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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.

Standard exclusion:

  1. Pregnancy and child birth
  2. HIV and 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.

It should be ascertained that when you purchase a top-up cover the deductible amount should match your base policy sum insured otherwise the difference would have to be borne by you


Why Opt for a Top-up Cover?

The simplest reason for buying a top-up cover is that your health insurance policy may not always be sufficient when it comes to large medical expenses. Let us take the example of Aditi:

Aditi is a young corporate professional. She has health insurance for Rs.3 lakh. One day, she is diagnosed with a serious illness and is hospitalized for treatment. Within 5 months, her health insurance policy has been exhausted due to the treatment being very expensive. Luckily for Aditi, she had taken a top-up cover of Rs.10 lakh, with a deductible of Rs.3 lakh. So her medical bills continue to be paid without any trouble. 

Top-up covers are also useful if you are a senior citizen, or approaching that age. As you grow older, getting an increase is the sum insured of your base policy will be difficult and expensive. The premium rates will be very high and there will be numerous medical tests to undergo as well. In this case, having a top-up cover means that you can stick with your base policy, while letting the top-up cover take care of any extra expenses that arise. To illustrate this better, let us see the example of Narayan and Irshad.

Irshad and Narayan joined the same company together when they were 25 years old and have been working there for 27 years. All these years, their employer had been providing health insurance for them, for Rs.3 lakh each. Now, at the age of 52, they want to change jobs and move to another company. Unfortunately, this company does not provide health insurance for its employees, and they both have to buy their own individual health policies. They both realise that as senior citizens with greater health risks, a Rs.3 lakh policy is no longer sufficient, so must go for a higher sum insured.

Narayan had remained content with the health insurance provided by the company. Now, when he goes to buy an individual policy, he finds out that there are numerous medical tests for him to take, and that when he finally takes insurance for Rs.10 lakh, the premium is extremely high.

 Irshad, however, had taken the precaution of buying a top-up cover for Rs.15 lakh, to go with his employee health insurance. Now, he does not need to buy a policy with a higher sum insured. He simply takes a Rs.3 lakh policy. He knows that though a Rs.3 lakh cover alone is not sufficient, his top-up cover will take care of any extra expenses.

In the end, Irshad’s precaution of buying a top-up cover many years ago means that now he has to pay far less in premium amount, whereas Narayan must pay a very high premium while having less cover than Irshad.

So go for a top-up cover to secure yourself against health-related risks to your lifestyle and savings, and jiyo befikar!


To learn more about the Bajaj Allianz Extra Care Policy and how it can extend your health insurance, click here.

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Published on:22 May, 2012

By: | Tags: , , , , , , , , | Comments: 23


23 thoughts on “Health Insurance – Top-up Covers

  1. vinay kumar soni

    I have a individual health guard policy no – OG-13-1901-8401-00001846. Under this policy myself and my wife is insured for 3 lacs each. No i have opted to extra care poliyc for 10 lacs which is a floater. I want to know that clause of critical illness covered after 4 years will be applicable in this extra care policy or not. What insurance agent told me is that this clause will not be applicable in this case.
    Pls clarify me.


  2. Saurabh

    I have 3 Lac sum insured with X company. I want to buy top up 10 Lacs from your company. Please answer me following queries.
    If 1st claim is 2 Lac and 2nd claim is 5 lacs then am I eligible for 2nd 5 lacs claim amount ? it means your top up activate with multiple claims ?


    • CFU

      Dear Saurabh,

      We have sent the mail to your email id kindly check and plese feel free and contact us.

      Thanks for writing to us.

      Thanks and Regards,
      Help and Support Team

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