Private health insurance companies have bought new products in the market which offer greater choices when you choose to increase your health insurance coverage.
Traditionally, the only way to increase your cover was to buy a new policy that will add to your coverage amount or increase the sum insured under your existing policy. This would increase the premium amounts and become too expensive.
However, with rising medical expenses it has become very important to be adequately insured. To cater to this need to increase the coverage, L &T has introduced a Medisure Super Top up insurance plan. This Super Top Up policy provides you an option of buying top-up insurance along with your current health insurance policy. Your current health insurance policy could be individual, floater or corporate.
A Super top up policy is different from the Top up policy that is widely available in the market.
A top-up cover demands your basic policy cover to be exhausted for any one (single) hospitalization. But the Super Top Up policy considers all your hospitalizations in given policy year to exhaust your basic cover. You will agree that chances of your basic sum insured threshold getting exhausted in any single hospitalization are lesser than the same getting exhausting in one year & hence, Super Top Up makes more sense than a basic Top Up. For instance: If you have an existing health insurance for 3 lakhs , you can increase your coverage by buying an additional L & T Medisure Super top up health insurance policy of 7 lakhs with a deductible of 3 lakhs to increase your cover to 10 lakhs.
At the time of claims, the first 3 lakhs would be paid be your existing health insurance provider and the rest of the claim amount up to Rs 10 lakh would be paid by L&T Insurance. This means you can make a total claim of 10 lakhs in one year either through one claim or multiple claims.
In this case, the main advantage of the super top up policy in comparison to the top up policy is that you can claim for expenses if the total value of expenses incurred in a single transaction or various transactions in a policy year crosses the threshold of 3 lakh rupees while in a top up policy each transaction should be above the threshold limit of 3 lakh to be effective.
The highlight of this policy is that you can buy the super top policy even if you do not have a health insurance policy. In the above instance, you can pay the ‘threshold level’ or ‘compulsory deductible’ yourself and claim the rest of from the Super top up policy.
Salient Features of L&T Medisure Super Top up insurance:
- There are no medical tests for individuals below 55.
- They offer higher sum insured at a low premium with the option of choosing from wide range of deductibles (2 Lakhs, 3 Lakhs, 4 Lakhs & 5 Lakhs).
- There is no loading charged at the time of renewal even if you make a claim during the policy year
- The policy includes pre and post hospitalization and day care procedures without any sub limits.
- The policy offers the option of individual plan or floater option where the individual can cover spouse, 2 dependent children parents and parents in laws.
- L&T offers an assurance of service response within 6 hours for a cashless facility provided your intimation is received during working hours on a working day. They offer a fixed compensation of Rs 1000 if they fail to meet their assurance. If the response is received outside working hours or during a holiday they assure a response within 8 hours.
- In case of reimbursement, they assure a response within 6 working days from the date of receipt of the complete set of documents.
Other Important benefits of L&T Medisure Super Top up insurance:
- They offer lifelong renewal of the policy.
- Fixed premiums even after the age of 60 years.
- The entry age of super top up has been extended to 65 years making at accessible to older people
- The policy covers pre existing diseases after 3 continuous renewals.
- This policy offers tax benefits u/s 80 D
- You can take the policy for 2 continuous years and get a 5 % discount on the total premium amount of 2 years.
- You can also get a discount of 10% on final premium if more than 2 members of the family are enrolled in a single policy with individual sum insured.
Conditions you should be aware of:
- Pre existing ailments will be covered after 3 continuous years of renewals.
- There is medical underwriting loading on the basis of :
- Health conditions at the time of premium payment
- Medical conditions (existing or cured)
- Medical test results
- Other co morbid factors
- Loading for most common diseases are based on the above factors and can change on the basis of medical test results.
Approx Premium loading
10%- 40 %
Blood Pressure/ Hypertension
10%- 30 %
10%- 30 %
Kidney related disorders
10%- 30 %
- All expenses along with their complications on ailments which are excluded will be covered after 24 months of continuous operation of this insurance cover.
- Knee replacement surgery ( other than caused by an accident)
- Piles or fissures
- Hypertension and diabetes related complications( to check the complete list please refer the policy wordings)
- A co payment of 10 % will be charged for each and every charge for individuals above the age of 80 years.
Quick Comparison of Super top up products:
To understand in a simpler way, let’s look at this case study.
Case A): Floater policy for 10 lakhs with 2 adults aged 38 yrs and 34 yrs and 2 children below 10 years.
The premium for Oriental Happy Family floater policy with 2 adults and 2 children for 10 lacs sum insured = Rs 23348/-
Case B): Premium for combination of floater policy for 3 lakhs with 2 adults aged 38 yrs and 34 yrs and 2 children below 10 years with L& T super top up policy.
Oriental Happy Family floater policy for 3 lakh floater– Rs 6876/- + super top of 7 lakh with a 3 lakh deductible – Rs 3831/- So the total premium would be Rs.10707.
As you see in the above comparison, there is a huge difference in cost when you buy the traditional health insurance plan in comparison to buying a Super Top Up Policy. Also the cost of the floater policy increases with increase in sum insured considerably.
However, the pricing of L&T Super top up policy is such that higher the deductible, lower the premium. This is because most of the health insurance claims are generally below Rs 3 lakhs. Also, the range of sum insured is directly proportional to a higher deductible which means if you need a higher super top up cover, your deductible would be higher.
The only downside of this policy that in case of claims, you have a room rent limits of only up to the individual policy i.e. In case A, you will have a room rent limit of up to Rs 10,000 while in case B, your room rent would be restricted to Rs 3,000.
Verdict: Is it worth buying L&T Super top up policy?
Top up (or Super Top Up) is typically like Term Insurance cover in Life Insurance Segment which offers financial protection against death at very small amount. Similarly, Top Up Cover offers protection against catastrophic large financial losses at very attractive premiums.
With growing age and the rise in medical inflation, it is necessary to have a wider coverage. L & T Super Top Up policy is value for money when you are looking at higher coverage.
If you have any doubts about this product or if you wish to share your inputs, please use the comments section below.