What are Topup Covers in Health Insurance?

Many of us ignore buying a personal Health Insurance plan (Mediclaim) as we think that the coverage provided by the employer is sufficient enough to cover any unforeseen medical expenses. However, this is not true as one finds in unfortunate circumstances as group mediclaim is generally in the range of Rs 2 Lakh to Rs 5 Lakh while serious incidences can cause expenses of way above these amount and impair financial savings critically. Can you afford to pay for the medical expenses out of your pocket? Do you agree that medical expenses are increasing at a very fast rate every year? As per HDFC ERGO, medical treatment costs are increasing at nearly 20 per cent every year that raises the need to increase the health cover to cope up with rising medical costs. This is where a ‘Top-Up Plan’ becomes handy.
What is a topup plan?
A regular policy reimburses hospital bills up to the sum insured while a top-up plan covers costs after a certain threshold is reached. In simple words, when you are hospitalised, the insurer will pay up to the set sum insured limit. The top-up, on the other hand, will kick in only after a certain amount, say, Rs 2 lakh has been crossed. It’ll pay for the claim amount over and above it.
Let’s say you have an Employer’s Mediclaim policy for Rs 3 Lakh and also a Top up Health cover for Rs 10 Lakh with the threshold limit (called a deductible) of Rs 3 Lakh.
If there is a claim for Rs 5 Lakh, your mediclaim policy (employer’s) will pay Rs 3 Lakh and the remaining claim amount of Rs 2 Lakh will be covered by your Top up policy.
So, such Top up health insurance policies come handy when the threshold of the existing health cover is already used or exhausted and there are some medical costs left to deal with, which would otherwise exert pressure on your financial savings. Do note that to buy a Top up plan, it is not mandatory to have an existing health insurance policy. The threshold limit is the mandatory deductible, which can be borne by you or by your existing health insurance policy i.e., your company’s or personal regular health insurance policy, called the Base policy, Also, in top-up policies, most insurers do not ask for medical check-ups up to the age of 55 years. In reimbursement plans, this is usually 45 years.

So, a top-up plan makes sense when you want to increase the cover without paying too much.

And because there is a deductible, apart from single hospitalization conditions, these plans are much cheaper than buying a new health cover. The underwriting may differ slightly as the base policy reduces risk for the insurer. Typically, small illnesses take up most of the claim and are covered in the primary product.
Also, in top-up policies, most insurers do not ask for medical check-ups up to the age of 55 years. In reimbursement plans, this is usually 45 years.


Apart from having a high deductible, a top-up plan generally covers only single incidence hospitalisation. In addition, there may be a single illness clause as well as specific guidelines on what is considered single illness. Before selecting a policy, do not forget to check the deductible criteria for single illness, waiting period for pre-existing diseases, limits inclusive of donor expenses, pre- and post-hospitalisation expenses and understand the criteria for single illness as this could be a big setback if the insurer insists on this clause when a claim is admitted. There should be clarity whether the plan mandates “per-claim” deductible or “overall deductible”. Also, check who all can be covered.

Riders in usual policies cover a few serious illnesses whereas top-up policies cover all treatment costs due to hospitalisation. Moreover, while riders or add-on covers belong to particular policies and can be taken only with them, top-up plans are independent covers that can be bought separately from the existing policy. This means you can buy regular hospitalisation reimbursement plan and top-up cover from different insurers.

Both your indemnity policy and the top-up plan can be claimed together for single hospitalisation. The only condition to be met is the threshold of the top-up plan.

We are now clear that the Top up plans often work on ‘per claim’ or ‘per single hospitalization’ basis and are beneficial as long as the single claim amount is above the threshold limit. There is another slightly more expensive (than topup) variant called the “Super Top” up plans which consider ‘the total of all the bills’ in a given year. Super Top up plans cover ‘multiple’ hospitalizations and they look at the aggregate claim. This means they put together several cases of hospitalization to calculate the deductible limit(threshold limit).
Email us at insurance@plindia.com to understand the plans on offer and why they may benefit you in constructing the appropriate insurance covers at a competitive price!
Remember, the price of not doing so may be huge!

Secure yourself with Super top up cover and never worry about your medical expenses again.

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