Is pre-authorization required to file a Top-up Health Insurance claim?

Yes, most insurers require pre-authorization for planned hospitalizations to enable faster approvals.

Health Insurance

Top Up Health Insurance Plan

Name: Top Up Health Insurance Plans
Brand: Bajaj General Insurance
Rating: 4.7 (1208 reviews)

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GST-Free Top-Up Health Insurance, No-Tax Boost to Your Existing Cover

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Coverage Highlights

Highlights

Top Up Product

Avail an option to top up your base health insurance with extra sum insured

Aggregate Deductables

Covers medical expenses for in-patient hospitalisation beyond the voluntary aggregate deductible limit as per the policy terms

High Coverage at Affordable Premiums

Avail high sum insured options at relatively lower premiums than regular health insurance policies

Entry Age for Policy

This policy is applicable for up to 80 years of age (as per policy terms)

Pre-Policy Check Up Waiver

No pre-policy medical tests up to the age of 55 years

Note

Please read policy wording for detailed terms and conditions

Key Inclusions

What’s covered?

Hospitalisation & Day Care Expenses

Coverage for the cost of in-patient hospitalisation (including room rent type choices), all types of day care procedures, and surgeries

Pre- & Post-Hospitalization Expenses

Pre-hospitalisation expenses (up to 60 days) and post-hospitalisation expenses (up to 90 days) are covered as per policy terms

Modern Treatment Methods & Technologies

Medical expenses incurred in undergoing treatment using modern and advanced procedures and technologies

Organ Donor Expenses

Medical expenses for an organ donor's in-patient treatment during organ harvesting are covered, provided the insured is the recipient of the donated organ

AYUSH Hospitalization Cost

Coverage for Ayurvedic, Yoga, Unani, Siddha and Homeopathic (AYUSH) treatment on a doctor's advice for treating illness or body injury

Maternity & Newborn Care

Medical expenses related to delivery of baby and the treatment of the new born are covered under the selected plans

Ambulance Cover

Get the coverage for an emergency need of ambulance when in need

Floater & Individual Sum Insured

Option to cover your family members under shared SI in case of a floater plan or separate SI in case of an individual plan

Note

Please read policy wording for detailed terms and conditions

Key Exclusions

What’s not covered?

Initial Waiting Period

Treatment expenses during the first 30 days except for treatment of accidental injuries7

Pre-Existing Disease Waiting period

Treatment expenses for pre-existing diseases, including diabetes, asthma, and thyroid, during the pre-defined, continuous waiting period of 12 months

Specific Illness Waiting Period

Expenses incurred during treatment of certain illnesses, including cataract, knee-replacement, hernia, gout, and endometriosis, for the pre-defined, continuous waiting period of 12 months

Maternity Expenses

Coverage for maternity treatment for a pre-defined, continuous waiting period of 12 months

Expenses for Medical Investigation & Evaluation

Cost of diagnostic procedures and medical evaluation unrelated to the current diagnosis or treatment

Dietary Supplements & Substances

Cost of supplements that are purchased without a prescription by a certified doctor as a part of treatment, including vitamins, minerals and organic substances

Cosmetic Surgery Expenses

Treatment to change appearance unless it is for reconstruction required for a medically essential treatment or following an accident or burns

Treatment for Self Inflicted Acts

Medical expenses incurred as a result of self-harm, illegal actions, hazardous activities, etc.

Deductibles & Co-pays

Part of the claim will by you (the policyholder ) if you have opted for Deductibles or Copay

Refractive Error

Covers the expenses for the treatment of correction of eye sight due to refractive error less than 7.5 dioptres

Sterility and Infertility

Expenses related to sterility and infertility are not covered as per the policy terms

Reversal of Sterilization

Expenses related to reversal of sterilization procedures like vasectomy reversal and tubal litigation are not covered

Note

Please read policy wording for detailed exclusions

More Details

What else can you get?

