Top up & Super Top up Health Insurance Covers – How they work ?

POSTED BY manish ON May 9, 2013 COMMENTS (133)

What do you do when you want to take a very high health insurance cover like 20 lacs? Is the only option a regular health insurance plan? In this case, you can use top up health insurance plans, which are one of the best ways to enhance your health cover after a certain threshold? In this article lets understand how top up and super top up health plans work and how they benefit you. So we will understand both “top up health insurance” and “Super top up health insurance” in this article, but let’s understand first what the meaning of “Top up” is, in general.

What is the meaning of “Top Up” Cover ?

A top up cover actually covers you after a “threshold limit” is already exhausted or used. To give you an example lets say you have a top up health cover of Rs 10 lacs sum assured with the threshold limit of Rs 5 lacs, in which case the policy will only cover your expenses beyond Rs 5 lacs only. If your claim amount is Rs 8 lacs, then it will only pay you Rs 3 lacs (8 – 5), and NOT Rs 8 lacs total. That’s the main difference between a regular health cover policy and a top up cover.

So now if you already have a health insurance cover of Rs 5 lacs sum assured, then you can take a top up cover up to Rs 10 lacs with threshold limit of Rs 5 lacs, that way you will be covered up to 10 lacs. The first policy will cover you up to Rs 5 lacs, and the top up cover will cover you for the 5-10 lacs range. You can understand that more clearly with following image.

Suppose you have following 2 policies.

  • Policy A –  Regular Health Insurance Plan with Rs 5 lacs sum assured.
  • Policy B –  Top up cover of Rs 10 lacs with threshold limit of Rs 5 lacs.

top up health insurance plan

Now let’s take this same example and try to understand how Policy A (Regular Health Insurance) and Policy B (Top up health insurance) will pay you in 3 different scenarios, just to make sure you fully understand how top up health insurance policies work.

Scenario 1 – Claim of Rs 3 lacs

In this case, the first policy will cover you for full Rs 3 lacs, as your policy itself is for up to Rs 5 lacs.

Scenario 2 – Claim of Rs 8 lacs

In this example, the first plan A, will cover you up to Rs 5 lacs, but if your hospitalization expenses go to say Rs 8 lacs, then the first policy will only pay Rs 5 lacs, but the second policy (B) will cover you for the rest of  the Rs 3 lacs, which is above the threshold of Rs 5 lacs.

Scenario 3 – Claim of Rs 12 lacs

In this case, first policy A will pay you Rs 5 lacs, and the second policy B, will pay you next 5 lacs only, because you have taken a top up cover of up to Rs 10 lacs only. So the Rs 2 lacs extra, you will have to pay from your own pocket.

What is Super Top up Cover ?

Just like a top-up cover, there is something called as Super Top-Up cover, with a very small difference. A top-up cover will pay you only if your claim amount (bill for a single hospitalization) is above the threshold. Like, in our example above, the top up cover will help you only when your bill is above Rs 5 lacs each time, only then it will come into picture, like in the case of the Rs 8 lacs bill, then the top up cover will pay you an additional Rs 3 lacs. But if you have two bills of Rs 4 lacs each, then the normal Top up cover will not help because no single bill amount is above the threshold limit of Rs 5 lacs.

That’s where Super top up plans come into picture, which takes into consideration the TOTAL of the bills in a year and not just the single instance. So in case of two bills of Rs 4 lacs each, your total bill is Rs 8 lacs (above threshold limit of Rs 5 lacs), then Super top up cover will pay you, where a Top up cover will not.

Let me clear that with a more detailed example by using the chart below

difference between top-up and super top-up health insurance cover

Companies Offering Top up and Super top up plans in India

Companies offering Top up

  • Apollo Munich OptimaPlus
  • Bajaj Allianz Extra Care
  • Bharti Axa High Deductible Health Insurance
  • ICICI Lombard Healthcare Plus
  • Star Health Super Surplus
  • United India Top up Health Insurance

Companies offering Super Top up 

  • United India
  • HDFC Ergo Health Suraksha (offering to bank and credit customers, currently)

Let me give you a comparison chart of the current Top up health insurance plans in India at the moment. Not many Super top up plans, so they are not in the chart while comparing.

top up health insurance policies comparision

Super Top up Cover for Employees having group cover from Employer

A lot of salaried employees already have a group cover from their employer and they feel that they should not waste their money in a separate health insurance policy (which is not quite a right way of thinking, and you can read this article to know why I say that.) A top up cover is a very useful way for those employees to extend their cover beyond a point.

Lets say you already have a 5 lacs cover from your employer, but you feel that it’s insufficient and you wanted to have a cover up to Rs 10 lacs. Now, one way of doing it is to take a separate cover of Rs 10 lacs, but you can take a top up cover of up to Rs 10 lacs with threshold of Rs 5 lacs (as you are already covered from your employer up to 5 lacs). This way you will be covered up to 10 lacs. But understand that in that case you will have to claim your expenses multiple times.

Additional Health Insurance cover or Top up cover – Comparison

Just give me pointers, I will write about it, or just send me an example where we are comparing a 10 lac cover with A 5 Lac cover + top of 5 lacs

When does a top cover policy makes sense – Hear from experts

So is topup or super top up cover the best option to upgrade your health insurance coverage ? No !. Here is what Mahavir Chopra, a health insurance expert suggests –

Most Insurance advisers recommend a top-up plan to upgrade your coverage. In terms of convenience of purchase and claims, we would recommend upgrade of the same health insurance policy, as the best option. This is of-course, provided you are happy with the policy terms and services.

The second best option would be to compare available options of Super Top-up with option of Additional Mediclaim Policy. If the premium is more or less the same, we would recommend additional policy more than a Super Top-up.

