Are you a working professional covered under the Group Health Insurance Policy and think that the cover offered is adequate? It’s common to think that way. Most working professionals think the same way. However, it would be wise to take a close look at your situation and evaluate your options before arriving at any conclusion.
Group insurance schemes are a great means to reduce the burden of medical expenses. However, in many cases, group insurance health plans fall short of matching the actual need. In such a scenario, super top-ups can come to the rescue. Here, we discuss how availing of a super top-up alongside a group insurance scheme can help you build a comprehensive health cover.
Why is additional coverage necessary in Group Health Insurance?
Medical cost escalation is quite high, and the demand for speciality healthcare has led the costs to increase at a pace much higher than the inflation rate. Such rising costs often render the cover offered by group insurance health plans insufficient.
This leaves the individual with 3 options:
- Avail top-up on your group insurance policy
- Avail super top-up on a group insurance scheme
- Get a separate individual health insurance policy
Evaluating the three options for Group Health Insurance:
Top-up plans:
By availing of a top-up on group insurance health plans, employees will be able to claim the amount that exceeds the sum assured of the base policy during a single hospitalization event. The deductible limit is as per the policy schedule, all claims are treated on an individual basis under this cover and any multiple claims for the same policy period are not aggregated.
Super top-up plans:
Super top-up plans honour claims for cumulative medical expenses within a policy year. The amount exceeding the sum assured of the base policy is allowed for claims. It offers coverage for claims that are not payable by your base policy and your top-up policy. You can avail such a super-top up plan from any insurer and not necessarily from your base insurer. This essentially means that irrespective of your base group insurance scheme insurer, you can avail of the super top-up plan from any insurer complementary to your group insurance policy.
Personal health insurance policy:
This is the best option as you would have complete coverage even if you happen to leave the group or your company, but this could be quite an expensive and elaborate exercise, especially if you intend to have coverage for critical illness and pre-existing diseases as well.
Thus, it is more expensive than the other two options but provides you with a wider range of coverage without any deductible and can be continued lifelong.
Difference between top-up and super top-up plans:
On the face of it both seem to have a similar feature, both these plans come into play only if the claim amount exceeds the base policy sum assured. However, both of these plans are different, especially concerning their workings, here is a brief on the difference based on various scenarios:
| Scenario analysis | Top up cover | Super top-up cover |
| Group policy of Rs. 5 lakh sum assured | Purchase of Rs. 10 lakh top-up plan with Rs. 5 lakhs as deductible | Purchase of Rs. 10 lakh super top-up plan with Rs. 5 lakhs as deductible |
| The single claim of Rs. 13 lakh | The base policy (group) covers Rs. 5 Lakh; the Top-up plan covers the remaining Rs. 8 Lakh as it exceeds the deductible. | The base policy (group) covers Rs. 5 Lakh; the Super top-up plan covers the remaining Rs. 8 Lakh as it exceeds the deductible. |
| Two claims of Rs. 4 lakh each | The base policy covers Rs. 4 Lakh (completely) the for first claim and Rs. 1 lakh for the subsequent claim. No payout from the top-up plan, the individual claim amount does not exceed the deductible amount. | The base policy covers Rs. 4 Lakh (completely) for the first claim and Rs. 1 lakh for the subsequent claim. Super top-up cover offers coverage for a balance of Rs. 3 lakhs as well since the aggregate claim, is considered. |
| The claim of Rs. 8 Lakh and Rs. 4 Lakh | The base policy covers Rs. 5 Lakh. Top-up offers Rs. 3 lakh for the first claim. The claim is not payable for the second instance as the claim amount does not exceed the deductible limit. | The base policy covers Rs. 5 Lakh. Super top-up offers Rs. 3 lakh for the first claim. Super top-up will cover the second claim of Rs. 4 lakh |
Top-up V/S super–top-up plans:
While both these options complement your base group insurance policy, a super top-up plan will be a cost saver and offers comprehensive coverage. They come in handy, especially for senior citizens who have multiple instances of illnesses during the same policy year. You should opt for a plan based on a thorough evaluation of the premiums applicable, overall budget and individual medical requirements.
Super-top ups can relieve you of your stress about your health risk. It is an easy, efficient and cost-effective way to achieve a wide range of coverage and enhanced hedging of health risks.
Health solution for corporate employees:
Ideally, you should opt for a comprehensive health insurance plan along with your group plan since it can be customized to your needs, opt for additional benefits, and continue the same lifelong. However, if budget is a constraint, then you may consider opting for a super top-up health plan with the deductible as the coverage for your group plan. But, do remember, this is a stop-gap solution as you definitely need a base plan to provide coverage for your post-retirement life (or if you choose to quit before for your entrepreneurial journey). And for that explore the plans by clicking on our website here.
You can also read about the pros and cons of group health insurance by clicking here.