Health Insurance – Top-Up Covers

Top-up covers are, to put it simply, additional health insurance covers that take care of medical expenses that go over your main policy cover.

How Do Top-up Covers Work?

Top-up covers work on the deductible sum insured concept. Deductible amount means the amount which you have to pay first so as to trigger the top-up cover. You can pay this deductible amount from your existing / base health insurance policy, or out of your own pocket.

Here’s an example to explain this better:

You have a health insurance cover with sum insured X lakh.

There is a claim in the policy for X+3 lakh.

The base policy provides cover up to X lakh and the sum insured gets exhausted.

The remaining 3 lakh of claim amount has to be paid.

The top-up cover takes care of this surplus amount and the complete claim of X+3 lakh can be taken care of without you paying a single penny out of your own pocket.

These are some reasons to purchase top-up cover:

  1. Increase in hospitalization expenses
  2. Increase in the frequency for serious hospitalizations
  3. Additional cover over and above the existing cover
  4. Reasonable premiums as compared to the covered sum insured
  5. Waiting periods and exclusions are as per the base policy

The question would arise in your mind regarding the necessity of having a base policy to purchase a top-up cover? Though the base policy is a requirement, you can still buy a standalone top-up cover where you do not have any base policy. In this case, as suggested earlier, the deductible amount will have to be paid from your pocket and all the standard waiting periods and exclusions would apply for this as it would for a regular policy.

Standard waiting periods:

  1. First 30 days waiting period.
  2. Waiting periods for pre-existing diseases and joint replacement surgeries health insurance experts.

Standard exclusion:

  1. Pregnancy and child birth
  2. HIV, AIDS
  3. Plastic or cosmetic surgery
  4. External equipment or aid
  5. Dental treatment
  6. Hospitalization for diagnostic purpose only

The exclusive lists of each can be read in the policy wordings.

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