After all the above options, look for the option of a simple top-up to increase your cover. Be sure you are aware of the fact, that this option is more useful in the very long term (6-10 years), since it will trigger only when your one claim goes above the threshold/deductible mentioned in the policy.

Features of Top up Health Insurance Plans

Let me tell some more points and features about the top up plans so that you are more clear about it and if its useful for you or not

1. Cheaper than regular health insurance plans – You have already seen that they are cheaper than the regular health insurance plans because they cover you only beyond a threshold, the probability of which happening is very less.

2. You can buy it from anywhere – You can buy a top-up cover from any company, there is no compulsion that you need to have another cover from same company. In-fact there is no requirement that you should have another health cover at all. You can just take a top up cover even if you do not have any other health insurance product. If you want the expert advice on super topup products, Coverfox can help you buy the right policy.

3. Available with the option of individual and Family Floater Cover – A top up cover is available as individual cover and also as a family floater. So you can extend the cover for your entire family. Just that some policies might consider parents into family floater and others might not.

4. Concept of Pre-existing illnesses and Exclusions – Just like a normal health cover policy, even a top up cover can impose the restrictions on the pre-existing illnesses and exclude the diseases which they feel they do not want to cover. Also some top up covers might not cover pre and post hospitalization expenses. Some policies like Bajaj Allianz Extra Care provides continuity for already existing main policies. For instance, if you have a policy for 10 years with say New India Assurance, and you are buying a Top up from Bajaj Allianz, you will get continuity for the 10 years on the top-up and hence the waiting periods will not apply to you.

5. Tax benefits under Section 80D – You can get the tax benefit under sec 80D for the top up cover policies

6. Cashless facility would be difficult – I am not sure on this one, please guide! You need to follow the same cashless procedure, when your hospital bill exceeds the sum insured of main policy. If you are aware in advance about the high hospital bill, ensure you intimate at the time of admission itself.

Are you looking for extending your health insurance cover using a top up or a super topup cover ?

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133 replies on this article “Top up & Super Top up Health Insurance Covers – How they work ?”

  1. Nitin Gupta says:

    Hi Manish, i think there is a mistake. as per my understanding.
    if i buy a top up policy of sum insured 10 L with deductible 5 L. and i have a base policy of 5 L so it means i am getting total cover of 15 L.
    from your article getting impression that we will get total cover of 10 L only.

    1. No , its a 10 lacs coverage only.

      The base cover will cover 0-5 lacs
      10 lacs cover with 5 lacs deductible will cover 5-10 lacs cover.

      However note that some companies use words differently .. Check with company exact thing

  2. bhuppi says:

    Hi manish,

    Its a nice article for understanding the super top up plans working.
    My case is, I have a employer cover of 3 L for my entire family(myself, spouse, 2 daughters & mother). On coverfox they suggest me for separate plans for my mother & rest family. So in condition my mother has exhausted my employer insurance cover i.e. 3 L then she can get above 3L amount from the super topup policy for my mother, but what about rest family topup plan. As the base cover was not exhausted on rest family,so will the super topup plan for rest family consider the bill for payment (whatever the bill will be as the base plan limit is reached).

    1. I think they are suggesting correct. You should take a seperate plan for your mother for you . Have you already taken the plan?

      1. Bhuppi says:

        Thanks Manish for reply. Still I haven’t taken the plan, since I didn’t find any answer for my question asked above.

        1. You should take two super top up policies. One for your mother and one as floater one for your other family members. Let me know if I should connect you back to coverfox team. Wondering if you went to coverfox using out link ? I mean by clicking on some link on our blog, so that they know that you are our reader and they take good case of you

          Manish

  3. Prashant says:

    Hi Manish…want to buy family floater plan.but confused between supertop and regain plans…hdfc ergo gives both plans.so to increase cover which is to opt …base plan+ supertop up / plan with regain option.pls comment..thanx

    1. Hi Prashant

      Thanks for asking your health insurance question. We will get on call with you and help you resolve your query. Please fill up your details at

      https://www.jagoinvestor.com/services/health-insurance

      We will call you back

      Manish

  4. Sunildutt says:

    Hi Mohit ,

    Its great way to go and understand the insurance ,when lots of options available then more confusion creates.

    We are three of in family myself (age 44) , wife (age 43) and son (age 3)

    My queries are below:
    1) I have base policy of 10 lakhs ( Family floater )(premium Rs.38000/-) want to reduced this year by Rs.5 lakhs (premium Rs.23000/-) and go for super top up Rs.20 lakhs (premium Rs.5000/- ) – Is it advisable – since it saves on premium as well as increasing coverage . I will get coverage of Rs.25 lakhs in a premium of Rs. 28000/- , instead of taking 10 lakhs in Rs.38000/-
    2) Or should i take super top up separately for me and son as family floater , and one individual for my wife .
    3) what is the concept of threshold limit ? If I am not wrong then if i have 5 base + 20 super top up then over all i get 25 lakhs coverage , with first 5 lakhs exhaust, and then remaining from super top up .
    4) If i am not going for separate super top up for my wife , and continue with family floater – then in that case if in a year one family member claim for any critical illness , then can another family member will claim for the same in that year , or it will exhaust .

    please advise urgently ,as my policy is on renewal .

    Thanks and regards

    2)
    2)

    1. Hi Sunildutt

      Thanks for asking your health insurance question. We will get on call with you and help you resolve your query. Please fill up your details at

      https://www.jagoinvestor.com/services/health-insurance

      We will call you back

      Manish

  5. Nakul says:

    Hi,
    If the base medical policy gets changed, what happens to the top up cover?
    I am covered from my employer for medical insurance and thinking of buying an additional top up plan, what will happen if i change to a different employer which will have a different sum assured

    1. There is no link between base policy and top up cover. Top up cover is independent of it .

      If you take a topup cover of 10 lacs with 5 lacs deductible, that only means that if expenses are above 5 lacs , like say 8 lacs, then on producing the bills etc, they will settle the rest of the claim . thats all !

