Super top-up plans to bridge gaps in employer-provided health insurance plans

With Covid-19 cases continuing to affect normal life, the fear of being infected is natural. What also crosses anyone’s mind are the costs associated with getting treatment. One can often think that their employee health insurance can cover the costs. Does it though?

Unaware of coverage

Insurance by itself is a tricky term. More often than not we sign the policy papers without reading even a word of it. This luxury is not available when you receive a health card from your employer. You get an insurance that your company subscribes to in what is called a group insurance policy. Of course, the HR induction on this induces sleep, and none would fault you for thinking there is always another day to find out details.

Cut to today’s scenario where all health layers: infrastructure, telemedicine, pharmacies, and health insurance have become topics of everyday discussion. A hospitalization due to the Covid-19 infection may cost anywhere between Rs 2 lakh to Rs 16 lakh (for 14 days to a month) in a private hospital. If the patient is at high risk, then one can only assume the costs to run higher, depending on whether ICU and oxygen/ventilators are necessary.

What’s not covered?

Most coverage that employees are provided is minimal with an average upper limit of Rs 5 lakh. Clauses like copayment, room rent caps and non-coverage of certain diseases are some key points individuals often realize only when the time comes to use the insurance. Frantic calls to HR are then made over what the particulars on it are. You even realize that you have to shell out money from your own pocket.

Very often out-patient services, quarantine facilities, pre-existing conditions, preventive health check-ups are not covered. Room rent restrictions or cap on the pricing and co-payment clauses can add a burden to your pocket if you haven’t read your health insurance policy already. While there are policies that are now covering Covid treatments, there are limits on how much the spend can be. A clause that if tested negative the cost of investigation will not be covered can be present too.

Super top-ups to bridge the gap

Super top-up health insurance plans cover what is not covered in your basic health policy. Knowing what is right for your needs will help you decide on the additional coverage you will need.

These five pointers should help you decide:

Your employee health plan (coverage and clauses) may change when you move jobs, so it is advisable to be aware of what is covered and what isn’t to alter the super top-up plan if necessary.

You might want to check which dependents are covered in your employee health insurance. While some may cover your parents, often only the spouse and two children are covered. Some super top-ups provide cover for extended family.

A super top up plan is ideal if you are prone to critical illnesses and there could be a risk of hospitalizations. In-patient hospitalizations without sub limits, pre and post hospitalization care and day care procedures are typically covered.

If you buy the cover for a longer period, you could even get discounted premiums.

Some insurers don’t conduct health checks till a certain age (often 55). This can be beneficial for anyone looking for a super top-up.

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