Non-Medical Expenses

Covers cost of consumable items (e.g., gloves, syringes, bandages) used during treatment up to the sum insured limit

Health Prime Rider

Coverage for in-person or online doctor consultation, dental wellness, diet & nutrition consultations as per the chosen plan

Respect Rider (Senior Care)

Senior citizens can avail emergency assistance with services such as SOS alert, doctor on call, and 24x7 ambulance service

Air Ambulance Cover

Covers expenses incurred for rapid ambulance transportation to the nearest hospital in an airplane or helicopter from the first incident site of illness or accident during policy period

Note

Please refer prospectus of above add-ons for more details

What is Top Up Health Insurance?

A top-up health insurance policy helps policyholders enhance their existing health insurance cover once a specified deductible is exceeded. Unlike a regular policy, medical top-up plans incur a small amount. These protect from high medical expenses that arise during hospitalisation, surgeries, or treatments.

Policyholders looking for a supplement to their existing coverage choose top-ups, which can cover significant expenses. It includes expenses like room rent, ambulance charges, and so on, which are not usually included in a standard health plan. That way, top-up policies act as a shield that not only reduces financial burden but also prepares policyholders to cope with rising healthcare costs.

Quick Overview

1
What It Is: A top-up health insurance plan offers additional medical coverage once a specified deductible limit is crossed.
2
Advantages: Beyond an existing health insurance policy, a top-up health cover protects, so it becomes easier to manage expensive medical treatments and hospitalisation.
3
Features: Additional health insurance coverage is affordable, flexible and complementary to the existing health insurance policy.
4
Ideal For: It is suitable for individuals seeking higher health coverage at affordable premiums without replacing existing insurance plans.
5
Claim Process: You can make a cashless as well as reimbursement claim under a top-up health insurance. For cashless benefits, ensure the insurer has network hospitals.
6
How to Choose: To choose the best top-up, it is crucial to check the coverage amount, claim process and availability of network hospitals.
7
How to Renew: Renewing your top-up health insurance plan is usually straightforward. Visit the insurer’s website, select policy details, and pay the premium.
8
Tax Benefits: Learn how policyholders can enjoy tax benefits by paying the premiums for top-up or super top-up health insurance policies under the Income Tax Act.

How Does Top-Up Health Insurance Work?

If you already own a high sum insured health insurance from Bajaj General Insurance and are still looking for affordable extended coverage, you can consider our Top Up Health Insurance Plan. Here is how it works:

Activates Once Deductible Exhausts

The top-up health cover under Bajaj General Insurance activates when the policyholder's medical bill is higher than the deductible threshold mentioned. The top-up can cover that extra portion.
Existing Insurance Pays Initially

During a medical emergency, suppose your hospital bill is ₹8 Lakh. With your base policy, you can cover the ₹5 Lakh deductible. You can utilise the top-up sum insured for the remaining ₹3 Lakh.
Works on Single Claim-Based Coverage

It is important to note that a top-up health insurance policy considers each hospitalisation claim separately when evaluating the deductible. Meaning, the policy does not combine multiple claims.

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Top Up Health Insurance at a Glance

Here are some of the key features of top-up health insurance:

Sr No.	Feature	What is it
1	Premium Cost	Premium is the amount in exchange for which the insurer offers medical coverage to policyholders. Top-up health insurance attracts lower premiums compared to a regular standard plan.
2	Deductible	A deductible is the predefined amount the insurer or the policyholder pays before the top-up plan becomes active.
3	Coverage Trigger	Only when the hospitalisation claim exceeds the deductible amount threshold does the top-up coverage trigger take place.
4	Claim Basis	For each hospitalisation, the deductible gets calculated separately. Based on that, the claim settlement amount is determined.
5	Waiting Period	Similar to standard health insurance, policyholders with a preexisting condition or specific diseases must wait a period before coverage begins.
6	Sum Insured	This is the maximum amount an insurer pays under the top-up health coverage plan after the deductible is exhausted.

What are the Key Features of Top-Up Health Insurance Policy?

Here are some of the best super top-up health insurance policy features you must know before getting it:

Pre-and Post Hospitalisation Coverage

Once the base policy deductible cover is exceeded, the top-up health insurance covers pre- and post-hospitalisation up to 60 days. The treatments include advanced surgeries and daycare procedures.

