With uprising medical costs, getting treatment in a good hospital has become extremely expensive. To combat the soaring costs, it is important to have an alternative arrangement which can take care of the expenses for the overall treatment without affecting your savings and funds which are accumulated for other major financial objectives. “Health Insurance Policy” constitutes one such important form of financial arrangement to take care of the hefty medical bills and to combat medical inflation. let’s know How to make Your “Health Insurance” Cover Affordable? – PART 1
Opt for Top up and Super Top up Health Insurance Plans
But, many people underestimate the importance of having a health insurance policy, assuming that nothing can happen to them. It is good to take care of your health and stay fit, but health hazards come uninvited causing a drain in your financial kitty to pay for the treatment and allied expenses.
As per the government statistics, only 18% of the urban people are covered under any kind of government schemes or any other health schemes. The significant reason for a low percentage is due to the lack of awareness about the benefits of buying a Health Insurance policy. The cost of health insurance can also be accounted as another significant reason, which makes people defer the decision of buying a health insurance plan.
Even for the people who possess the health policy are either underinsured or primarily buy the policy to save tax under section 80 D of the Income Tax Act, 1961. Even though medical costs are mounting high, still the average ticket size of a health insurance policy range between Rs.2 Lakhs to Rs 3 Lakhs. Such an amount may be sufficient to endow small hospitalization costs, but may not suffice in the event of a serious case of a heart attack or to treat cancer. Buying the health plan merely to claim a tax deduction without assessing the need based buying is another blunder.
Many of us have an employer provided health plan which makes us feel relaxed. Employer based health plans come with their own benefits and limitations which may not prove to be an adequate health cover. Now, the point comes how much additional or extra health insurance coverage, one should have over and above the basic health insurance cover?
Let us Understand it With an Example:
Sanjeev is a 35 year old IT professional, his company has provided him a 4 Lakhs health cover. He needs an additional Rs 10 Lakhs health insurance cover as per his health need analysis based on his medical condition, age, family history of critical illness, medical inflation,etc .
Now to secure an additional Rs 10 Lakhs of Health insurance at his age, there are 2 options:
|Option 1: BUY AN INDIVIDUAL HEALTH INSURANCE PLAN
Sanjeev can either buy a regular Health Insurance policy of Rs 10 Lakhs. A regular indemnity based health plan will cost him Rs 9,000 to Rs 10,000 or more annually.
|Option 2: BUY A TOP UP/ SUPER TOP UP HEALTH INSURANCE PLAN
Top up/Super Top up health insurance policy is an ideal way to stay adequately insured with the right coverage amount at an affordable premium price. Top up/Super top up health insurance policy comes into action when your basic health cover amount falls insufficient to fund your medical bills. Top up/Super Top up health plan offers additional cover, typically over and above the current available limit, at lower premium amounts. It can be considered as a safety net which helps you in case you exceed certain limits/threshold limit or deductibles.
Let us understand the concept and the difference between Top up and Super Top up Plans with the help of an illustrative examples below:
TOP UP HEALTH INSURANCE PLAN
To enhance the health insurance cover affordable at a reasonable cost, Sanjeev can opt to buy a Top up Health Plan of Rs 10 Lakhs which will cost him between Rs 6,000 to Rs 6,300 annually with a deductible limit of 4 Lakhs in place of choosing option 1.
Like in Sanjeev’s case, if his hospitalization bill is within the range of Rs 4 Lakhs, it will be taken care by his regular health plan. If the bill exceeds Rs 4 lakh say, for example, the bill is Rs 7 Lakhs, the remaining amount of Rs 3 Lakhs can be funded via his top up health insurance plan (where the deductible limit chosen by Sanjeev is Rs 4 Lakhs). Top up Health plans will supplement your basic health insurance plan in case of claims of higher amounts. The higher the deductible limit you opt under a top up plan, the lower is the premium.
