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Factors to consider before purchasing a top-up health plan


A top-up health insurance plan comes into play when the cost of treatment leads to the exhaustion of the sum insured offered by the base health policy. In other words, a top-up plan provides additional coverage over the existing base health policy sum insured limit after it has been utilized, thereby enhancing financial protection. Here is what you need to check before you get a top-up:

Waiting duration: You must know that top-up plans are separate health plans and have a waiting period for several pre-existing diseases or illnesses during which you cannot make any claims. The waiting period differs for such health policies.

Rakesh Goyal, director of Probus Insurance Broker, said, “Most top-up plans have a waiting period, preventing you from making any claims for medical costs for the first time. Be sure to check the policy’s waiting period and understand how it affects your coverage.”

Deductible sum: Top-up health plans mostly come with a deductible. This is the sum you will have to pay from your base health policy (regular health policy) or your pocket before the top-up plan takes effect. Therefore, check whether you can afford the deductible if your base policy sum insured gets exhausted. If you don’t have a base health policy, you will have to pay for medical expenses equal to the deductible from your pocket.

Co-payment clause: Like base health policies, top-up plans too have a co-payment clause. It implies that you are responsible for a portion of the medical costs while the insurer covers the remainder.

Therefore, it is essential that you consider such clauses carefully before increasing your health coverage via top-up plans.

Age of policy renewal: The renewal date of top-up plans may differ from the renewal date of the base health policy. Moreover, some top-up plans may have a limited renewal age, beyond which you cannot renew the insurance. Hence, you must ensure the coverage meets your needs at the time of renewal.

Network hospitals: You must verify whether a network of hospitals under your base health policy is also affiliated with the top-up plan. A tie-up with network hospitals helps you receive cashless benefits and decrease the financial load.

Exclusions: When buying a top-up plan, you must recognise its exclusions or the medical costs it does not cover. Aniruddha Sen, co-founder of Kenko Health, said, “Cases involving self-imposed injuries and dental care, or sexually transmitted infections (STIs) and diseases caused by excessive smoking do not come under its coverage.”

Adding to it, Goyal said, “You must verify the top-up plan’s coverage and the amount insured before you buy it. Be sure the insurance covers the medical costs you are likely to incur and that the sum covered is high enough to pay for any significant hospital costs.”

Thus, by looking at some crucial factors, you can make informed decisions and select the top-up health insurance plan that best meets your needs.

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