The super top up policy issued by insurance companies is proving to be very useful at a time when medical expenses are on the rise. Handles super top up policy status at a lower premium if you incur higher costs due to an illness or accident. Medicum’s base (matching) policy has to pay a very high premium for a higher cover, but the super top up on top of the base plan offers more cover at a lower cost. The super top up applies after the base plan’s health insurance amount (called deductible) has been used.
Super top up policy base policy can be taken from the issuing insurance company or another company. E.g. You can get a base plan of Rs 5 lakh and a top up plan of Rs 10 lakh on top of that. If the treatment bill is more than Rs 5 lakh, the above amount can be paid from the top up of Rs 10 lakh.
Seven points to consider when buying a super top up policy:
1. Room rent limit
The room rent limit in a super top up policy is different from the base policy. Most super top up plans cover single air conditioned (AC) room rates, which vary from hospital to hospital. Single AC rooms also have different ranges. The insurance company clearly states in the policy that they will pay only the reasonable and customary applicable charges. Therefore, before taking insurance, the customer should inquire about the exact amount in case of a claim.
2. Waiting period
Consumers should be aware that the wai ting period for a pre-existing disease for a super top up policy may differ from the base policy. It is also possible that the waiting period for the cost of kidney stone, cataract or any other surgery may be different.
3. Minimum and maximum age for taking out insurance
Under the Super Top Up policy, new insurance can be availed from a 21-day-old child to a 60-year-old person. However, the base policy has certain limitations on the age of the person taking out the insurance. So keep this in mind while taking a super top up policy.
4. Claims under both the policies
Let us understand by example the situation when it comes time to make a claim under both base policy and super top up:
A) When both base and super top up policies belong to the same company
Suppose the cost of Kesarwar is 2 lakh rupees. As the insurance company is the same, a full claim of Rs 5 lakh will be paid under the cashless scheme, of which Rs 5 lakh will be paid from the base policy and Rs 3 lakh from the super top up.
B) When both base and super top up policies are from different companies
Suppose the cost of treatment is 3 lakh rupees. In these circumstances, Rs 5 lakh will be received from the base policy on cashless basis and the remaining Rs 3 lakh will be received from the super top up policy through reimbursement. To obtain a claim under the Super Top Up Policy, the patient has to submit the required documents after discharge from the hospital.
5. Network Hospital
If the super top up policy belongs to a company other than the base policy company, its network of cashless hospitals may be different. Therefore, it is important to be careful when choosing a hospital for treatment.
6. Buy at the same time
It is advisable to take the base policy and the super top up policy on the same date of the same month, as in that case there is no hassle while processing the application and making the claim. In a super top up plan, the deductible is calculated on an annual basis. This means that a claim under the Super Top Up Policy is received only after the deductible amount has been met throughout the year.
7. Optional cover
Health insurance covers matters such as air ambulance, critical illness, reduction of waiting period for pre-existing disease, etc. All of these matters are covered under the Base Policy, but not under the Super Top Up Policy. You have to pay extra premium to get it. It is to be mentioned here that top up plans are cheaper than super top up. Many things are reduced in the super top up. Therefore, policy should be decided only after understanding the difference between base plan, top up and super top up.
Q: Is it necessary to have a base policy to take a super top up policy?
Answer: No, not necessarily. Even if there is no base policy, a super top up policy can be taken. However, the amount that is deductible in Super Top Up is to be borne by the insured out of his own pocket.