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Over and above mediclaim | Health Insurance

May 19th, 2010

Man is the best machine designed by God. Like any other machine due to wear and tear with age and use becomes expensive to maintain. Similarly as you age, risks of hospitalization increases which means ever increasing medical bills plus rising inflation. So, double the problem. So here is the solution, top-up and super top-up plans which help you pay for expenses over the mediclaim cover.

Usually the maximum sum assured for a health insurance is Rs.5lac which is decent amount for middle age but with time (with help of inflation of course) this amount seems or will seem too small, especially in metropolitan cities.

Top-up and super top-up plans offered by general insurers cover hospitalization over and above the regular mediclaim cover.

Top-up Plans:

Insurers like United India Insurance and Star Health & Allied Insurance have introduced a top-up mediclaim policy that insures you for larger sum, at much lower cost.  Even ICICI Lombard has filed for a similar product with Irda.

A top-up policy increases the benefits due under the existing/regular health insurance scheme (ground policy) especially to increase the provision for insurance when the premium paying capacity increases (which enables the insured to pay increased premiums).

For example if you have a mediclaim of Rs 5 lakh and buy a top-up of Rs 10 lakh with a threshold of Rs 5 lakh. Your total sum assured goes up to Rs 15 lakh (Rs 5 lakh of mediclaim + Rs 10 lakh of top-up plan).
Now suppose you get hospitalized, and the bill comes to Rs 7 lakh. In this case, the first Rs 5 lakh will be paid by the regular mediclaim policy, and the top-up policy will pay the remaining Rs 2 lakh.
Now, if you are admitted again to the hospital in the same year and your bill comes to Rs 8 lakh. There are two possibilities:

You have renewed your mediclaim policy as you had already exhausted the limit of the same during your last hospitalization, or, not.
Renewed policy means mediclaim will pay Rs 5 lakh and top-up remaining Rs 3 lakh. If you have not got the renewal the first Rs 5 lakh (the threshold of your top-up policy) will have to be borne by you but the remaining Rs 3 lakh will be paid by the top-up policy.

This clarifies that a top-up policy will pay for every hospitalization during the term of the policy, over and above the threshold limit chosen by you while buying the plan. But it has to borne in mind that bill amount should cross the threshold limit every time of hospitalization and cover is restricted to a maximum of the sum assured of the top-up policy.

Super top-up plan:

Similar to the top-up product discussed above, a super top-up also increases the total health insurance but the working is different.

For the same example discussed above – First time hospitalization cost Rs 7 lakh, the mediclaim will pay Rs 5 lakh and the super top-up will pay Rs 2 lakh. For second time hospitalization in a super top-up pays the entire Rs 8 lakh (as your sum assured was Rs 10 lakh and you had only used Rs 2 lakh in the earlier hospitalization), and not just Rs 3 lakh.

So even with no renewal, you won’t have to fork out anything from your pocket.

Top-up and super top-up plans have been offer at a time when medical costs are escalating at super speed. This combination helps you when you have the means. This protects you from the future inflationary medical expenses.

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