What is Top-Up Plan?

A top-up plan is a regular health insurance policy that gives protections regarding the hospitalization costs but only after a threshold limit, known as deductible, is crossed. This base health insurance policy to make a claim up till the deductible amount and use your top-up plan for any payments over that.

Advantages of Top-up Health Insurance Plan

  • Even if your current health insurance policy gets exhausted while filing a claim, you can still feel and enjoy your peace of mind as you are covered for the remaining duration.However, it is recommended that you get a health insurance plan with a sum insured amount equivalent to the deductibles
  • Option to improve your policy coverage while renewing your current policy.
  • You can buy a Top-Up Plan even if you don’t have a basic medical policy

Benefits And Features of Top-up Health Insurance Plan

  • A family discount is also provided in some plans. This includes the policyholder, spouse, dependent parents and children up to a specified limit. Parents will be covered in a separate family floater plan
  • Easily convertible to a basic health plan
  • If both the parents are covered then you can include your children in the same plan
  • No restrictions and sub-limits are applicable on hospitalization expenses like fees charged by the medical practitioner, room rents, doctor fees etc.
  • Policy can be issued for a period of 1 to 2 years (depending on the insurer.
  • Tax Benefits on the insurance premium paid under section 80/D of the Income Tax Act

What is covered in a Top-up Health Insurance Plan?

  • Compensation for in-patient hospitalization expenses including nursing and boarding charges s, room rent charges, doctors’ fees, OT charges, cost of oxygen, prosthetic devices or implantation of any other equipment during surgery, blood, diagnostic procedures, and other similar expenses
  • Daycare procedures that do not require hospitalization for more than a day
  • Organ donor expenses cover in some plans
  • Post-hospitalization expenses to be covered 90 days immediately after hospitalization
  • Pre-hospitalization expenses 60 days prior to hospitalization
  • Some insurers also provide a cumulative bonus at the time of policy renewal
  • The coverage varies from one insurance provider to another.

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Health insurance is a type of insurance coverage that protects an individual or a group of people against medical and surgical costs against payment of regular premiums.

Mounting healthcare and surgical costs are a major strain on household budgets. Like any other insurance, mediclaim or health insurance is the best possible protection you or your family may have against any medical (usually hospitalization or surgical) costs. Health insurance also makes medical help affordable for everyone.

Mediclaim or health insurance makes you eligible for tax benefits on premium paid under 80D of the Income Tax Act.

Given the current healthcare scenario, there is no right age to get medical insurance the earlier, the better. Children can be added to either parents mediclaim policy. Many health insurance providers also have special plans for senior citizens and old age related health costs.

Most health insurance providers offer customized mediclaim or health plans. They are broadly of 4 types

  • Individual health plan
  • Family health plan
  • Critical illness plan
  • Senior citizen health plan

Accident-related medical costs are generally covered by all health insurance plans or may be taken as an add-on rider.

Health insurance costs vary depending on the following factors

  • Number of persons covered
  • Age of the person/persons assured
  • Health of the person/persons assured
  • Location (health risks in metros is deemed more than that of people residing in small cities and villages)
  • Additional riders (if any are opted for)

When a person signs up for a health insurance, the insurance company ascertains premium based on a number of criteria. Once determined, the company usually charges the same premium for that age group. The older a policy holder gets, the more the premium amount is. In the meantime, if there is a claim in any year, the premium may be hiked upon policy renewal. This is called load premium. The insurance company may sometimes offer a discount on premium, if no claim is registered for a number of years.

Mediclaim health insurance policies usually do not cover the following

  • Congenital medical conditions and diseases
  • Pre-existing diseases diagnosed prior to policy issuance
  • Medical costs arising out of self-inflicted injuries and/or attempted suicide
  • Cosmetic surgeries and/or treatments including dental treatment
  • Drunken driving related accidents
  • Cost of spectacles or contact lenses
  • Treatment of HIV/AIDS

Planned hospitalization Submit a written application with the TPA. Include doctors recommendation for hospitalization, medical records, and planned expenses. Once approval comes through go ahead with hospitalization. Notify TPA and make a claim through the hospital to avail cashless benefits.

Unplanned hospitalization/Accidents Notify TPA within 24 hours of hospitalization. Submit a notification statement with name, policy number, and known medical details. The insurer is likely to clear your eligibility details within a day or two. Stake cashless claim through the hospital to avail cashless services or pay cash and stake claim with all bills and records at the completion of treatment.