Getting a fresh health insurance cover? Do this instead

With the necessity of being hospitalized especially due to COVID-19, and with a steep rise in medical costs, people have started taking health insurance seriously. According to industry data, most people are seen dependent on their employer’s health insurance policy only. What these employees don’t consider is that corporate medical insurance policies mostly do not cover the entire expense/ hospitalization bill.

Depending only on an employer’s policy will leave you partially covered. Experts say it is often seen due to the low sum assured of health plans, policyholders fail to meet the medical expenses during a crisis. Note that, major accidents or diseases are not covered by corporate medical insurances, or at least not the entire bill.

Hence, experts suggest one should get additional coverage on one’s own, apart from the one provided by the employer. Having said that, instead of opting for a basic health plan, in addition, you can alternatively opt for a top-up or a super top-up plan, depending on your requirements. When compared to basic health plans, top-up or super top-up plans are more cost-effective options. These top-up plans can be availed for both individual and family floaters.

These top-up and super top-up plans work as supplementary health plans, especially for policyholders that only hold an employer’s health plan as well as for policyholders that have a low sum insured in their basic health plan. According to experts, for policyholders with a lower sum insured, enhancing the basic policy could be an expensive approach as compared to buying a top-up plan.

Additionally, basic health insurance policies include limitations such as exclusions of a certain disease, co-payments with high percentage, corporate health covers (come with various restrictions), along with that the coverage also varies from year to year. Top-up plans come with higher deductibility, because of which the premiums are also low than the basic health covers.

Basic Health Cover and Top-Up: Combining the two

Experts say the ideal way to be fully insured and to avoid the rising healthcare costs and paying from your own pocket is to opt for a basic health insurance plan and combining it with a top-up. You can also combine the top up with your corporate cover. Having a cover this way ensures that once you have exhausted the sum insured of your basic health cover/corporate cover, the top-up cover can come into play.

While opting for a top-up cover, you need to choose a deductible for it, an amount that you will have to pay either using your basic health policy or corporate policy or from your own pocket before the top-up cover activates. The bill that goes above the deductible limit is paid through the top-up plan.

In contrast to a top-up plan, a super top-up plan offers a better deal. For instance, a top-up plan only gets activated in case a single claim is made and the amount exceeds the deductible amount. However, a super top-up plan does not require a single claim amount to exceed the deductible amount, it accepts two or more separate bills as one expense and pays for the claim.

For example, if you have a top-up cover with a deductible of Rs 1 lakh, meaning any expenses above Rs 1 lakh will be borne by the top-up cover, and in a year you get two hospitalization bills of Rs 60,000 and Rs 90,000 – your top-up plan will not get activated. It needs a combined bill of Rs 1.5 lakh to reimburse the Rs 50,000. However, with a super top-up plan, even if you produce three separate hospitalization bills of Rs 50,000, Rs 60,000, and Rs 40,000, a total of Rs 1.5 lakh in a year, you will get the reimbursement of Rs 50,000.