Benefits Of Health Insurance Top Up Plans

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With the rising cost of healthcare and the increasing incidences of illnesses, health insurance has become essential. Health insurance provides crucial financial support during medical emergencies. While health risks and uncertainties are an inherent part of life, financial preparedness for such unforeseen health issues is possible. One way to achieve this preparedness is by purchasing medical insurance. Additionally, top up health insurance serves as a supplement to your primary health coverage. Continue reading to discover the benefits of buying a health insurance top up plan.

What is a Top Up Health Insurance Policy?

A health insurance top up plan is an additional coverage policy designed for individuals who already have a primary health insurance policy. This plan activates when the sum insured of the regular health insurance policy is exhausted. It includes a mandatory threshold limit or deductible, which means the policyholder must pay a certain amount before the top up plan starts covering medical expenses. Notably, top up health insurance plans are more affordable than primary health insurance. This added coverage ensures you have extra financial support for unforeseen medical emergencies, especially if you feel your existing medical policy might not be sufficient.

Understanding Health Insurance Top Up Plans

A health insurance top up plan activates only when the sum insured of your regular health policy is exhausted. The plan includes a deductible amount chosen by the policyholder at the time of purchase. You can claim the top up insurance plan only after paying this deductible amount, which can be covered out of pocket or through some other health policy. The deductible must be exceeded in a single hospitalisation bill, and the top up plan can be claimed only once per policy year.

For instance, if you hold a health insurance policy with a sum insured of ₹5 lakh and you purchase a top up health insurance plan of ₹10 lakh with a deductible of ₹2 lakh, and you incur a hospital bill of ₹7 lakh, the sum insured of your base policy (₹5 lakh) will be used up first. Since this amount covers the deductible, you can then claim the remaining ₹2 lakh from your top up plan. Thus, for a ₹7 lakh bill, ₹5 lakh would be paid by your base policy and the remaining ₹2 lakh by your top up plan.

Key Benefits of Top Up Health Insurance Plans

Here are some benefits of buying a health insurance top up plan:

  • Mitigating Medical Inflation: With the rising cost of medical care, a basic health insurance policy may not provide enough coverage for you and your family. A top up plan can prevent you from depleting your savings after exhausting your base cover, ensuring continued access to quality medical care without financial strain. 
  • Cost-effective Solution: A top up health insurance policy allows you to add to your sum insured at a minimal cost. This plan supplements your basic insurance, saving you from paying higher premiums for a new policy with increased coverage or for upgrading your existing policy. 
  • Enhanced Coverage: These plans provide additional coverage, ensuring you're protected against high medical expenses that exceed your primary health insurance limits, covering a broader range of treatments and services. 
  • Flexibility and Customisation: Top up plans offer flexibility to choose coverage limits and deductibles according to your needs. This customisation allows you to tailor the plan to fit your unique health and financial requirements. 
  • Senior Citizen Protection: top up health insurance plans often offer better and more comprehensive coverage for senior citizens compared to base policies. Many top up plans don’t have any restrictions or sub-limits on hospital costs, making them ideal for seniors who often need medical care. 
  • Cumulative Bonus: If you do not use your top up plan during the policy period, you may receive a cumulative bonus - a preset percentage increase in your sum insured - for each claim-free year, enhancing your coverage without additional cost.
  • Tax Benefits: You can claim tax benefits on the insurance premium paid for a top up plan under Section 80D of the Income Tax Act.

What Do Top Up Health Insurance Plans Cover?

Here are some of the key things covered by a health insurance top up plan.

  • In-patient Hospitalisation Treatment Coverage: A top up health insurance policy covers charges incurred during hospitalisation for treatments, medical procedures, or tests. This includes medical expenses, although room rent capping may vary depending on the insurance provider. 
  • Pre- and Post-hospitalisation Coverage: top up plans often cover medical expenses incurred before hospital admission and after discharge. This can include diagnostic tests like X-rays, MRIs, angiograms and necessary medications. Typically, coverage extends up to 60 days before and 90 days after hospitalisation, though this duration can differ between insurers. 
  • Organ Donor Expenses Coverage: top up health insurance plans cover the surgical and medical costs associated with harvesting an organ for transplant to the insured, which can help alleviate a significant financial burden and encourage donor participation.
  • Emergency Ambulance Coverage: If your primary health insurance does not cover emergency ambulance charges, a top up plan can provide coverage for these expenses, ensuring that you don't have to pay out of pocket. 
  • Pre-existing Illnesses: Many top up health insurance plans provide coverage for various pre-existing diseases after a waiting period, typically ranging from 2 to 4 years. During this waiting period, claims for treatments related to pre-existing conditions are not covered. Specific conditions and waiting periods may vary by insurer.

Who Should Consider Health Insurance Top Up Plans?

Here are some individuals who can greatly benefit from purchasing a top up health insurance plan. 

