My age is 33 years and I have a health insurance policy of ₹ 10 lakh. I have developed hypertension, which was declared during the renewal with my current insurer. However, considering the medical inflation and the uncertain environment we live in, I feel that ₹ 10 lakh might be less in case of any unfortunate event. I want to increase my sum insured; which option would be the best — carrying to a higher sum insured plan, getting a super top-up or would the restoration benefit in my health insurance suffice?
Rajan Gulati, Guwahati
It’s great that you already have a security net in place. But considering the rising healthcare costs, it is quite possible that the entire sum insured of ₹10 lakh could get exhausted in a single hospitalisation. This gives rise to the need of having additional support over and above the amount your current policy will cover. To make a wise decision as to what you need, first you must understand the options:
Restoration Benefit is a feature that restores the total sum insured if it is depleted during the policy year. Restoration benefit, which is quite common among family-floater plans, covers all members insured in a health insurance policy. It is also known as “Recharge Benefit” or “Sum Insured Restoration”. Although restoration benefits are pretty straightforward, there is often a fine-print attached to it. Basically, most health insurance plans offering restoration benefits allow the subsequent claim only for an unrelated illness. It implies that the second claim cannot be related to the first claim in any way. Usage of sum Insured: Mostly, the restoration feature is available if the sum insured is used up entirely. The restore feature would not apply on the second claim if the sum insured is remaining. Restoration amount: Usually, restoration of 100 per cent of the sum insured is allowed. However, some plans may restrict this percentage and fluctuate. Additionally, some insurance plans may allow you to enhance the restoration amount through an add-on.
Super top up: A super top-up health insurance gives coverage for cumulative medical costs incurred after the deductible limit is crossed. Deductible limit is the threshold amount that the insured either pays from their pocket, or which is paid from the base health insurance policy. Once this threshold limit is crossed, the super top-up comes into effect and covers medicare expenses up to the sum insured. Super top-ups go on to supplement an existing health cover with its prime advantage — covering multiple claims in a policy year.
Porting to higher sum insured: The need for carrying your health insurance generally stems from a point where your requirements start outgrowing the coverage of your plan. Customers can port their policy at the time of renewal. You need to approach the new insurer at least 45 days before the expiry of your existing policy.
You may choose to opt for a super top-up plan to enhance your coverage over and above your existing base plan. While you can go for the option that suits you the best, having both base plan and super top-up from the same insurer increases your chances of a hassle-free cashless claim settlement. You may also port your policy if you are not happy with your current insurer or with the features of your existing plan. However, a few insurers might have reservations on portability in your case because of PED (pre-existing disease) hypertension. In that case, you may also exercise another option, enhancement of sum insured in the existing policy, subject to a reasonable premium and medical underwriting. Having restoration benefit in the base plan does not omit the need of enhancing the cover for a comprehensive coverage.
The writer is Jt. Chairman & MD – Bajaj Capital Ltd
September 10, 2022