Author: Manshu

This is a guest post by Priyanka Khandelwal who is heading eBusiness vertical  at MediManage, a specialist health insurance advisory service for Individuals, Families and Corporates. Know more about Medimanage’s free advisory services here

Life is full of risk and unpredictable most of the time. A sudden situation might arise and end up making you physically, emotionally & financially stressed.

One grave example is the fact of not buying an additional cover & relying only on your company insurance. It is often believe that the coverage provided by the employer is sufficient to take care of any unforeseen medical expenses which may arise. Let us look at 2 important facts to get a clear understanding as to why we require a supplementary cover.

• The average medical cover that a company insurance offers ranges from Rs. 2 to 4 lakhs.
• In the last 5yrs the medical cost has increased making it difficult for a common man to borne the expenses from his pocket. Let us look at the cost of few medical treatments in India:-

Procedures	2008	2013	Increase %
Heart Valve Replacement	Rs. 1,75,415	Rs. 3,43,145	52%
Knee Replacement	Rs. 2,70,220	Rs. 4,36,730	61%
Cataract Removal	Rs. 16,000	Rs. 25,000	56%
Angiography	Rs. 14,000	Rs. 22,000	57%
Coronary Artery Bypass Graft	Rs. 1,65,000	Rs. 2,40,000	45%
Appendectomy	Rs. 28,000	Rs. 47,000	66%
Gall Bladder Removal	Rs. 32,000	Rs. 59,000	84%
Angioplasty (PTCA) with 2 Stents	Rs. 1,75,000	Rs. 2,65,000	51%

Please Note: Rates are as per the approximate cost of treatment.

Looking at the above figures, do you still feel that your coverage is sufficient enough ?The answer will be “NO”.

It is also important to note that along with the cost of the medical expenses the premium rates may also inflate Thus, it may not be practically possible to either enhance the current cover or buy an additional cover. So in such situation, what should be the solutions?

The answer is Super Top-up policies.

In this article, let us understand – What is a super Top-up Policy? How will this be beneficial? We will also be providing a detailed comparison between 2 notch products available in the market for your reference .

What is a Super Top-up Policy?

A Super Top-up Policy is a unique type of health insurance policy available which offers an additional coverage, beyond the “ Aggregate Threshold Limit”. Thus it acts as a cushion & comes in to action when you have exhausted the exisiting cover.

Let us understand with an Example:-

Let’s say if you have an individual Policy of Rs. 5Lac and a Super Top-up Policy of 10lac with 5 Lac Threshold Limit.

Incase there is a claim for 7Lakh, your individual health insurance policy will pay Rs. 5Lakh and the remaining claim amount of Rs. 2 Lakh will be paid by your Super Top-up Policy.

Now if there is another claim of 4Lakh in the same policy year, then the entire 4Lakh claim shall be paid by the super top-up policy. Because your aggregate threshold limit of 5 lakhs is crossed. This claim will be paid upto the limit of sum insured.

When you buy Super top-up, consider the below points:-

• While buying a super Top-up policy it is not mandatory to have an existing health insurance cover
• The threshold limit is applicable for each policy year
• The threshold limit is the mandatory deductible, which needs to be take care by the customer either by way of a corporate policy or any other individual policy. You can also pay this from your pocket.
• An aggregate threshold limit is sum total of all hospitalization expenses in a policy year.

 

Let us also look at the comparison – L&T Medisure Classic & Apollo Munich – Optima Super

ELIGIBILITY DETAILS:

