Is Your Health Insurance Sufficient for you?

Written on Friday, April 29, 2016
By Narendra Anand - Head GI - La Premier & ANG

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Many of us feel relieved and protected having bought a health insurance plan. However, at times, inadequate coverage becomes a concern and therefore, a closer look to health insurance becomes imminent. Several factors are addressed at the time of buying - we tend to ask about the benefits, waiting period, pre-existing clause and what not, but we forget to analyze the adequate need. What we end up doing is that we make our own conviction and finally, buy an insurance. Very few of us actually make a need-based analysis.


Rising inflation could well send medical costs upwards. From hospitalization to various diagnostic tests, the costs seem to be increasing with every passing year. A seemingly large cover now, becomes shrunken, thanks to inflation and can really be a big blow to you in the future. Be it a hit on your savings or worse, you have to compromise on the healthcare quality – by opting for a cheaper doctor or hospital, it just isn't worth it. A concern for health insurance policyholders at such times is whether their existing cover would be adequate to meet any medical emergency. To tackle such concerns of policyholders, insurance companies offer Super Top-ups.


Topping It Up

A top-up health insurance plan is a regular indemnity plan that covers hospitalization costs, but only after a threshold limit is crossed. In insurance parlance, this limit is called deductible. A deductible is that portion of the claim amount that is not covered by the insurer and has to be paid by the insured person before the benefits of the policy can kick-in. So, if you already have a health insurance policy or are covered by your employer, the deductible limit can be paid by the employer’s policy and anything above that limit by the top-up cover.


Top-Up vs Super Top-Up

However, it is essential to understand the difference between top up and super top up. The difference between a super top up plan and a top up plan lies in its working. In a top up plan, the reimbursement for medical expenses is for a single illness. The expenses for a single injury or disease should be over the threshold limit to be eligible for a claim. In a super top-up plan, the expenses covered are for all illnesses put together that occur during an entire year. In other words, the total expenses in a year must be above the threshold level for the claim to be eligible. Super top ups prove to be more advantages as they would cover a range of ailments in a year.


How it works?

In a regular health insurance plan, expenses reimbursed are upto the sum insured in the policy. In a top up/super top plan, the medical expenses are covered on the basis of a threshold limit. This threshold limit (also known as compulsory deductibles) is the level from where the plan would start kicking-in. Any claims over and above this threshold limit would be entertained under top up/super top up plans. For example: - If the client has opted for a Sum Insured of Rs. 8,00,000 and an aggregate deductible of Rs. 2,00,000. The aggregate deductible is the amount that client’s existing health insurance policy will pay for medical expenses incurred. If he/she make 3 claims in a policy year and the total claim amount is Rs.10,00,000 then, after the initial Rs. 2,00,000 (aggregate deductible) is paid by him/her for current health insurance policy, the additional Rs.8,00,000 will be paid by us.



As far as health insurance needs rise, being covered under the corporate group plan of your employer or buying a policy for a tiny sum insured of, say, Rs.1-2 lakh is not enough. In fact, this is the most common mistake that people make with health insurance, which is to settle with little cover or for the one given by the employer. Medical costs have skyrocketed and the process to port health insurance from a corporate plan to an individual plan is not smooth. But, not everyone can afford to buy sufficient health cover. For such individuals, a health insurance top-up plan is an excellent way to increase the cover, while keeping costs in check.  Having an adequate coverage is a must for all of us in order to be worry-free from health issues, however, don't shed away all your hard-earned money as well, therefore, start investing in smarter options and stay protected.


Things to remember before buying a top-up plan

Consider the exact requirement for self or for the family.

The top-up plan's deductibles should be less than or equal to the base policy sum insured.

Top-up plans provide dual benefits of low cost and higher sum insured.

For all those, who have parents about to enter the senior citizen category, this would be the perfect product. As that is the time, when the probability of falling ill is high and medical expenses are bound to increase.

For the salaried, who are covered under employer’s health insurance policy should also buy a top-up plan for higher protection.

Top-ups are one of the cheapest and best way to enhance your coverage, without shelling-out a lot of money. Build them into your healthcare planning. It’s simple, cheaper and effective.

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