If your health plan falls short :: Business Line

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This new super top-up plan can be considered

New India Assurance Company recently launched a super top-up health plan. New India’s plan, like other super top-up plans, can be used once hospitalisation expenses in a year exceed the deductible (or what is called the threshold) limit chosen by you. The deductible is applied on a cumulative basis and not on each claim.

Say the sum insured is ₹10 lakh and the deductible chosen is ₹5 lakh. In the first instance of hospitalisation, if the insured person faces a bill for ₹6 lakh, the super top-up plan will pay up ₹1 lakh after deducting the agreed ₹5 lakh. In the same year, if the insured incurs another ₹4 lakh expense on hospitalisation, the super top-up insurer will pay the full ₹4 lakh.

But had it been a top-up plan, the insured wouldn’t have got any benefit from the cover as expenses didn’t hit the deductible limit of ₹5 lakh. However, note that the maximum liability under the super top-up plan is limited to the sum insured under the policy.

Covered or not

The plan has a four-year waiting period for all pre-existing diseases and excludes treatment outside India. Furthermore, there is a two-year waiting period to cover hospitalisation expenses arising out of treatment for cataract or age-related eye disorders, duodenal ulcer, hernia of all types, skin disorders, stones in the urinary systems, besides a few other ailments. The plan covers cosmetic surgeries too, but after a waiting period of four years (not applicable if it is a treatment post an accident). Expenses incurred on naturopathy or acupuncture, genetic disorders, dental surgery except those arising out of accident, will all be excluded until the policyholder has been continuously renewing the policy for a period more than 48 months.

Our take

New India’s plan has limits on room rent, doctor fees and ambulance charges. The waiting period for a pre-existing disease is four years, though some insurers keep it at three years. Besides, the deductible starts from ₹5 lakh. There are plans in the market with ₹1 lakh/2 lakh deductibles.

However, there are some unique features in the product. It covers organ donors (excluding organ cost) and provides a hospital cash benefit of ₹500 or ₹800 per day, depending on the plan.

It also covers ayush treatments, provided the treatment is taken in a government hospital. And, it gives a ‘get well’ benefit of ₹5,000 or ₹8,000, for the first four claims under the policy (though the sum insured will reduce accordingly).

So you can go for this plan, if it fits your requirements. Comparing on premiums, we find that there is at least one player that offers a slightly lower premium compared to New India Assurance in case of super top-up plans. For an individual of 40 years, a ₹10 lakh sum insured plan with a deductible of ₹5 lakh will cost ₹3,146 with New India Assurance.