I am a little bit confused about some of the health insurance add-ons — top-up, super top-up and unlimited restoration. How and when are these useful? Please explain in detail.

Sukhwinder

I am happy to see this question being asked because despite the rising awareness about health insurance, there are many features of health policies that remain relatively less understood. So let me try to make a clear distinction between the three.

First up, a Top Up plan is an add-on cover to go with a health insurance policy. It offers additional protection, over and above the sum insured under your basic health insurance plan. Let’s say you have a health cover of ₹10 lakh with a Top Up plan of an additional ₹90 lakh; your effective cover would be ₹1 crore.

However, the condition is that you can use the Top Up cover when your medical bills exceed ₹10 lakh (the threshold limit or the deductible amount). For instance, if you undergo medical treatment and the total bill amounts to ₹20 lakh, you are covered for ₹20 lakh because the first ₹10 lakh would be covered by your base health insurance plan, and the rest with the Top Up plan.

This is a great feature for those who are otherwise healthy but encounter an unexpected illness and incur a huge medical bill. However, the condition is that you can make a claim only once during policy term above the deductible limit. If you get medical treatments multiple times a year with each claim amounting to less than ₹10 lakh, it will not get triggered.

This is where the Super Top Up Plan comes into the picture. Similar to a Top Up plan, this feature gives you the additional benefit of cumulating all your claims in a year to determine if the threshold limit is exceeded. In the above example, if you make four claims of ₹5 lakh each in a year, a Top Up plan would not be helpful since the threshold limit of ₹10 lakh is not exceeded in any of the claims individually. So your first two claims (₹10 lakh in total) would be paid by your base plan, the other two claims would not be covered at all. On the other hand, if you have a Super Top Up Plan, it would be triggered after the second claim as the threshold amount is hit when you combine the first two claims. So the third and fourth claims would be covered by the Super Top Up.

Now, enters the third option — Unlimited Restoration benefit. Under the most modern version of this add-on feature, every time a claim is made, the sum insured is restored in its entirety and can be used again for any subsequent hospitalisation. So, if you have a floater policy of ₹10 lakh with Unlimited Restoration benefit, and you make a claim of ₹10 lakh, then no need to worry. During the same policy year, the sum insured would be replenished unlimited number of times for same illness as well as an unrelated illness, and for all the family members (in case of a family-floater plan). Thus, in case other family member requires to make a claim of another ₹10 lakh, it will be payable. The unlimited restoration feature protects you against multiple claims in a single year, but with each claim paid till ₹10 lakhs only.

As a final thought, it’s important to underline that all these features have their own benefits but none of them is a substitute for a higher sum insured. It is always advisable to go for that. And then you can boost your protection by a suitable add-on from among these.

The writer is Joint Group CEO, PB Fintech

Send your queries to insurancequeries@thehindu.co.in

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