Insurance Company	L&T – Medisure – Super Top-up	Apollo Munich – Optima Super
Sum Insured	SI 3Lac & 8Lac – 2Lac Deductible SI – 7 & 12Lac – 3Lac Deductible SI – 6, 11 & 16Lac – 4Lac Deductible SI – 5,10,15 & 20Lac – 5Lac Deductible	SI – 5Lac, 7Lac & 10Lac Deductible – 1, 2, 3, 4, 5, 6, 7 & 10Lac
Min Entry Age	Adult – 18yrs Child – 91days	Adult – 18yrs Child – 91 days
Max Entry Age	Adult – 65yrs Child – 23yrs	Adult – 65yrs Child – 21yrs
Renewal Age	Lifelong	Lifelong
Pre Acceptance Medical Checkup	55yrs	45yrs
Cost of Medical	On acceptance of proposal, 50% of the cost of medicals will be re-imbursed.	On acceptance of proposal, 100% of the cost of medicals will be re-imbursed.
Family Defination	Individual Cover – Self, Spouse, Children, Parents, Parent-in-laws, Siblings, Grandparents, Daughter-in-law, Son-in-Law, Nephew, Niece, Grand children. Floater Cover – Self, Spouse, 2 Children (Parents & Parent-in-Laws can also be covered as a separate cover)	Individual – Spouse, dependent children and dependent parents (Max 4Adults & 5Children) Floater – Self, Spouse, 2 Children (Max 2 Adults & 2 Children) Parent-in-law – If financially dependant.
Family Discount	2 or more family members are enrolled 10% Discount	2 or more family members are enrolled 10% Discount
Policy Tenure	1 & 2yrs	1 & 2yrs
Tenure Discount	5% discount on premium	7.5% Discount on premium

 

BENEFITS:-

Insurance Company	L&T – Medisure – Super Top-up	Apollo Munich – Optima Super
Room Rent	Upto the Sum Insured	Upto the Sum Insured
ICU Rent	Upto the Sum Insured	Upto the Sum Insured
Doctor’s fees and related charges, Other Medical Charges	Upto the Sum Insured	Upto the Sum Insured
Ambulance Charges	Not Covered	Rs. 2000 per Hospitalisation
Per & Post Hospitalization	30Days Pre & 60Days Post Hosptialization	60 Days Pre & 90Days Post
Day Care Procedures	Covered – No Static List.	Covered. 144 day care procedures
Organ Transplant	Not Covered	Covered – Only Hospitalization Expenses
Addo-on Benefits	Service Guarantee. Cashless hospitalization Response in 6 hrs	NA
Co-payment	10% Co-payment for Insured age 80yrs & above.	No Co-payment

 

EXCLUSIONS & WAITING PERIOD:

Insurance Company	L&T – Medisure – Super Top-up	Apollo Munich – Optima Super
Waiting Period for Accident	None	None
Waiting Period for Specific Ailments	24months	24months
Joint Replacement Waiting Period	24months	24months
Cataract – Limitation	None	None
Limitation on Major Illness	None	None
Waiting Period for Pre-Existing Diseases	36months	48months

 

Let us also look at an example – Mr. Rao wants to enhance his existing Health Insurance of cover.

Age: 35yrs                      Existing Health Insurance: 5Lac  Required Super Top Up Cover: 10Lac

How much premium will be charged to Mr. Rao?

Insurance Company	L&T – Medisure – Super Top-up	Apollo Munich – Optima Super
Premium	Rs. 1,236	Rs. 2,475

Please Note: L&T Premium is Inclusive of ST & other companies Premium is exclusive of ST.

Our Opinion:

Super Top-up Policy are the best way to enhance your basic sum insured. If we look at the comparison both the products are good but there are few points where L&T – Medisure Classic takes an upper hand. Let us look at those points:

1. In terms of premium, it is lighter on the pocket.
2. Service Guarantee: Cashless hospitalization response in 6hrs.
3. No Pre-Acceptance medical check up till the age of 55yrs.
4. Option to add more extended family members under one policy (Customer has the choice of adding Grandparents, Siblings, Grandchildren, etc.)
5. Family Discount of 10% in case you add 2 or more members in an Individual policy.
6. The customer has the option of paying 2yrs premium at one shot and avail additional 5% discount.
7. No Sub Limits on Room Rent, ICU, Nursing, Doctor’s expenses, medical bills, etc.
8. Day Care procedures are covered without any static list.
9. Pre-existing diseases covered after 36months.
10. Under a single policy multiple relationships can be covered.

When you buy a policy always keep in mind the medical inflation while selecting the sum insured. Cost should not only be the deciding factor in choosing the Best Health Insurance plan. The ability of the plan to function when required should be the core of selection.

If you want to speak to Priyanka’s team of expert advisors for a one-to-one discussion on your requirements, post your inquiry here.