How Does Top-Up Health Insurance Work?
- Author :
- TATA AIG Team
- ●
- Last Updated On :
- 23/05/2025
The expensive healthcare facilities in India often result in hefty medical bills. Many times, the bill amount is so high that it exceeds your insurance coverage. In situations like this, you need to pay the exceeding amount even if you have health insurance.
This is where a top-up health insurance plan comes into the picture. It provides you with a financial backup in the form of an extra sum insured, which proves valuable in times of contingencies. Thus, you can protect yourself from getting into a financial crisis.
But how does top-up health insurance work? Read on to find out all about it below!
What is a Top-Up Health Insurance Policy?
A top-up health policy is an additional coverage which is activated when your existing medical coverage or sum insured limit is exhausted. Such a plan is designed to provide you with an extra layer of financial protection during medical emergencies. Let us understand top-up health insurance with an example.
Mr. Gupta has medical insurance of ₹5,00,00. He pays an annual premium of ₹8000 for this plan. However, he feels that the coverage is inadequate. If he increases the existing coverage limit from ₹5,00,000 to ₹8,00,000, his premium will also go up. He will have to shell out ₹12,000 annually.
Instead, he opts for a top-up plan of ₹10 lakhs by paying a deductible of ₹2 lakhs. Now, if Mr Gupta faces any medical contingency that results in a bill of more than ₹5,00,000, the top plan will have him covered.
Also Read: Deductible in Health Insurance
Working of Top-Up Health Insurance Plans
A top-up plan is an addition to your basic health insurance plan. It provides you with financial assistance when the limit or the coverage of your basic plan is exhausted. Thus, it covers the excess amount up to the threshold of the top-up plan.
However, a top-up plan also includes a mandatory threshold limit and deductible amount. You are eligible to receive the benefits of the top-up plan only after paying the deductible amount.
Benefits of Top-Up Health Insurance
Enhanced Health Insurance Coverage
Our top-up insurance plan offers wider health coverage. You can get assistance for medical expenses over and above your base health insurance. It includes coverage for AYUSH treatment, wellness services, compassionate travel, vaccination cover and so on.
Affordable
TATA AIG Medicare Plus Insurance is an affordable way to enhance your insurance coverage. You can get comprehensive medical coverage and a higher sum insured at lower premium rates as deductibles are involved.
Flexible
A top-up health insurance offers flexibility to keep your expenses within a set limit. You can choose a deductible amount between ₹2 lakhs and ₹20 lakhs, depending on your financial situation. Thus, you do not have to strain your finances to get additional coverage.
Tax-Savings
The tax benefits under Section 80D can be availed for the premium you pay for a top-up health insurance plan. It can help you to reduce tax liability while offering health protection.
Customised Top-Up
You can customise the top-up insurance as per your requirements. You can choose the insured sum from ₹3 lakhs to ₹1 crore, depending on your requirements.
No Pre-Policy Check-Up
No pre-policy check-up is necessary to purchase our top-up insurance plan. It is a very convenient insurance option for all individuals, regardless of their health conditions.
Cashless Facility
Our top-up insurance plan also offers a cashless treatment facility. You can get the treatment done at any hospital. We shall directly settle the bill at the hospital as per the terms of the policy.
Also Read: Tax Benefit of Health Insurance Plans
Top-Up Vs Regular Health Insurance Plan
| Parameter | Regular Health Insurance | Top-Up Health Insurance |
|---|---|---|
| Plan Coverage | It covers the medical expenses up to the maximum sum insured. | The coverage begins after the medical expenses exceed the deductible limit. |
| Premium Cost | The premium cost is higher as all the costs from the beginning are covered. | The premium for top-up health insurance is lower than the base health insurance. |
| Ideal For | Ideal for basic medical expenses, hospitalisation, minor surgeries, etc. | Ideal if high treatment costs are involved and major expenses pop up exceeding the base plan limit. |
| Deductible | A regular health plan does not have any mandatory deductible clause. | Every top-up insurance consists of a mandatory deductible. |
What is Covered Under Top-Up Health Insurance?
Just like your regular health policy, a top-up plan also covers various medical expenses in the event of an emergency. Here are some of the inclusions.
In-Patient Charges
It covers the medical treatment charges if you are admitted to a hospital. You can get coverage for room rent, doctor charges, pharmacy bills, nurse charges, etc.
Day Care Procedure
Our top-up insurance also covers charges for medical treatment that do not require a 24-hour hospitalisation. It includes 540+ treatments that you may avail yourself of at a daycare facility or hospital.
Preventive Health Check-Up
It also covers expenses for preventive health check-ups as mentioned in the policy.
AYUSH Benefit
You get coverage for AYUSH treatment expenses, whether daycare or in-patient, taken at any AYUSH hospital. It also covers the pre and post-hospitalisation charges.
Lifelong Renewals
We offer lifelong renewal of your plan when the premium is paid without any breaks. It ensures that you continue to get insurance benefits, regardless of age and medical conditions.
How to Select the Right Top-Up Health Insurance
Follow these crucial points while selecting a top-up health insurance plan to ensure that you pick the best one.
