Krishna is a 40 year old finance professional working with a private firm.  His family consists of his home maker wife and two young children. A couple of years back, an article in a magazine made him aware of the importance of medically insuring himself and his family. This prompted him to buy a family floater policy with an annual sum insured of 4 lakhs on which he pays a premium of around 15,000/- per annum. He was pleased with his decision of having adequately provided for any unforeseen medical emergency.

A recent incident set him thinking on whether his existing cover was really adequate. A colleague of his was hospitalized due to some sudden medical condition, which took a serious turn requiring intensive care and monitoring and a prolonged stay at the hospital. By the time he was declared stable and discharged from the hospital, he had run up bills of around 9 lakhs, of which hardly 50 % was covered by his health insurance, the rest has to be borne by him personally.

While this episode made him realize that his medical cover was not sufficient, a little research told him that doubling his cover would also mean shelling out at least double the annual premium too, which would put a considerable strain on his finances, given that he already had liabilities to pay. So, what is the way out in a situation like this where one realizes and wants a higher coverage, but the annual premium is not affordable?

Here is where a top up mediclaim would come to the rescue.

How a top up plan works-

A top up plan works similar to a health policy, and reimburses hospitalization expenses on a single bill after the specified threshold limit known as the deductible, is crossed. To understand this further, if in the above example, Krishna opts for a top up policy of 10 lakhs sum insured with a deductible of 4 lakhs-

Scenario 1  :  He is hospitalized and the bill is Rs 11 lakhs – 4 lakhs is paid from his mediclaim policy, and the balance of 7 lakhs is paid from the top up plan. Hence he gets full reimbursement.

Scenario 2 – He and his wife both incur hospital expenses of 3 lakhs each in the same policy year – The existing mediclaim would pay 4 lakhs totally but the balance of 2 lakhs would have to be borne by him. Top up will not help here, as it gets triggered only if a single bill crosses 4 lakhs, and would pay whatever expenses are incurred above 4 lakhs in a single hospitalization.

Advantages –

1. The biggest advantage is the huge medical coverage at an affordable cost. In the above example, If Krishna opts for a top up of Rs 10 Lakhs, it would cost him around Rs 6000 per annum- he gets an additional of more than double the existing cover for his entire family for less than half the additional cost.
2. Another advantage is that the top up premium does not increase with the age of the insured, and once taken is fixed till the policy is renewable, which is usually till age 65. This is unlike the standard health insurance, where there are age slabs and the premium increases as the insured moves to a higher age bracket.
3. No medical tests are required to be done till age 55 for a top up policy. The upper age limit for a no medical test for a standard health policy is 45 years.

Drawbacks –

1. The only drawback of these policies is that it gets activated only after the specified limit is exhausted. Even if the family runs up multiple bills in a policy year and all of them individually are below this limit, nothing would be reimbursed by this top up policy.

Given the skyrocketing medical costs and rise in health ailments, a top up plan is a good way to get an additional health cover at a nominal extra cost.