How Does a Top Up Health Insurance Work?

Posted on: Jun 6, 2025 | 3 mins | Written by: HDFC ERGO Team

How Does a Top Up Health Insurance Work?

A top up health insurance policy is a supplemental plan that offers additional financial protection when your primary policy cover is exhausted. Unlike a regular health policy, it comes into effect only when your medical expenses exceed a specified amount known as the "deductible".

Key Terminologies to Understand

• Deductible:

The threshold limit above which the top up plan begins to pay.

• Sum Insured:

The total coverage provided under the top up policy.

Let’s say your deductible is Rs. 3 lakh and your top up sum insured is Rs. 7 lakh. If your medical bill is Rs. 5 lakh:

• The base plan covers up to Rs. 3 lakh.

• The top up plan covers the remaining Rs. 2 lakh.

If the claim amount is less than the deductible, the top up cover will not be triggered.

Why Consider a Top Up Health Insurance?

Medical inflation in India is rising at around 14% annually. A base plan may not be enough during a major health crisis. Here’s why top up plans are worth considering:

Benefits:

• Cost-Effective:

Cheaper than increasing the sum insured of a base policy.

• Flexible Deductibles:

You can choose deductibles based on your existing coverage.

• Wider Protection:

Helpful during major surgeries, hospitalisation, or chronic illnesses.

• Covers Expensive Treatments:

Useful in covering treatments like chemotherapy, cardiac procedures, etc.

How Does It Work With Existing Health Insurance Policies?

Top up health insurance does not replace your existing plan; it complements it. You must have a base plan or be prepared to cover the deductible yourself.

For instance, if your health insurance policies cover you up to Rs. 3 lakh, then selecting a top up plan with a Rs. 3 lakh deductible makes sense.

Key Differences: Top Up vs Super Top Up

Both sound similar but differ significantly:

Feature	Top up plan	Super top up plan
Basis of Deductible	Per hospitalisation	Total expenses in a year
Number of Claims	Works once per claim	Works after cumulative claims
Ideal For	Single large claims	Multiple hospital visits

Super top up plans may offer broader protection, especially for the elderly or those with chronic issues.

Who Should Buy a Top Up Plan?

• Salaried individuals with employer-provided cover.

• Senior citizens looking to save on premiums.

• Those with a base plan under Rs. 5 lakh.

• Families with a history of serious medical conditions.

If your base coverage is limited or hasn’t been updated recently, a top up cover may provide that much-needed financial cushion.

Features to Look For in a Top Up Health Plan

When evaluating top up options, consider the following features:

• Deductible Limit:

Must align with your base cover.

• Cashless Hospital Network:

Helps avoid out-of-pocket costs.

• Room Rent Limits:

Should ideally be unrestricted.

• Co-payment Clause:

Some plans may require you to share costs.

• Waiting Periods:

Especially for pre-existing diseases.

• Coverage Type:

Individual or family floater.

Claim Process: How It Works

Claiming under a top up policy can be slightly cumbersome. Here's a general outline:

If You Have a Base Plan:

1. Submit the claim to your primary insurer.

2. Once the deductible is met, claim the balance under the top up policy.

If You Don't Have a Base Plan:

1. Pay expenses up to the deductible limit yourself.

2. Submit the bills to your top up insurer.

In both cases, ensure your documents are intact and the treatment is within the policy's scope.

Tips to Maximise Value

• Align the deductible to match your health insurance policies.

• Review hospital networks and waiting periods before buying.

• Choose a higher deductible to lower the premium, but only if you’re financially sound.

Conclusion

Top up health insurance can be a smart, cost-effective way to extend your health coverage without inflating premiums. It gives you flexibility, high cover and better protection against serious medical issues. When paired wisely with your existing health insurance policies, a top up plan can bridge coverage gaps and offer peace of mind.

Disclaimer: The above information is for illustrative purposes only. For more details, please refer to the policy wordings and prospectus before concluding the sales.

Top-Up Plan vs. Higher Sum Insured – What is the Best Choice for Your Family’s Health Insurance?

Find Out How Top-up Plans Can Upgrade your Existing Health Insurance Policy

Things to Consider While Buying a Top-up Health Insurance Plan

Do You Need a Top-Up Plan for Family Health Insurance?