The health insurance sector in India has witnessed significant growth in recent years. However, despite this growth, many individuals still find that their existing health insurance coverage is insufficient to cover all of their medical expenses. This is where top-up health insurance comes in.
Top-up health insurance is an additional health insurance policy that provides coverage over and above your primary health insurance policy. It acts as a supplement to your existing health insurance coverage and can be used to cover medical expenses that exceed the limit of your regular health insurance policy.
What Is a Top-Up Health Insurance Policy?
A top-up health insurance policy is similar to a regular health insurance policy. The only difference is that the deductibles of the top-up plans make them affordable on the wallet. A deductible represents the maximum healthcare costs the insurer will cover.
What Is the Difference Between Top-Up and Super Top-Up?
Top-up health insurance is an additional insurance policy that you can purchase on top of your regular health insurance. The main advantage of a top-up plan is that it provides additional coverage at an affordable cost.
Here is an overview of two types of additional health insurance plans:
Top-up plan: This plan provides coverage by supplementing the sum insured up to a specified amount
Super Top-up plan: Unlike the Top-up plan, which considers the deductible limit for each claim, the Super Top-up plan considers all claims made within a policy period.
Benefits of a Top-Up Health Insurance Policy
One of the key features of a top-up medical insurance policy is that it is designed to cover significant expenses. Moreover, a top-up plan can also cover additional expenses which are not covered by your regular health insurance, such as ambulance charges, room rent, and more.
How Does a Top-Up Health Insurance Policy Work?
Let's consider an example. Suppose your current policy has a coverage limit of INR 10 lakhs, and you purchase a top-up plan of INR 7 lakhs. If you file a claim for INR 15 lakhs, your basic sum assured of INR 10 lakh will be utilised first, and the top-up plan will cover the remaining INR 5 lakhs. However, if the claim amount exceeds INR 17 lakhs, you would need to pay the remaining amount.
Understanding The Deductible Concept In Top-Up Health Insurance
The deductible in a top-up health insurance policy is higher than in a regular health insurance policy. The main advantage of a top-up medical insurance policy is that it provides high coverage at a lower premium. Since the deductible is higher, it lowers the premiums for the policyholder.
Calculating The Deductible In Top-Up Health Insurance
The deductible in a Top-Up Health Insurance can be calculated as follows:
In the event of a health insurance claim for INR 200,000, if your policy has a deductible of INR 70,000, then you will be required to pay the deductible amount. The health insurance company will cover the remaining amount of INR 130,000.
Who Should Buy a Top-Up Health Insurance Policy?
Here are a few factors to consider before purchasing a top-up health insurance policy:
Existing health insurance coverage: It is essential to make sure that your primary health insurance policy covers all your medical needs. If your current health insurance policy has a low sum insured, then it is recommended to opt for a top-up medical insurance policy
Family medical history: If you have a family history of a particular medical condition, you should consider purchasing a top-up plan
Situations Where Top-Up Health Insurance Is Recommended
There are several situations where top-up health insurance is recommended. Here are a few:
Self-employed individuals: If you are self-employed, it is crucial to have a comprehensive health insurance policy that covers all your medical expenses, as you would not have the benefit of an employer-sponsored health insurance policy
Older adults: As you age, the risk of developing chronic medical conditions increases. In such a scenario, having a top-up health insurance plan can provide additional coverage for medical emergencies
High-risk professions: If you work in a high-risk profession, such as construction, mining, or transportation, the chances of suffering a medical emergency are higher, and thus, a top-up plan becomes imperative
How to Choose the Right Top-Up Health Insurance Policy
Choosing the right top-up health insurance plan can be a daunting task. A few factors, such as deductible amount, coverage amount, waiting period, network hospitals, and premiums, should be considered before purchasing a top-up health insurance plan:
What Does a Top-Up Health Insurance Policy Cover?
A top-up plan is meant to step in when your medical bill crosses a certain threshold (that deductible). Once that limit is crossed, the top-up can help take care of the remaining eligible expenses, so you’re not left scrambling.
Here’s what top-up coverage typically supports (depending on your policy terms):
- In-patient hospitalization expenses: This usually includes room charges, doctor fees, medicines, and other hospital-related costs, after the deductible is met.
