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Claims in a top-up plan are triggered once the claim amount exceeds the deductible (Mint )
Claims in a top-up plan are triggered once the claim amount exceeds the deductible (Mint )

A top-up insurance plan does not depend on primary cover

A regular top-up plan considers each claim independently for the deductible threshold

How do family floater top-up health insurance covers work? The primary floater cover, as I understand, covers multiple claims in a year up to the sum insured. Suppose I have a primary floater cover of 5 lakh and a top-up insurance of 20 lakh, and two claims of 3 lakh each arise in a year for different family members. Will top-up insurance provide coverage for the extra 1 lakh? Also, will the top-up policy be useful for a claim that arises after we have exhausted the primary cover in a year?

—Ajit Srivastava

Top-up health plans have a sum insured and a deductible limit up to which the insurance policy won’t pay. Claims in a top-up plan are triggered once the claim amount exceeds the deductible. So, whether the top-up plan would pay the additional 1 lakh would depend on the deductible of the top-up plan, and the manner in which the deductible is ascertained by the plan.

A regular top-up plan considers each claim independently for the deductible threshold. So, if the deductible in the top-up plan is 5 lakh, then in the above scenario, claim will not be allowed under the top-up plan. In a super top-up plan, deductible is considered as aggregate of the claim incurred in the policy year. So, two claims of 3 lakh will help cross a threshold of 5 lakh, and 1 lakh would be payable by the top-up plan.

You should also check if the top-up plan aggregates claims of all insured members of the policy for the deductible, or considers claims of each individual independently. Increasingly, insurers are introducing the super top-up variants.

A top-up plan is not dependent on the primary coverage. So, whether or not you exhaust the primary plan, you can claim under the top-up plan once the claim amount or hospitalization expenses cross the deductible threshold. You can buy a top-up plan with a slightly lower deductible threshold such as 2 lakh or 3 lakh, and split your claim between the primary and top-up plan.

Abhishek Bondia is principal officer and managing director, SecureNow.in. Queries and views at mintmoney@livemint.com

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