  6. Anil says:

    My father has new india assurance parivar mediclaim poilcy sum insured 3 lakhs, however the agent was saying that if hospitalized approx 50 % is refunded. So if he takes a top up of 5 lakhs and the hospital bill is four lakhs. The first 3 lakhs would be covered by New India assurance and the remaining 1 lakhs by the top up plan. But from the initial 3 lakhs he would still have to pay 1.5 approx from his own pocket right? or is there a way out?

    1. I dont think there is a way out . You shouls take a totally new separate policy for this which does not have any copay

      1. Anil says:

        Thank you for the reply

  7. ChiragJain says:

    Can you give me the list of Top up Product and Super Top Up products currently available in Indian Market ?

    1. Hi ChiragJain

      Thanks for sharing your health insurance requirement. I think the best think you can do is leave your details at https://www.coverfox.com/jagoinvestor . And you will get a expert assistance on selecting and buying the right policy for you.

      You can then take the decision.

      Manish

  8. rvramani says:

    I have really have a big doubt. In case of necessary will these companies pay the expenses fully or try to disown the responsibility of payment of expenses and try to make profit? This doubt has come to me because of an incident I came across. A gentle man who has accident insurance died on accident. His wife, who has school going children, submitted claim papers. One fine day, a person from the insurance company came and said she will get only few lakh rupees but not full insurance and insisted her to sign papers for that lesser amount. Probably he offered leser amount seeing her dare need for money. She refused to sign and informed the agent. The agent insisted for settlement for full claim and told the insurance company that if they cheat the public like this no body will do insurance. With his interference only the woman got full amount. He is an exceptional agent as generally these agents will not see the face of the insured when in need.

    1. I am not sure if this case is true or not. Because is not how it operates. THe claim is settled in full only !

  9. Vijay says:

    Hi Manish,

    I have a confusion regarding this specifically related to limits and thresholds.
    My base insurance is 8Lakhs from New India which has a limit of Rs 24000 for cataract and the top UP from New India (with threshold of 8L) the limit for cataract is 50,000.

    So my question is how much exactly will I get if the doctor charges 40000 for the cataract operation.
    Will 24000 be passed under main policy and remaining 16000 under top up OR
    I will get only 24000 and nothing under Top Up since threshold of 8L is not crossed.

    Regards,
    Vijay

    1. Yes, top will not come into picture in your scenario . It comes in to picture only when your bill is above the threshhold limit !

  10. Nikhil says:

    I have a query regarding Super Top Up Policy and Co-payment.

    Suppose I have an existing insurance with comp. A for 4 lacs with 20% co-payment. Now, I want to buy super topup of 5 lacs. How will that work out ?
    My existing policy (from A) gives me upto 4 lacs for claims upto 5 lacs (20% i.e. 1 lac has to be borne by me).
    Does, the situation change if I buy a super top up of 5 lacs from comp. B ?
    My guess is that, I will still have to pay 1 lac co-payment and super topup will come into picture only when I exhaust 4 lacs from existing insurer (i.e. through bills of 5 lacs in a year).

    I need clarification over the same.

    Thanks
    Nikhil

    1. You can buy a super topup with deductible of 4 lacs in that case.

      I think the best think you can do is right now is leave your details at https://www.coverfox.com/jagoinvestor . And you will get a expert assistance on selecting and buying the right policy for you.

      You can then take the decision.

      Manish

  11. Arun says:

    Sir,
    you mentioned that “In-fact there is no requirement that you should have another health cover at all. You can just take a top up cover even if you do not have any other health insurance product”

    Kindly provide more info on above quote.. (i think in that case we have to pay the bill upto threshold)

    also pl confirm whether above is true for super top up also.

    thanks & best regards
    Arun Gupta

    1. Yes, its true for super top up .

      You can just take a super top up with 10 lacs insurance with 5 lacs deductible , means you have to bear the expenses upto 5 lacs and above that upto 10 lacs the super top up will pay off !

  12. Salil says:

    Hi Manish,
    Thanks for a very helpful blog. I really appreciate the detailed info. that you have provided and also your prompt responses to queries raised.
    I (age 42) have an existing policy with my mother (age 67) from United India Insurance. My sum assured is 5 Lakhs while it is only 1 lakh for my mother. My father(age 73) has a separate policy with sum assured of Rs. 50 K only. I feel that all the sums assured should increase thinking long term (especially for me). I have following 2 questions –
    1. In my case, I can take the super top up from United India – as per the above article. (I am single, so family floater is not applicable). I however feel that taking the long term view, this floater provided will be insufficient. What is the way out – Is it better to go for another basic + floater policy from some other company – so that together the limit is higher or should I take only additional floater policies of United India + some other Company ? (By long term view, I mean that currently I am healthy but I do not know about the future).
    2) What can be done in case of my parents ? They are healthy as of now but future is uncertain. I am told that because of the age, United India will neither increase the sum assured nor will they give any top up.
    Kindly advise.
    Thanks,
    Salil

    1. In both the cases (for yourself + parents) try to increase the cover to 5/10 lacs from existing insurance company . Super topup is to be taken once you have a base policy for a good sum assured.

      I think the best think you can do is right now is leave your details at https://www.coverfox.com/jagoinvestor . And you will get a expert assistance on selecting and buying the right policy for you.

      You can then take the decision.

