Despite increased knowledge of health insurance, many aspects of health plans remain poorly understood by policyholders. Let us try to understand the basic difference between the add-ons ‘top-up’, ‘super top-up’ and ‘Unlimited restoration’ in a health insurance policy.
Firstly, a ‘top-up plan’ is an add-on coverage that supplements a health insurance policy. It provides additional protection in excess of the amount protected under your standard health insurance plan.
Assume you have a health insurance policy worth Rs. 10 lakh with a Rs. 20 lakh top-up plan. Your total cover will now be Rs. 30 lakh. However, you may only utilize the Top-up cover if your medical costs reach Rs. 10 lakh (your base plan’s threshold limit or deductible amount). For example, if you require medical treatment and the entire cost is Rs. 15 lakh, you are covered for Rs. 15 lakh since the first Rs. 10 lakh is covered by your base health insurance plan and the remainder Rs. 5 lakhs by the Top-up plan. This is an excellent feature for individuals who are otherwise healthy but suffer an unexpected sickness, resulting in a large medical expenditure. However, you are only allowed to submit a claim beyond the deductible amount once throughout the policy’s duration. Also, if you have medical treatments many times per year with each claim totaling less than Rs. 10 lakh, the top-up plan will not be activated.
The next one is the ‘Super top-up plan’. This function, like a Top-up plan, has the added benefit of building up all of your claims in a year to figure out if the threshold limit has been surpassed. In the scenario outlined above, if you make four claims of Rs. 5 lakh each in a year, a Top-up plan will be ineffective because the Rs. 10 lakh threshold limit is not surpassed in any of the claims solely. So your first two claims (a total of Rs. 10 lakh) would be covered by your basic plan, but the remaining two would not be. However, if you have a Super top-up plan, it will be activated after the second claim because the threshold amount is reached when the first two claims are used. Therefore, the third and fourth claims would be reimbursed by the Super top-up.
Now comes the ‘Unlimited Restoration’ coverage plan. Under this add-on function, if a claim is made, the whole sum covered is returned and can be utilized for any future hospitalizations. As a result, in the event that you make a claim for the full amount of Rs. 10 lakh under a floater policy with an Unlimited Restoration benefit within the same policy year, the sum insured will be replenished indefinitely for the same illness or for some other unrelated illnesses, as well as for each and every member of your family (if you have a family-floater plan). Thus, if someone else in your family requires submitting a claim for additional Rs. 10 lakh, it will be reimbursed. The unlimited restoration option secures you from numerous claims within a single year. However, it is important to remember that each claim would only be reimbursed up to the base plan cover of Rs. 10 lakh only.
