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Difference Between Top-Up & Super Top-Up Health Plans

Health insurance policy serves as a shield against your financial losses. It aids in the protection of one’s health and gives safety and security in the event of a medical emergency. However, in some circumstances, the coverage provided by the policy is insufficient for an individual and it is very difficult to purchase a second insurance plan for wider coverage. 

Top-up insurance and super top-up insurance are two new products that have emerged for such people. Both of these plans boost your amount insured over and above your primary health insurance plan. 

But what’s the difference between top-up and super-top-up health insurance? Continue reading to find out.

What Is A Top-Up Health Plan?

A top-up health insurance plan boosts the sum insured amount of your existing health insurance policy. It gives more coverage over and above the current available limit, that too, for a lower premium. As a result, when the defined sum insured amount is exhausted, it serves as a financial safety net and backup to your primary health insurance plan.

Let’s understand top-up health insurance plans with an example and its scenarios!

Suppose you have purchased a health insurance plan with a sum insured of Rs. 6 lakhs. In order to enhance your existing health insurance plan, you also purchased a top-up insurance plan of Rs. 10 lakhs. Here, the total sum insured amount is Rs. 16 lakhs, and the defined threshold limit is Rs. 6 lakhs.

Scenario 1 (Single Claim)

Let’s say your medical bill is Rs. 10 lakhs. Therefore, your insurer will pay Rs. 6 lakhs, and the rest of Rs. 4 lakhs will be paid by your top-up plan.

For your convenience, the sample is included in the table below:

ParametersTop-Up Plan
Sum Insured Of The Base Health InsuranceRs. 6 Lakhs
Sum Insured Of The Top-Up Insurance PlanRs. 10 Lakhs
Total Amount Of Sum InsuredRs. 10 + Rs. 6 Lakhs = Rs. 16 Lakhs
Threshold LimitRs. 6 Lakhs
1st Claim Amount In A YearRs. 10 Lakhs
Amount Paid By The Health InsurerRs. 6 Lakhs
Amount Paid By Your Top-Up PlanRs. 4 Lakhs
What Will You Pay?Nothing

Scenario 2 (Double Claim):

Suppose you file two claims in a year. Your claim 1 is for Rs. 6 lakhs and claim 2 is for Rs. 5 lakhs. Here, your regular health insurance will pay for claim 1 and it will get exhausted. However, the claim 2 amount will not be covered by your regular as well as your top-up plan. This is because the threshold limit is Rs. 6 lakhs and your top-up plan will only cover the amount if it is more than Rs. 6 lakhs.

The sample for the same is displayed in the table below:

ParametersTop-Up Plan
Sum Insured Of The Base Health InsuranceRs. 6 Lakhs
Sum Insured Of The Top-Up Insurance PlanRs. 10 Lakhs
Total Amount Of Sum InsuredRs. 10 Lakhs + Rs. 6 Lakhs = Rs. 16 Lakhs
Threshold LimitRs. 6 Lakhs
1st Claim Amount In A YearRs. 6 Lakhs
2nd Claim Amount In A YearRs. 5 Lakhs
Amount Paid By The Health Insurer For Claim 1Rs. 6 Lakhs
Amount Paid By The Health Insurer For Claim 2Nothing
Amount Paid By Your Top-Up Plan For Claim 1Nothing
Amount Paid By Your Top-Up Plan For Claim 2Nothing
What Will You Pay?Rs. 6 Lakhs

What Is A Super Top-Up Health Plan?

Super top-up plans, like top-up plans, enhance your sum insured amount of health insurance policy. However, they do not work on a claim-by-claim basis, but rather on the total medical expenses incurred within the policy year. When the total claims throughout the policy period exceed the threshold limit, the super top-up plan kicks in.

Let’s take an example to understand how a super top-up plan works!

You have purchased a health insurance coverage of up to Rs. 6 lakhs. You also purchased a Rs. 10 lakhs super top-up insurance plan to supplement your existing health insurance coverage. Therefore, the total amount of sum insured is Rs. 16 lakhs along with the threshold limit of Rs. 6 lakhs.

Scenario 1 (Single Claim)

Let’s say you need to go through treatments after your heart attack, which will cost you Rs. 9 lakhs for multiple hospitalizations. Thus, Rs. 6 lakhs will be paid by your health insurance and the remaining 3 lakhs will be paid by your super top-up health insurance plan.