Assess Your Health Requirements
Before you purchase a top-up plan, assess your health and medical requirements. It will help you to opt for an adequate sum insured to cover the excess charges.
Determine the Deductible
Assess your capability to pay the deductibles. Since it is an out-of-pocket expense, choose a plan with a reasonable deductible that matches your payment capacity.
Compare the Premiums
Insurers offer varying premium charges. Compare the various premiums and pick one that falls within your budget. TATA AIG Medicare Plus offers premiums based on the age and the sum insured you choose.
Choose Flexible Plans
Opt for plans that provide flexibility in terms of coverage, add-ons, etc. It allows you to customise the plan as required.
Things to Consider While Choosing a Top-Up Plan
Co-Payment Clause
Some top-up plans may have a co-payment clause. You may be required to share a percentage of the claim amount with the insurer. You must verify the co-payment clause before opting for a top-up plan. It will give you an idea of the amount you need to spend.
Waiting Period
Top-up plans also have waiting periods for diseases. During the waiting period, you cannot make any claims. So, before you opt for a plan, find out the waiting period for specific diseases.
Deductible Value
Consider the deductible portion of the top-up plan. It is the threshold beyond which the top-up plan will be activated. The deductibles are high. Hence, they need careful pondering.
Renewability
Learn about the maximum renewability age of the top-up plan. Once you reach the maximum age, you cannot renew the plan. TATA AIG offers a lifetime renewability option with the top-up plan. You can reap the benefits of top-up insurance as long as you live.
Inclusions and Exclusions
Pay special attention to the inclusions and exclusions. Ensure that all the necessary expenses are covered. Make a note of the inclusions, as you have to bear their costs from your pocket.
Inclusions and Exclusions of Top-Up Health Insurance
Inclusions
Hospitalisation costs for in-patient treatment
Domiciliary treatment charges
In-patient dental treatment due to illness or injury
Pre-and post-hospitalisation charges
Second opinion for specified diseases
Ambulance cover
Global cover, etc.
Exclusions
Rehabilitation and rest care charges, which do not include any treatment
It excludes obesity and weight control treatments
Pre-existing diseases during the waiting period
Cosmetic procedures are not included in the cover
Sterility and fertility treatments
Medical expenses arising due to breach of law
Injury or illness arising due to self-inflicted harm, suicide attempt, etc.
Applying for Top-Up Health Insurance
Visit Our Website: Navigate to our official website and click on ‘Health. ’
Fill out the Details: On the next page, provide the insured’s details, such as birth date, email address, mobile number, etc. Click on ‘See Plans.”
Select the Plan: Select the plan that suits your requirements and fits your budget. Carefully assess the plan details, benefits, premium amount, etc.
Make the Payment: Use the online gateway to make the premium payment securely.
Get the Policy: Once the payment is completed, we shall send the policy documents to your registered email address.
Also Read: Co-Pay in Health Insurance
Conclusion
Now that you know about the working of top-up health insurance plans, it is wise to invest in one. It is a type of medical insurance that provides additional benefits at low costs. TATA AIGs Medicare Plus can be an excellent choice for those with family floater plans and history of medical ailments.
We also offer an efficient mediclaim policy to ensure you and your family get adequate protection. You can opt for the TATA AIG Medicare policy for all-around protection during medical emergencies. We offer multiple sums insured from 3 lakhs to 20 lakhs to suit the varied needs of individuals.
The benefits of our mediclaim policy include in-patient treatment, coverage for daycare procedures, vaccination coverage, ambulance coverage, AYUSH benefits, organ donor, compassionate travel, etc.
You can insure your family members as young as 91 days old and elders up to 71 years of age with our family medical insurance. Further, we have also introduced Wellness Service as the latest features of our health plans. Under this feature insured are provided with tele-consultations and ambulance booking facilities.
To find out more about the benefits and features of our insurance plans you can contact our customer support team.
Frequently Asked Questions
Can I purchase a top-up health insurance plan as a standalone policy?
No, you must have an existing health insurance policy if you want to buy top-up insurance. A top-up plan cannot be bought as a standalone policy.
Who must buy a top-up insurance plan?
A top-up insurance can be purchased by anyone who wants additional coverage besides a regular health insurance plan. There is no specific age limit for buying a top-up plan.
What is a deductible in top-up insurance?
A deductible is an amount that an insured must pay so the top-up plan can cover the additional medical expenses. It is the threshold limit that is set beforehand. The medical expenses must exceed this threshold limit for the plan to activate.
How does the claim process for top-up insurance work?
To claim under a top-up health insurance plan, you must first exhaust the sum insured of your base health insurance plan. If your medical bill exceeds the sum insured, you can claim it from the top-up plan.
Is top health insurance cashless?
Yes, you can avail of a cashless facility with your top-up plan. After taking the treatment at the hospital, the insurer will settle the bill directly at the hospital.
Disclaimer / TnC
Your policy is subjected to terms and conditions & inclusions and exclusions mentioned in your policy wording. Please go through the documents carefully.
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