What is a super top-up?
Super top-up is additional coverage of 20 lakhs added to your existing policy. You can avail the additional cover for yourself, and/or for your entire family (self+spouse+2 kids), and/or your parents.
Before you understand super top-ups, you need to know what a deductible is.
What is a deductible?
Deductible refers to the amount paid by the policyholder (via out of pocket or other medical insurance policy) before the super top-up kicks in.
Simply put, if you opt for a 20 lakh sum insured with a deductible of Rs. 3 lakhs, then Rs. 3 lakh will be paid by you or your employer's health insurance, and the rest will be paid for, by your super top-up plan.
How does super top-up work?
Consider an example where employee Neha policy covers the employee, her spouse, and her children.
Neha buys a super top-up for her parents with the sum insured as 20 lakhs, and a deductible of 3 lakhs. Neha paid a premium of Rs. 1248 for the year to get the super top-up (624 for her father + 624 for her mother).
Unfortunately, Neha's father runs into a situation where he needs to undergo treatment. Let's say the total hospital bill for the treatment was 7 lakhs.
Since the deductible that Neha opted for is 3 lakhs, she will have to pay 3 lakhs worth of bills out of her own pocket, or the father's sum insured (in case the father has been insured via an external health insurance policy bought separately) first.
Then, for the remaining 4 lakhs, Neha can use the super top-up.
The sum insured via the super top-up is 20 lakhs. Since 4 lakhs has been used up, the super top-up balance becomes 16 lakhs (20 - 4).
If Neha's father is hospitalized again, with a total bill of 10L, she can now directly use the super top-up to settle the entire bill. The super top-up balance becomes 6 lakhs (16 - 10).
Can I use my super top-up to claim for COVID-19?
Yes. Super top-up covers COVID-19 treatment but note that there is a 30-day waiting period from the purchase date. The claim can be made only after crossing the deductible limit.
Who can buy super top-ups?
Super top-ups can be bought by the primary member who has a group health insurance cover provided by Plum.
Who can I purchase a super top-up for?
You can add a super top-up to your spouse, child, or parent. The age limit for super top-ups is 75 years.
Can I purchase a super top-up for my parents?
If your plan covers your parents, you can directly add the super top-up to your parent's sum insured.
If your parents are not covered by your plan, you can still buy a super top-up for them but it will not be linked to your employer's group health insurance.
Can I add a super top-up to avail maternity benefits?
No, super top-up does not cover maternity.
What happens if I leave my company or my company discontinues using Plum before the expiry of my super top-up?
Your super top-up policy remains active for one full year from the purchase date. It remains active irrespective of you leaving the company or your company discontinuing Plum. The deductible amount can then either be covered by your personal health insurance policy or out of your own pocket.
E.g.: Say you had a deductible of 3 lakhs and then get a hospitalization bill of Rs. 5 lakhs after leaving your company.
3 lakhs will need to be covered either by your personal health insurance policy or out of your pocket and then, the remaining 2 lakhs will be covered by super top-up.
Is there a waiting period for super top-up policies?
A 30-day waiting period from the policy start date is applicable, except for injuries & accidents. Also, there is a 24-month waiting period for the following illnesses/surgeries:
Arthritis, if non-infective, gout, rheumatism and spinal disorders, joint replacement surgery
Benign ear, nose, and throat (ENT) disorders and surgeries (including but not limited to adenoidectomy, mastoidectomy, tonsillectomy, and tympanoplasty), nasal septum deviation, sinusitis, and related disorders
Benign prostatic hypertrophy
Dilatation and curettage
Fissure/fistula in anus, hemorrhoids/piles, pilonidal sinus, gastric and duodenal ulcers
Surgery of genitourinary system unless necessitated by malignancy
All types of hernia, hydrocele
Hysterectomy for menorrhagia or fibromyoma or prolapse of uterus unless necessitated by malignancy
Internal tumors, cysts, nodules, polyps including breast lumps (each of any kind) unless malignant
Kidney stone/ ureteric stone/ lithotripsy/ gall bladder
Myomectomy for fibroids
Skin tumors unless malignant
Varicose veins and varicose ulcers