      Manish

      1. Salil says:

        Hi Manish,
        Thanks for your advise. Just need one more clarification – In my case, I already have a basic cover of Rs. 5 Lakhs from United India Insurance. I feel it is insufficient but United India has refused to increase the same. In this case, should I go to some other Govt. / private insurance company and take additional basic cover of say Rs. 5 Lakhs ?

        1. Yes, its suggested . You can go for a super top up policy at a small cost.

          I think the best think you can do is right now is leave your details at https://www.coverfox.com/jagoinvestor . And you will get a expert assistance on selecting and buying the right policy for you.

          You can then take the decision.

          Manish

  13. Amit says:

    Dear Manish,

    Your blog confused me. After considerable research on the internet and going through the explanation as given in L&T super top up policy brochure, I deduce the following,
    There is an inherent flaw in the article.

    Reproducing a part of your article, as below to point out the same,

    “Suppose you have following 2 policies.

    Policy A – Regular Health Insurance Plan with Rs 5 lacs sum assured.
    Policy B – Top up cover of Rs 10 lacs with threshold limit of Rs 5 lacs.”

    This basically means you have a total coverage of,
    (5L + 10L) = 15L ( Base policy + Super Top up policy)
    and not 10L as stated in the article.

    Therefore in the given scenario 3: Nothing would be payable by the claimant until the claim amount exceeds 15L.

    Threshold limit on the Super top up or Top up policy signifies that these policies would trigger only when they are above the specified threshold value, but the sum Insured is over and above the base policy.

    Another example, United India Insurance Super top up policy premium chart says 3 L super top policy with threshold value of 3 L. As per the above article super top up policy would never get triggered.

    These are my observations logically based on the policy docs of different companies.

    Amit

    1. Hi Amit

      when we say 10 lacs of top up policy with 5 lacs of threshhold, we mean that the coverage is from 5-15 lacs band .

      So if bill is less than 5 lacs, the first policy pays.
      If its 8 lacs, then 5 lacs is paid by first and rest 3 lacs is paid by top up
      If its 20 lacs, then 5 from first, 10 from second and rest is borne by you!

      I hope you get it now ?

  14. AayushArya says:

    Hi Manish.

    I’m planning to get an ICICI Lombard iHealth family floater plan for my parents and sister along with an L&T Super Top Up. I want a total cover of ₹15 lac or more. Does it make more sense to go with a ₹10 lac base policy and ₹10 lac super top up, or should I make it ₹5 lac base and ₹10 lac super top up?

    I also have some feedback for you: you keep recommending Coverfox in your posts but you never seem to mention anywhere that there are other insurance companies apart from the ones Coverfox deals with. In all my research (looking at Mint’s health insurance ratings and checking out ICICI’s historic claims settlement ratios and time taken to settle), it emerges quite decisively that ICICI Lombard is the best health insurance provider in India by a wide margin. And yet, going by your recommendation, your readers would never even hear about it. I’d love to hear your thoughts on this.

    Thanks for running this blog, it’s a singularly excellent resource!

    1. Aayush

      I would suggest going for 10+10 combination. Regarding COverfgox. Note that coverfox is a broker which we are recommending. We do not recommend insurance company because it depends on your requirement. Regarding ICICI Lombard, It might be great in few aspects, but overall if you see there are some really good plans from Religare, L&T , Max bupa … so it differs from case to case.

      Dont go with ratings, its nothing but an algorithm run for few parameters, which gives a broader idea about a product. It cant be a criteria for selection. Buying a product based on Rating is like hiring an employee based on their CGPA .

      Manish

    2. Rajasekar says:

      Hi Aayush arya,

      How was your experience with L&T Super Top up? Have you done enough research on it? Will you recommend me to go with it?

  15. Kishor says:

    Hi Manish,
    Nice and detailed info.
    I have one question. if Super top is going to help in case of either single or multiple bills, then why one will go for TOP up. Everyone will by Super TOP only. I want to understand if there is any advantage of TOP UP policy over SUPER TOP policy? pl. let me know
    –kishor

  16. KK says:

    Hi, I am a long time follower of you. Is your association with Medimanage over, as you are recommending your readers to visit Coverfox?

    1. Yes KK

      Thats true, at any point of time, we want to associate with someone who is best in its category. We feel Coverfox is really good for insurance needs. HOwever incase you have personal comfort with other company, you should go to them ..

  17. Shirish says:

    Does a super top of 15 lac with 5 lacs threshold has any advantage with a 10lac base ? I have an existing 10 lac mediclaim from united india and I am planning to for 15 lac super top with 5 threshold from United india

    1. I think 10 lacs base with 5 lacs extra top up is better . I would like 10 lacs option

  18. Anurag says:

    1. United India has a super top-up plan, Insurance cover 7 lacs and threshold limit 3 lacs. This means total insurance cover is Rs. 10 lacs ( 3+7) or 7 lacs ( 3+4).

    2. Can we combine 2 policies. For example if I have one policy of 3 lacs and it gets exausted and I have another policy of 2 lacs. Can two differ policies be used for one treatment in continuation.

    1. Yes anurag

      Two policies can be used for a single treatment

      1. Prabhu says:

        Hi, could you please clarify the first query from Anurag, regarding total insurance sum, is it 10 or 7?

        Thanks in advance

  19. sameer says:

    I have a 3 lakh base policy from employer covering me,son,wife and parents.i am planning to take super top up Apollo Munich super top up family floater but it covers only me,son and wife…so my question is what will happen if for a 7 lakh super top up plan and lakh deductible if my parents utilise 2 lakhs of base policy and then after 5 lakhs claim comes from me.so will I have to bear 1 lakh or 3 lakhs as parents are not covered in super top up..kindly guide or suggest super top up with parents also included along with wife and son

    1. Hi sameer

      Thanks for sharing your health insurance requirement. I think the best think you can do is leave your details at https://www.coverfox.com/jagoinvestor . And you will get a expert assistance on selecting and buying the right policy for you.