  • Corporate Policy Holders: If you're covered by a group insurance policy through your employer, you may find that the coverage is insufficient for major medical expenses. While your base policy might cover minor issues, a top up plan can significantly increase your sum insured without drastically increasing your premium. 
  • Elderly Individuals: As people age, health insurance premiums tend to rise. If you are purchasing insurance for elderly parents, their premiums will be higher than yours for the same coverage. Opting for a lower coverage base policy supplemented with a top up plan can provide them with adequate coverage at a more affordable cost. 
  • Limited Coverage Policy Holders: Many individuals choose basic health insurance policies due to their affordability, but these often only cover essential hospitalisation expenses. If you have such a plan and want more comprehensive coverage, a top up plan can enhance your benefits without the higher cost associated with switching to a more comprehensive policy.

How to Choose the Right Top Up Plan?

Here are a few factors to consider while choosing top up health insurance for yourself and your family.

  • Assess Your Current Coverage: Start by reviewing your existing health insurance policy. Understand the coverage it offers and identify any gaps or limitations. This will help you determine how much additional coverage you need. 
  • Evaluate the Sum Insured and Deductible: Top up plans require you to pay a deductible amount before the coverage kicks in. Ensure that the deductible aligns with your existing policy’s coverage. The sum insured should be sufficient to cover potential medical expenses that exceed your base policy. 
  • Compare Premiums: While top up plans are generally more affordable than increasing your base policy, it's essential to compare premiums from different insurers. Look for a plan that offers the best value for your money without compromising on coverage. 
  • Check Policy Exclusions: Every insurance policy has exclusions. Read the fine print to understand what is not covered by the top up plan. This helps avoid any surprises during claim settlement. 
  • Network Hospitals: Ensure that the insurer has a broad network of hospitals, especially those that you prefer or that are conveniently located. This facilitates cashless treatment and minimises out-of-pocket expenses. 
  • Claim Settlement Ratio: The claim settlement ratio of an insurer is a good indicator of their reliability. Choose an insurer with a high claim settlement ratio to ensure a smooth and hassle-free claims process. 
  • Coverage for Pre-Existing Diseases: Some top up plans cover pre-existing conditions after a waiting period. If you have any pre-existing conditions, look for a plan that provides this benefit and understand the waiting period involved. 
  • Flexibility and Customisation: Opt for plans that offer flexibility in terms of sum insured and deductible options. Customizable plans allow you to tailor the coverage according to your specific needs. 
  • Additional Benefits: Look for additional benefits such as coverage for critical illnesses, wellness programs and preventive health check-ups. These can add significant value to your top up plan.

Common Myths About Health Insurance Top-Up Plans

There are several common myths flying around about top up health insurance that often leave people unsure about their health coverage. Here are some of these top myths and the truth behind them.

  1. Myth: Top up insurance is just like regular health insurance.
    Truth: A top up health insurance policy is a supplementary plan that kicks in after your basic health insurance sum insured is exhausted. It enhances your existing coverage rather than replacing your regular health insurance. 
  2. Myth: Only senior citizens need top up health insurance.
    Truth: Although beneficial for senior citizens, top up health insurance is advantageous for anyone with a basic policy. It allows individuals of all ages to increase their health coverage without substantial additional costs. 
  3. Myth: Top up plans have no waiting periods.
    Truth: Most top up insurance plans do have waiting periods, particularly for pre-existing conditions. It is crucial to be aware of the waiting periods specified in your policy. 
  4. Myth: Top up insurance is nor necessary if you have a high sum insured in your base insurance policy.
    Truth: Even with a high sum insured in your base policy, substantial medical costs can still be overwhelming. Top up health insurance provides an additional financial safety net in such scenarios.
  5. Myth: Top up health insurance is expensive.
    Truth: Top up health insurance plans are generally more affordable than comprehensive health insurance policies. They offer a cost-effective means to enhance your health coverage without significantly increasing your premiums.


All in all, top up health insurance plans offer a practical solution for enhancing your existing health coverage without incurring the high cost associated with increasing the sum insured of your primary policy. By covering the additional costs once the sum insured of your regular health insurance is exhausted, top up plans help mitigate medical inflation and protect your savings.

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Frequently Asked Questions

Who is top up health insurance suitable for?

Top up health insurance plans are ideal for those seeking higher coverage at a lower cost. These plans are generally more affordable than standard health insurance policies due to their mandatory deductible feature. 

Yes, similar to regular health insurance policies, top up health insurance plans have waiting periods during which claims cannot be made. 

A deductible is the amount that the policyholder must pay before the health insurance top up plan begins to cover expenses. This amount is part of the total claim and must be paid out-of-pocket by the policyholder before the insurance coverage kicks in. 

 Yes, you can purchase a top up health insurance policy even if you don’t have an existing regular health insurance policy. 

Top up health insurance plans are less expensive than basic health insurance policies because they include a built-in deductible, which lowers the insurance provider's liability.

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