Buy base policy, super top-up from same insurer to simplify claims

SBI General Insurance recently introduced the SBIG Health Super Top-Up Plan. Several other general and health insurers also offer them. In case of a critical illness or a hospitalisation where the bill is exorbitant, the base policy coverage often falls short. A super top-up comes in handy in such circumstances.  

High coverage at a low cost

A super top-up offers higher coverage at a lower premium.“If a 45-year-old buys a health cover of Rs 1 crore, with a base cover of Rs 10 lakh and a super top-up of Rs 90 lakh, the premium for the base policy would be Rs 11,000-13,000, and the super top-up would cost an additional Rs 2,000-5,000. The total cost would at most be Rs 18,000. In contrast, a base cover for Rs 1 crore would have a premium of Rs 36,000,” says Siddharth Singhal, head-health insurance, Policybazaar.

 

Anushri Pawar, senior manager-employee benefit practice, Anand Rathi Insurance Brokers, informs that this policy also qualifies for Section 80D tax deduction.

Choose the right deductible

The deductible is the amount paid through the base policy or out of pocket before the super top-up kicks in. A higher deductible reduces the premium.

“Ideally, the deductible should be equivalent to the sum insured of the base policy,” says Subramanyam Brahmajosyula, chief product and marketing officer, SBI General Insurance.

For instance, if your base policy is Rs 10 lakh and the super top-up is Rs 90 lakh, your deductible should be Rs 10 lakh. “If your base policy is for Rs 5 lakh and the deductible for the super top-up is Rs 10 lakh, and you get a bill of Rs 8 lakh, you will have to pay Rs 3 lakh out of your pocket,” says Singhal.

Some customers assume the deductible applies to each hospitalisation. “It’s calculated annually for a super top-up,” says Aayush Dubey, co-founder and head of research, Beshak.org.

Don't change the insurer

Purchasing the base policy and super top-up from the same insurer is advisable. “It simplifies the claims process and reduces paperwork,” says Brahmajosyula. An additional benefit, according to him, is that the waiting periods, exclusions, and other terms of both policies are also likely to be aligned.

Dubey warns that having different insurers would require two separate claims procedures, which would make matters complicated.

When both policies are from the same insurer, you can enjoy a cashless experience for the full insured amount. “Otherwise, you may get the cashless facility for the base policy and may have to file for reimbursement from the super top-up," says Singhal.

Pawar adds that some insurers offer discounts for purchasing multiple plans from them.

Key checks

Ensure the sum insured for the super top-up is enough to cover even worst-case scenarios. “Choosing a low sum insured could leave you financially exposed,” says Pawar.

The features of both policies should match. “If your base policy allows any room category and has a three-year waiting period for pre-existing conditions, the super top-up should offer the same,” says Singhal.

Brahmajosyula also recommends having similar room rent limits under the base and the super top-up policy to avoid any deduction. The exclusions in both policies should be similar. Having similar features in both policies ensures a smoother experience. Both policies should also be purchased from an insurer with a high claim settlement ratio.

Finally, Dubey recommends checking that the hospital network offered by the super top-up is broad and includes your preferred hospitals.