      You can then take the decision.

      Manish

  20. SheelJain says:

    I am already having 5 lac health coverage from Oriental Insurance for me ,wife and son . I am 59 yrs. . I want to have a super top up plan for another 5 to 10 Lacs. Please advice about the best companies and plans.
    Thanks

    1. Hi Sheel

      Bajaj has a good top up policy and even some more companies have it, I suggest that you reach out to https://www.coverfox.com/jagoinvestor/ and leave your details there . You will get dedicated support from Coverfox on this .

  21. Vinay says:

    Thank you for the very useful information on top-ups. I have two questions

    1. If I have two full fledged health policies – one from employer and one personal – in the event of a claim exceeding the limit of one policy how can I can claim the excess from another policy because the documents would be submitted to the first insurer. In this case does it make sense to have two full fledged but different insurance policies?

    2. If I opt for Top-Up/Super-Top over my employer mediclaim, how will the claims process work with the super top up insurer? Again all claim documents would have gone to the group insurer. This would be a problem especially if the group insurer and top up insurer are different.

    Regards
    Vinay

    1. Vinay

      1. In multiple claims the first company gives a declaration letter and writes that originals are with them . As a Industry standard , its accepted 🙂

      2. THe same answer as 1st

  22. Yogesh says:

    Very useful information. Let me know I have family floter plan of 4 lac including critical illness.from appolo Munich Now I want to make another 5 lac Health insurance cover for me. It is advisable to take topup or superior or by purchase another health policy.? And it must be whole family or only for me? Write now I am 40 years old. N its good to take policy from existing company.
    Pl guide
    Regards
    Yogesh kathe

    1. Hi Yogesh

      Thanks for sharing your health insurance requirement. I think the best think you can do is leave your details at https://www.coverfox.com/jagoinvestor . And you will get a expert assistance on selecting and buying the right policy for you.

      You can then take the decision.

      Manish

  23. GUNASEKARAN says:

    sir,
    will you pls let me know whether the insured have the option of selecting TPA at the time of taking health policy as well at renewal time.

    also pl advise me for top-up, super-topup whether insurance company gives cashless id card
    tks
    Gunasekaran

    1. TPA is fixed .

      Yes, you get the cards !

  24. Mojo says:

    Dear Manish,

    Thanks for nice article ! Just wanted to know which policy you have opt ?

    1. I dont have any top up

  25. Ashish Gupta says:

    Can you please update list of companies offering Super-top up? I think L&T also does now, apart from United India. But everyone uses confusing terminology and explanations are not clear. Also, does super top-up necessarily have to have regular mediclaim for deductible or cash payment of deductible is fine?

    1. Hi Ashish Gupta

      Will update it . thanks

  26. Binny Rehsi says:

    Hi Manish, First of all, I want to thank you tonnes for providing such useful information to us. Im 33 and in a way, buying a fresh policy for myself as I’ve recently left my job. I want to insure my father’s (69) and mother’s (60) health too. Could you please suggest-

    1) Whether I should buy individual policies for each of us or family floater
    2) What is the right age for taking a top up policy considering its long term benefits as explained in Point #10 in https://www.jagoinvestor.com/2015/02/buy-health-insurance-in-india.html? Should I take a top up policy for myself right away, or wait for a few years?

    Regards

  27. rajesh says:

    Hi Manish. superb article. Thanks a lot. I have taken ICICI LOMBARD family insurance. It’s running from 3 yrs. So far no claims. Now I am 39yrs. How far is it better to shift to another (thinking of star) insurance company??. Just to increase the sum assured with the same premium as I am paying now. now I am paying around 8k for 3 lakh insurance. In star it is 9k for five lakh insurance. What r the pluss and minus points of shifting to another company (portability).

    1. Hi Rajesh

      I think that needs some careful analysis on pros and cons. What you can do is , visit https://www.coverfox.com/jagoinvestor/ and leave your details there, and I am connecting you to them on your query. You will get expert advice on this.

      Manish

  28. Swapnil says:

    I have 5 lac mediclaim policy 2012 from NEw India for myself + 2lac{Son} as one policy and other 5lac mediclaim for my spouse.

    What options i should go for as i am turning 40 now for increasing the cover.
    a] take a new policy ? if Y which. I staay in Mumbai
    b]Upgrade mediclamim ? is this possible? or new policy from UnitedIndia of 10 lac is good.
    c]Hdfc Ergo Super top or LT policy reviews.

    I am a business owner self employed pl advice.

  29. cnu says:

    Hi,
    I have company provided insurance of 3 laks is active since my baby born. She has to undergo a surgery in 6 months, since company provided insurance is already existing from last one year, can we reduce the term for pre existing disease to 3 yrs if I go with Bajaj Allianz? Please comment..

    Thanks in advance

    1. I dont think it will help , Once the expenses are already near by and its predictable , no company is going to cover it !

  30. Nitin says:

    Manish ji/ Mahaveer ji,
    I am covered upto 6 lacs with Oriental happy family floater taken thru Medimanage 2 yrs back. My age is 42, my wife 39, child 12 years. Now the third policy claim free renewal is due on 23 Dec 2014.
    1. Should I upgrade my existing policy to 10 Lacs from Oriental. Premium for adding 4 lacs is 7686.
    2. Or is it beneficial to take Super top up plan from L&T insurance. The premium is 2966 for 5 LAC deductible with coverage 10 LAC.
    Please guide as i m lil bit confused.
    Thanks

    1. You can renew it now .. Its good time to increase it to 10 yrs ..

      I will connect you to medimanage for this .

