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How does the Group Super TopUp Insurance Work?

Group super top-up health insurance policy is usually taken with an existing group health insurance policy. The group super top-up health insurance policy is an extension of the group health insurance policy where the sum insured under the group top up health insurance plan would be on a higher level.

The premium under the group super top-up health plan would be comparatively much less than that of the group health insurance policy. This is due to the deductible limit present under the group super top-up health insurance plan. Deductible is the amount of claim that has to be borne by the insured after which the insurance company will settle the balance claim amount.

Let us understand the group super top-up health insurance plan with an example. For example Mr. Raju has a group health insurance policy of Rs. 5 Lakhs with a floater option and has also taken a group super top-up health insurance plan of Rs. 25 Lakhs with a deductible of Rs. 5 Lakhs sum insured for the same policy period.

Scenario 1: First claim of Rs. 10 Lakhs in which the group health insurance plan would pay Rs. 5 Lakhs which is the maximum limit under the policy. The remaining Rs. 5 Lakhs should be ideally paid by the super top-up health insurance plan, but the remaining claim amount is not exceeding the deductible limit due to which the claim amount would not be paid by the top-up plan. The remaining Rs. 5 Lakhs has to be borne by the insured customer.

Second claim of Rs. 5 Lakhs in which the group health insurance plan would not pay anything as the sum insured was exhausted in the first claim itself. The entire Rs. 5 Lakhs claim would be settled by the group super top-up health insurance plan as the deductible limit was already satisfied during the first claim itself. For any consecutive claims during the policy the super top up plan would settle the claims up to the sum insured available under the plan.

Scenario 2: Consider a first claim of Rs. 15 Lakhs in which the group health insurance policy would settle Rs.5 lakhs and the remaining Rs. 10 Lakhs should be technically paid by the super top-up health insurance plan. But the super top up health insurance plan would pay only Rs. 5 Lakhs as the deductible under the policy is Rs. 5 Lakhs and the claim is paid anything above the deductible only.

Now let us assume that there is a second claim of Rs. 10 Lakhs in which the total claim amount would be paid by the group super top-up health insurance plan as there is no deduction for deductible under the plan. The deductible amount was deducted during the first claim settlement for the policy period. The maximum claim amount payable under the group super top-up health insurance plan would be the sum insured under the plan minus aggregate deductible limit during the policy period.

Any claim amount to be paid under the group super top-up health insurance plan should be more than the deductible limit mentioned under the policy. The major advantage of group super top-up health insurance plan is that the deductible is aggregated for all the claims made during the policy period and not for each and every claim.