- Surgeries and major procedures: If a treatment involves a high bill, like surgery or an extended hospital stay, a top-up can be very helpful once your base policy limit gets exhausted.
- ICU and emergency care cost: ICU bills can climb fast. A top-up plan is often designed for exactly these high-cost situations.
- Add-on expenses (policy-dependent): Some plans may include expenses like ambulance charges, room rent variations, or other eligible hospital costs that your base policy may limit.
Quick reminder: top-up policies generally focus on bigger expenses. Day-to-day OPD costs, routine medicines, and non-payable items are usually not the main purpose of a top-up.
What Is Not Covered Under a Top-Up Health Insurance Policy?
This is the part people skip and then feel shocked later. Top-up plans aren’t “everything coverage”. They are “high expense support”, and exclusions still apply.
Here are common situations where a top-up may not help:
- Expenses below the deductible: If your bill doesn’t cross the deductible threshold, the top-up simply won’t activate.
- Non-medical / non-payable items: Things like toiletries, gloves, masks, and certain consumables are often not covered as per policy guidelines.
- Waiting period-related exclusions: Pre-existing conditions, specific treatments, or maternity benefits (if applicable) may be covered only after the waiting period is completed.
- Treatments excluded by the policy: Certain procedures, cosmetic treatments (unless medically necessary), or specific conditions may be excluded depending on your plan.
- Claims rejected due to documentation or incorrect disclosure: Missing documents or incomplete health disclosures can affect claims, top-up, or regular.
Role of Health Insurance Providers in Offering Top-Up Plans
Health insurance providers play a big role in making top-up plans actually useful—not just “cheap on paper”. The best insurers don’t just sell extra coverage; they make it easier to understand, easier to choose, and smoother to claim.
Here’s what to look for from a provider:
- Clear deductible options: A good provider offers multiple deductible choices so you can align the plan with your base policy and budget.
- Strong network hospital support: When the provider has a wide hospital network, coordination becomes easier, especially during high-cost hospitalizations.
- Transparent policy wording: You should be able to understand what triggers coverage, what’s excluded, and how claims work, without needing a decoder.
- Reliable claim support: When you’re dealing with a large medical bill, you want a provider that offers responsive claim assistance and clear timelines.
Conclusion
In closing, top-up health insurance is essential to your financial planning. Consulting with a licensed insurance agent or broker can help you find the right top-up health insurance plan that meets your healthcare needs and budget. In addition, an insurance agent or broker can help you understand the different policies available, compare the features and benefits of various plans, and provide expert advice on choosing the right policy.
ManipalCigna, one of the country's top health insurance providers, offers a remarkable top-up health insurance plan tailored to meet your specific needs.
FAQs
What is a top-up health policy?
A top-up health policy is an additional health insurance policy that provides coverage over and above your primary health insurance policy. It is designed to cover medical expenses that exceed the limit of your regular health insurance policy.
What is the difference between a plan and a top-up?
A health insurance plan provides coverage up to a specified limit, while a top-up health insurance policy provides coverage over and above that limit.
What is the minimum deductible amount for top-up health insurance?
The minimum deductible amount for a top-up health insurance policy varies from insurer to insurer. Typically, the minimum deductible amount ranges from Rs. 1 lakh to Rs. 5 lakhs.
Can I purchase a top-up health insurance policy without a regular health insurance plan?
No, you cannot purchase a top-up health insurance policy without a regular health insurance plan.
Will my existing health insurance provider offer top-up health insurance?
Yes, your existing health insurance provider may offer a top-up health insurance policy. However, comparing the benefits and premiums of the top-up health insurance policies is advisable before making a purchase.
Does top-up health insurance cover pre-existing conditions?
It depends upon your insurance policy provider. Some insurers may offer coverage for pre-existing conditions after a waiting period.
How does the claim process work for top-up health insurance?
The claim process for top-up health insurance is similar to regular health insurance. You need to inform the insurer about the medical emergency, submit the necessary documents, and wait for the claim to be processed. However, in a top-up health insurance policy, you must pay the deductible before the insurance company starts covering your medical expenses.