The same has been demonstrated in the table below:

ParametersSuper Top-Up Plan
Sum Insured Of The Base Health InsuranceRs. 6 Lakhs
Sum Insured Of The Super Top-Up Insurance PlanRs. 10 Lakhs
Total Amount Of Sum InsuredRs. 10 Lakhs + Rs. 6 Lakhs = Rs. 16 Lakhs
Threshold LimitRs. 6 Lakhs
1st Claim Amount In A YearRs. 9 Lakhs
Amount Paid By The Health InsurerRs. 6 Lakhs
Amount Paid By Your Super Top-Up PlanRs. 3 Lakhs
What Will You Pay?Nothing

Scenario 2 (Double Claim)

Suppose you file two claims in a year, claim 1 for Rs. 6 lakhs and claim 2 for Rs. 3 lakhs. Here, the regular health insurance policy will cover the claim 1 amount, i.e., Rs. 6 lakhs, and will get exhausted. The claim 2 amount will be paid by your super top-up plan, irrespective of the fact that the claim amount is less than the threshold limit of Rs. 6 lakhs.

Have a look at the table below:

ParametersSuper Top-Up Plan
Sum Insured Of The Base Health InsuranceRs. 6 Lakhs
Sum Insured Of The Super Top-Up Insurance PlanRs. 10 Lakhs
Total Amount Of Sum InsuredRs. 16 Lakhs
Threshold LimitRs. 6 Lakhs
1st Claim Amount In A YearRs. 6 Lakhs
2nd Claim Amount In A YearRs. 3 Lakhs
Amount Paid By The Health Insurer For Claim 1Rs. 6 Lakhs
Amount Paid By The Health Insurer For Claim 2Nothing
Amount Paid By Your Super Top-Up Plan For Claim 1Nothing
Amount Paid By Your Super Top-Up Plan For Claim 2Rs. 3 Lakhs
What Will You Pay?Nothing

NOTE: It’s important to remember that the threshold limit in super top-up plans is based on the total hospitalization expenditure for the policy period, not on each claim.

Scenario 3 (Double Claim)

Suppose you file two claims in a year, claim 1 for Rs. 7 lakhs and claim 2 for Rs. 8 lakhs. Here, the regular insurance policy will cover claim 1 amount, and the rest Rs. 1 lakh will be covered by your super top-up health insurance plan. As the regular health insurance plan has now been exhausted, the entire amount of claim 2, i.e. Rs. 8 lakhs will be paid up by your super top-up health insurance plan.

This example is illustrated in the table below:

ParametersSuper Top-Up Plan
Sum Insured Of The Base Health InsuranceRs. 6 Lakhs
Sum Insured Of The Super Top-Up Insurance PlanRs. 10 Lakhs
Total Amount Of Sum InsuredRs. 16 Lakhs
Threshold LimitRs. 6 Lakhs
1st Claim Amount In A YearRs. 7 Lakhs
2nd Claim Amount In A YearRs. 8 Lakhs
Amount Paid By The Health Insurer For Claim 1Rs. 6 Lakhs
Amount Paid By The Health Insurer For Claim 2Nothing
Amount Paid By Your Super Top-Up Plan For Claim 1Rs. 1 Lakh
Amount Paid By Your Super Top-Up Plan For Claim 2Rs. 8 Lakhs
What Will You Pay?Nothing

How Do Top-Up & Super Top-Up Health Plans Differ From Each Other?

After being understanding top-up and super top-up health plans, let’s now take a look at how do they differ from each other!

ParametersTop-Up PlanSuper Top-Up Plan
How Does It Work?Top-up health insurance works on the basis of the “per claim” or “per hospitalization” principle.Super top-up plan operates on the permission of multiple claims.
Claim SettlementOnly settles claims if the total bill amount exceeds the deductible.If the entire bill amount exceeds the deductible limit, the claim is settled.
Lapse Of ClaimAfter one claim, the policy expires.Only when all of the premiums have been paid does the policy expire.
HospitalizationA single admission in the hospital is covered.Multiple hospitalizations are covered.
DeductiblesEvery top-up insurance plan has a deductible that must be met before the additional coverage can be claimed.Other claims are reimbursable once the deductible amount is met.
Premium Payable In comparison to super top-up insurance, the premium for this policy is lower.The premium is a little bit higher than the premium for top-up insurance.

Which Is Better – Top-Up Vs. Super Top-Up Plan?

To answer this question, one must first ensure that they are medically fit. In case you are healthy and do not have a significant illness, you should consider a top-up insurance plan. However, if you are at a high risk of death or disease, such as high blood pressure or diabetes that may require you to be hospitalized multiple times, you may consider buying super top-up health insurance. When you save on a significantly draining amount like hospitalization charges, the premium amount pinches considerably less.

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