      1. Nitin says:

        Thanks

  31. Nikhil says:

    Manish, can you plz confirm Star Helath company have “Super Top Up Plan” ?, as there call center person told me they have , but i doubt.

    Regrd,
    Nikhil

    1. As far as I understand, its a top up policy . https://www.starhealth.in/supersurplus.php

      Do one thing , if you want to take it , you can take FREE help of our health insurance experts . Just fill this form

      https://www.jagoinvestor.com/services/health-insurance#fill-form

  32. sundar says:

    Hi Manish,

    I have 3 lakhs health coverage from my employer (myself, spouse and 1 kid). I feel we are under insured. should I buy new health insurance policy or go for super top up from united india.

    Thanks
    Sundar

    1. 3 lacs is too low these days .. You can go upto 10 lacs cover . I am mailing you for this

      Manish

      1. sundar says:

        Hi Manish,

        Thanks for the reply .In this case, shall i go for a new policy or a top up cover of 7 laksh with 3 laksh as deductible.

        Thanks
        Sundar

  33. Dominic says:

    Is the new Apollo Munich Super Top is really Super Top up as described in your article above? Could someone please comment.
    Regards Dominic

  34. Bipin says:

    Hi Manish and Manoj,

    I have a 3 lakh family floater from employer. I want to have one more family floater policy of 10 lakh.
    I am planning to take an additional policy form Max Bupa.

    Please advice if I should take a policy or go for supertops?

    Regards
    Bipin

    1. You can go for a policy itself , did you buy one ?

  35. pavithran says:

    I am an ULIP health Plan from ICICI prudential for Rs. 5 Lakhs, could u please suggest me a good top up plan please

    1. We have already listed some of them in this article, you can choose one of them !

  36. Ankush says:

    Hi Sir,
    I have few doubts:
    1. I do not have any medical insurance for my family +parents.I have only group medical insurance of Rs 3 Lac from my employer for myself+spouse+child+father+mother. Can I take the top up medical plan of 10Lac/3Lac considering my group insurance as my base medical insurance?

    2. If I quit job then I will not be eligible for any medical group insurance. So in that case can I continue my top up policy of 10Lac considering I will pay the deductible 3 lac from my pocket?

    3. In the group insurance scheme there is no waiting period or any pre-existing disease condition or any limit of amount. So will these top up plans follow the same conditions or what will be the changes.

    4. Which is the best company to go with for top up and super top up?

    Thanks,
    Ankush

    1. 1. Yes
      2. Yes, you can continue it
      3. No , they will have their own conditions, they are in no way related to your group cover
      4. There is no one company , Read this – https://www.jagoinvestor.com/2013/05/increase-your-health-insurance-cover-with-top-up-super-top-up-plans.html

  37. rajiv bansal says:

    sir,
    i am having an apollo optima restore policy for rs 5 lacs with rs 5 lacs bonus. it is a family floater for family of 4.bonus is now activated.
    i also have an icici Lombard top up for rs 10 lacs with rs 4 lacs deductible.for myself and my wife
    who will pay what in the following cases

    scenario 1 : – single claim of rs 25 lacs.

    i hve talked to 2 agents who say Apollo 10 and icici 10 next 5 self

    scenario 2 :- single claim rs 15 lacs
    can i limit my claim to Apollo to 5 and claim bal 10 frm icici
    or are they co-insurers who will share the claim like first 4 Apollo/next 6 shared/next 4 icici
    or 10 Apollo and 4 icici
    maybe irritating questions but i am not clear nor are the company representatives.

    thanking you in advance

    yours truly

    Rajiv bansal

    1. Yes, both the options is possible , depends on what you want

  38. Balaji says:

    Hi Manish,

    I realized during a recent illness that when the hospital charged 3 lakh to insurance, it was actually only around 2.2 lakh if I had paid in cash. Since it was insurance, they inflated the bill.

    Hence, I plan not to take insurance upto 2 lakh and pay in cash (hopefully the savings on premium will pay for itself in 5-7 yrs) and take only a super top up cover for 10 lakhs with a 2 lakh deductible.

    Can I take a super top up cover with a thresh hold without having a base policy; or is it a condition for super top up that I should have a base policy.

    1. You can take a super top up or top up without having the base policy. I agree that hospitals inflate the bills if they come to know that you have health insurance !

  39. Suraj Shetty says:

    I have a query . I checked for normal health insurance for 10 lacs for my age (34) and found it was just 1000 more than 5 lac . Whereas the the top up of 10 Lacs with 5 lacs deductible cost around 2K . So doesn’t it make more sense to just extend your main health cover to 10 lacs instead of taking a top up ?

    Or is it that as we grow older the gap between 5 lac and 10 lac coverage grows and Top up insurance then ends up being cheaper ?

    1. Top should always be taken only when you are not able to take the proper full health cover. So I suggest you go for full cover

      Manish

  40. Superrn says:

    Dear Manish,
    I believe that you dont understand the meaning of topup.

    For eg. Apollo offers a top up policy 0f 5 lac sum insuredwith 5 lac deductible.
    If we go according to your explanation then the benefit is nil!

    Regards

    1. True , then the benefit would be NIL . It has to be 5 lacs of additional top up after 5 lac deductible .

  41. feroz says:

    who is the best top up plan?

    i have 3 lakhs max bumpa i need top up 10 lakhs in family floater

    best plan and 100% claim no sub limit plz help me

  42. Mustafizur Rahaman says:

    Hi Manish,

    After going through all the above comments & comparing premium of upgrade vs. top-up, following is my understanding. Just sharing to confirm if there is any gap in my understanding
    1. For 2+1, 5L cover, ICICI lombard premium comes around ~11.5K, where as the premium for 10L cover comes around 13.5K
    2. Under the same circumstances, if I take a 5L normal cover & additional 10L/4L-deductible(that’s the max ICICI is offering right now), premium comes around ~5K, which means I am paying much more than I have to pay for a single 10L cover from ICICI.
    3. Also, Top-up does not cover pre/post expenses.
    4. If I have 2 claim in a year of 4L + 3L, even if I have top-up, it will not cover as it does not cross threshold. But a 10L cover will cover everything.

