our website or mobile app to transact directly with us. Here are some of the key benefits of buying health insurance from ACKO.

  • Continuous support: You can buy, renew, and register claims through the website or mobile app. The process is simple to follow and faster.

  • Zero paperwork: You can ditch the tedious paperwork and documentation while buying ACKO health insurance plans. There is no paperwork involved, and the process is entirely online.

  • A vast network of hospitals: You get access to more than 6,500 network hospitals across the country to avail of cashless claims.

Frequently asked questions

Here are some commonly asked questions about top-up health insurance plans.

What do you mean by deductible in top-up health insurance?

A deductible is an amount you (policyholder) must pay before the top-up, or the super top-up insurance plan pays for the medical costs. Suppose the top-up plan has a deductible of Rs. 3 lakhs, and the sum insured of the top-up plan is Rs. 10 lakhs. In case of a claim of Rs. 4 lakhs, you have to pay Rs. 3 lakhs, and your insurer will pay the balance of Rs. 1 lakh through the top-up plan.

What factors affect the top-up health insurance premium?

The factors that affect the premium of top-up health insurance are your age, geographical location, and the deductible and the sum insured amount you have chosen.

How can I top up my mediclaim policy?

You can top up or increase your sum insured amount by including the top-up or the super top-up health insurance plan. They provide financial protection when medical costs go above the sum insured amount.

Can I buy a top-up health insurance plan for my family?

Yes, you can buy top-up health insurance plans as a family floater or individual plans.

Can I purchase the base health insurance plan from one insurer and the top-up insurance plan from another?

Yes, you can buy the top-up insurance plan from another insurer based on the choice of the sum insured, threshold limit and availability of the plan.

What happens if my top-up or super top-up health insurance plan expires?

Similar to other health insurance plans, you will not be able to raise a claim since the policy is in inactive status. You need to renew the plan to receive the benefits of the coverage.

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