Let us understand Top up Health Plans with different claim scenario’s
Health Plans owned by Sanjeev:
- Regular Health insurance plan with SI- Rs 4 Lakhs
- Top up Health insurance plan of Rs 10 Lakhs with a deductible limit-Rs 4 Lakhs
Super Top up health plan is another way of getting an enhanced health cover with a reasonable premium amount.Super top up health plans works under ‘multiple’ hospitalizations and consider the aggregate claim in a policy year to calculate the deductible or threshold limit. This is not the case for Top up health plan as a top up health plan, pay per claim or per hospitalization basis.
Sanjeev has opted for Rs 4 Lakh as SI under basic health insurance policy and Rs 10 Lakhs SI under Super top up health policy with a deductible limit of Rs 4 Lakhs. Let us understand super top up benefits under different claim scenarios.
The above scenarios explain that the Super Top up Health plans take into account ‘the total of all the bills’ in a given year. Super Top up Health plans cover ‘multiple’ hospitalizations and consider the aggregate claim. Super Top up health plans consider several cases of hospitalization to calculate the deductible/threshold limit which makes it different from the Top up Health Insurance Plan.
TOP UP & SUPER TOP UP PLANS
- Enhance-Super Top up Insurance by Care Health Insurance Co.
- Optima Cash & Optima Plus Plan by HDFC ERGO Health Insurance Limited
- HDFC ERGO Health Optima Super Top Up by HDFC ERGO Health Insurance Limited
- Heartbeat High Deductible Plan Max Bupa
- ProHealth Plus Plan (Under ‘Protect’ & ‘Plus’ Plans) by Cigna TTK
- Health Suraksha Top Up Plus by HDFC Ergo General Insurance Company, etc.
- Extra Care by Bajaj Allianz Health Insurance Company,
- United India Super Top up plan by United India General Insurance Co.
Let us take an example of a regular health plan and Super top up health plan from Care to understand the premium difference.
|Health Plan||Super Top up Plan|
|Plans||Care (a regular health insurance plan)||Care Enhance – Super Top up Plan|
|Premium||Rs 8,139 (inclusive of 18% GST)
(For an individual between the age range of 25 to 35 years, opting for a Sum Insured of Rs 10 Lakhs)
|Rs 3,320 (inclusive of 18% GST)
(For an individual between the age range of 25 to 35 years, opting for a Sum Insured of Rs 12 Lakhs with the deductible of Rs 4 Lakhs)
- The probability of getting higher claim amounts of Rs 10 Lakhs is much lower than getting a claim amount of Rs 1 Lakh to 3 Lakhs. With top up/super top up plans coming with a threshold/deductible limit (which is either to be borne by the policyholder or claimed under other health insurance policy), the insurance company assumes that your claim amount will not exceed the deductible limit under a single claim or multiple claims in a policy year.That is why higher the risk of claim borne by you, (higher the deductible limit you choose), lower will be the cost of buying the top up/super top up health plan (lower will be the premium).In nutshell, Deductible amount and Premium amount are inversely proportional to one another.
- It is prudent to choose the deductible limit equal to the sum insured under your regular or employee based health insurance plan. So that over and above your basic health cover, you can avail the benefits of top up/super top up plans at a lower premium.
- It is prudent and beneficial to split your total health coverage amount into a base policy and a top up / super top up policy to attain an optimum health insurance cover at an affordable price. This does not imply that you opt for a health cover of Rs 1 Lakh and takes the top up plan of Rs 10 Lakhs to reduce your premium cost. There has to be an ideal mix between the basic health plan and top up/super top up health plan.
- Buying a Top up/Super top up Health plan is one prudent way to reduce your health insurance cost.Do not buy the Top up/Super Top up plans merely because of the low premiums only, understand the fine print and compare the plans before making a final purchase.
- Most of the companies don’t offer cashless under the top up/super top up claims, so initially the cost has to be borne by the policyholder. Consider this aspect as well before buying the product.
- If we compare between the costing of top up plan and super top up plans,it is clear from the above illustrations that super top-up plans offer wider coverage than top-up plans. Therefore, super top up plan comes at a higher premium as compared to top-up plans.
Keep watching the space for more insights on “How to make your Health Insurance Cover more affordable”!