    So, basically in my understanding, top-up is not making much sense unless I am getting it at a very cheap cost compared to normal insurance, which is NOT the case presently. I have compared the premium for both ICICI & Bajaj for the same condition as described above, and I get the same picture about top-up plan premium.
    Is there any gap in my understanding?
    Thanks.

    1. Correct . If its not cheap , then better to go for full fledged cover !

  43. Vishal Jain says:

    Hi Manish / Mahavir,

    Currently there are 4 members in my family, me, my wife and my parents. We have 2 family floater health insurance policy from national.

    1. One is a family floater of 3 lacs + bonus of 1.4 lacs in the name of my parents.
    2. Another floater of 3.5 lacs + bonus of 63k in the name of me & my wife.

    I feel we are under insured and i am looking for options. I have shortlisted religare care policy but i am confused what pattern i should go for.

    1. Should I close my current policy and start a new individual or floater policy?
    2. Should I continue with my current policy and start a new individual / floater policy?
    3. Should I go for a top up/ super top up plan?
    4. Also what about critical illness, should I take it and from which company?

    Your suggestions in this regard will be very helpful.

    Thanks & regards.

    1. I would say that get a brand new insurance plan for a big cover and later after 3-4 yrs , close the old policy if the new one is sufficient and covers your all illnesses

      1. Vishal Jain says:

        Thanks for the reply. Can I go for porting? Will it benefit in any way.

        1. You can look at that option . But only your target company will be able to share more on that

  44. Citizen says:

    For ‘United India Insurance Company Ltd.’ what will be the ‘family health policy premium’ for a primary health policy of Rs 2 Lakhs with a top-up of Rs 3 Lakhs i.e. total cover of Rs 5 Lakhs family member’s ages are indicated below? Is there any disadvantage/exclusions in adding top-up to an existing Health Policy? Why do insurance companies have this ‘top-up’ feature instead of transparently increasing the ‘Health Cover’? If you have any better policy option from a reputable company, then your suggestion with plausible reasons are welcome. Is ‘family health cover’ cost effective than separate, individual health covers? Does buying/renewing such policy from United India Insurance directly save money versus buying from an agent?
    (1)Son (Proposer): 28 years old
    (2)Parent (father):56 years old Date of Birth Feb’1958
    (3)Parent (mother):52 years old Date of Birth Feb’1962

      1. Citizen says:

        The link you have provided is not relevant in my case. I think you have misunderstood. Kindly read my query as below:

        For ‘United India Insurance Company Ltd.’ what will be the ‘family health policy premium’ for a primary health policy of Rs 2 Lakhs with a top-up of Rs 3 Lakhs i.e. total cover of Rs 5 Lakhs family member’s ages are indicated below? Is there any disadvantage/exclusions in adding top-up to an existing Health Policy? Why do insurance companies have this ‘top-up’ feature instead of transparently increasing the ‘Health Cover’? If you have any better policy option from a reputable company, then your suggestion with plausible reasons are welcome. Is ‘family health cover’ cost effective than separate, individual health covers? Does buying/renewing such policy from United India Insurance directly save money versus buying from an agent?

        (1)Son (Proposer): 28 years old
        (2)Parent (father):56 years old Date of Birth Feb’1958
        (3)Parent (mother):52 years old Date of Birth Feb’1962

        Can any of the above parties pay the premium & claim the Tax deduction benefit, or is the proposer only supposed to make the payment & claim the tax benefit. The mother/father wish to pay and claim the tax benefit. Is the account from which the payment is made relevant?

        1. Only proposer will be able to claim the tax benefit !

          1. Citizen says:

            Regret, you have still not answered/clarified the issues raised regarding premium and other queries. Was expecting a response with clarity on the queries raised. Be assured that your kind response will be of considerable help to many other who have similar doubts. Hence please respond & oblige.

            1. Please open a thread on our forum to discuss it in detail – https://www.jagoinvestor.com/forum/

  45. Satish says:

    Hi Manish, Nice to read you after some time.
    Would like to add few points and options.
    1. Theoretically top up plan pays once claim triggers by crossing the threshold. Generally a top-up is opted above the standard plan (like an umbrella). It is suggested to opt for top up from same company (std plan) instead of other insurance company. This simplifies claim payment. In practice, one may face some difficulties to claim from top up insurer (lets say A) when std plan is with other (lets say B). Especially when B pays through cashless.
    2. Now a days many health policies come with reinstatement inbuilt. Reinstatement option replenishes your sum insured that had gone down due to a claim. If such option is available then super top up may not be much handy.
    3. The high sum insured may be required only for critical condition treatments like heart ailments where a critical illness policy can be an alternate. Remember; generally critical illness policies are like life insurance policies; the policy pays (fixed sum) due to happening of such condition and ceases.

    1. Yes Satish

      These problems are there with top up . Agree to it .

  46. Prasoon says:

    Dear Manish and Mahavir ,
    I m asking the same question asked by Manoj .
    Why should one go for higher primary health insurance , instead one should go for lower sum insured and take top up insutance .
    e.g : instead of taking say 5 lakh insurance and then top up of another 5 lakhs .
    would not it be better to take, say even 1 , or 2 or 3 lakh insurance and then take top up for upto 10 lakhs ?

    Secondly what combination makes health insurance complete : Basic + TopUp + Critical illness coverage ?

    1. Hello Prasoon,

      1. A Top up policy works only when your one hospitalization cost goes above the threshold amount of the policy. If there are multiple claims in a year where the threshold is not reached in each of them, you could lose out on a good amount of money. For instance if you have a Rs. 2 Lakh basic policy, and 10 lakh top up with 2 lakh threshold. If you have say 2 claims of Rs. 1 Lakh and Rs. 1.5 Lakh each, you will not be able to claim from this top up policy. On the other hand if you have a Rs. 5 Lakh policy you will be able to claim all these claims.
      2. You should buy a super top up only when there is a good say 20-30% difference in premium from cost of upgrading the existing product. There is a cost and pain attached to claiming from 2 insurance companies, even same insurance company.

    2. The best thing is to take a complete cover. Any combination of top up , critical etc will always some some disadvantage

  47. Chetan Ambi says:

    Tnx for very detailed description on top-up and super top-up plans. This cleared all my doubts about top up plans. Keep up the work Manish!!..

  48. Balasaheb Kale says:

    Dear Sir,

    Thank you for the useful information. Though I’ve family insurance (ham do hamare do) from Allianz as well as Aetna (valid in India s well) provided by my and my wife’s employer, I’m trying to buy health insurance from Indian insurers as well. Main objective is to build a claims free history for next 8-10 years (possibly). Following is I’m trying to do. let me know if there are any gaps. Many thanks.

    — Basic health insurane cover of 5 lacs each from Apollo munich’s Optima Restore;
    — Super Top up of 10 lacs each (5 lacs deductible) from Max Bupa or HDFC Ergo;
    — Critical Illness cover of 15 lacs each for me and my wife from Max Bupa (presently it covers maximum illnesses)

    1. Hello Mr. Kale,

      Must day this is a good plan for the next 10 years. Note, by the age 40-42 you should have at least Rs. 20-25 Lakhs of total coverage.

      Do compare the premium you pay for Super Topup for the upgrade Vs the premium you pay for a higher coverage with better benefits with your core product. An upgrade is any day better and more convenient than a top-up.

      Regards,

      1. Babu says:

        Very informative article. Can someone help me to understand the term ” Pre-existing waiting period” ? Many thanks.

        1. Yes, it means that for all the pre-existing illnesses , you will have to wait for few years because you can apply for any claim

          1. Babu says:

            Thanks for your reply. You are doing an amazing job.

    2. This looks good enough to me

  49. Yes, in topup Manish’s calculations are right.

    1. Rakesh says:

      @Mahavir,

      Does Medimanage also cater to transfer of health insurance from one company to another. I had written to your team but did not get any reply.

      Rakesh

  50. Dear Manish, please try to get answer from either dear Mahavir or from individual insurers on the following scenario. In a same policy year, (considering family floater policy both regular as well as top up)

    First Claim = 8L
    Second Claim = 7L

    What ‘ll be the situation for claim settlement? Specially for 2nd claim?

    Thanks

    Ashal

    1. Ok let me also check with Mahavir, but as per my understanding

      Claim 1 – you will be paid Rs 3 lacs (above 5 lacs)

      Claim 2 – You will be paid Rs 2 lacs (above 5 lacs)

  51. Chaitanya says:

    Very helpful, thanks!

    One question – all the plans comprison table are topup plans only, not super top up? So are super topup plans not popular or not many companies offer it?

    1. Chaitanya

      There is only 1-2 companies offering it , so we do not have many companies to compare, hence the table only has top up plans

  52. M.Thilakarajan says:

    very useful

  53. Anil Kuppa says:

    Hi Manish,
    Earlier I was able to read the entire article in feedly, but now I can read only part of it and have to come back to the website to complete it. Is it possible to restore to old settings?

    1. Hi Anil

      Let me check on that .

  54. bhrat shah says:

    one more informative article. thank you

    1. Thanks Bharat 🙂

  55. manoj mehra says:

    very very useful .

  56. Arun says:

    I have Max Bupa’s Family First health insurance plan which works something like the Top up plan – once a individual uses the individual cover the family (floater) cover, this in effect reduces the premium and gives more cover (when compared to a pure floater plan).

    1. Great to hear that Arun 🙂

  57. Uttam k das says:

    It was an eye opener, thanks a lot.

  58. Manoj Maindola says:

    Nice Article…..

    One question. Suppose if I have a health cover of 5 lacs and a super top up cover of up to Rs 10 lacs with threshold of Rs 5 lacs. Now in the future suppose if I increase my health cover to 7 lacs, then:
    1) Does my super top up will auto increased to 12 lacs with threshold of Rs 5 lacs?
    2) Do I need to inform my super top up service provider about the change?
    3) Does it has any impact on my super top up premium? Will it come down or move up?

    Thanks
    Manoj

    1. Sunil says:

      These two are SEPARATE policies. You have to treat them as such. No auto. changes. And why should one increase Regular Health Cover from 5 to 7 AFTER having taken a Top-up Cover ? Remember Regular Mediclaim is way more expensive !

      1. Manoj Maindola says:

        Itn’t it upto the individual to decide how much basic insurance he need? Going by ur logic, no one should ever buy big basic cover, all that matter is the top up. So why shud one buy 5 lacs of insurance at all? He shud instead always buy say 3 lacs and then top up upto 10 lacs.

        That brought one more question in my mind that if I buy a super top up from a different company (or from the same company), does my existing terms like copayment, room rent limit, waiting period etc remains the same?

    2. Manoj

      1. NO , super top up has nothing to do with your other policies . It just just pay you above 5 lacs as defined.

      2. No

      3. No

  59. umang agarwal says:

    Very useful information.Thanks………….

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