Critical Illness Coverage

Policyholders diagnosed with critical illnesses can also utilise the top-up option to extend the base policy coverage. That way, they do not have to bear a higher premium.

Cashless Claim Availability

Similar to a standard health insurance, top-up coverage also comes with cashless claim availability. This provides policyholders peace of mind so they can reduce out-of-pocket charges.

Increased Scope of Coverage

From emergency treatments to advanced surgeries, maternity cover, organ donation, and alternative treatments like AYUSH, top-up health insurance has an increased scope of coverage.

Tax Savings Benefits

As per the 56th GST Council meeting, health insurance premiums are GST-exempt. Not only that, section 126 (80D as per the old tax regime) makes top-up health insurance holders eligible for tax deductions.

No Pre-medical Screening

The best part of top-up health coverage is that it does not require pre-medical check-ups. So, during emergencies, they can simply purchase the top-ups without waiting for the medical test reports.

What are the Benefits of Buying a Top-Up Health Insurance Plan?

A top-up health insurance plan primarily protects against medical inflation by extending your existing coverage. Check out the benefits in the section below:

Enhanced Health Coverage

Increases your overall health insurance protection without requiring a significant increase in premium costs.

Affordable Premiums

Provides high coverage limits at a comparatively lower premium than purchasing a higher-sum-insured base policy.

Protection Against Medical Inflation

Helps manage rising healthcare expenses and costly treatments that may exceed your existing coverage.

Financial Security During Emergencies

Reduces the burden of paying large medical bills out of pocket during unexpected health emergencies.

Covers Major Hospitalisation Expenses

Offers additional support for expensive surgeries, critical treatments, and prolonged hospital stays.

Complements Existing Health Plans

Works seamlessly with individual, family floater, or employer-sponsored health insurance policies.

How is Top-Up Insurance Different from a Basic Health Insurance Plan?

A basic health insurance plan provides primary medical coverage up to the chosen sum insured, while a top-up health insurance plan offers additional protection beyond a deductible threshold. Understanding their differences in coverage, premiums, deductibles, and claim applicability can help policyholders select suitable health insurance protection.

The table below highlights the major differences between a basic health insurance plan and a top-up health insurance plan:

Parameters	Basic Health Insurance Plan	Top-up Health Insurance Plan
Meaning	A basic health insurance plan provides coverage of the incurred medical bills up to the limit of the sum insured.	A top-up health insurance plan provides coverage after exhaustion of the basic health insurance plan.
Range of Benefits	Offers standard coverage mainly for hospitalisation within the sum insured.	Provides extended benefits such as pre-existing disease cover (after waiting period), maternity cover, and emergency ambulance services, enhancing overall protection.
Mandatory Deductions	No mandatory deductible is applicable.	Every claim comprises a mandatory deductible.
Activation of Policy	A basic health insurance plan is activated from the first day of the policy for accident-related claims.	A top-up health insurance plan is activated after exhaustion of the base policy, and you end up paying the deductible amount.
Premium Amount	Premiums under a basic health insurance plan are comparatively higher than those of any top-up health plan.	Premium amounts are comparatively lower as the deductible amount lowers the liability of the insurer.
Sub-limits	Sub-limits are applicable for a basic health insurance plan.	Sub-limits do not apply to any top-up health insurance plan.
Pre-medical Screening	It is mandated to undergo pre-policy medical check-ups under the majority of basic health insurance plans.	Most of the top-up health insurance plans do not require pre-medical screening till the age of 50 years.

Can You Claim Base Health Insurance and Top-up Health Insurance Together?

Yes, you can claim both your base health insurance along with top-up health cover. For example, you have a base health insurance sum insured amount of ₹10 Lakh and a top-up health insurance cover of ₹10 Lakh. Now, if the hospitalisation bill is ₹12 Lakh, your basic deductible of ₹10 Lakh will be covered from the base plan. The remaining ₹2 Lakh will be covered from the top-up cover.

How to Select a Top-Up Health Insurance Plan?

Here is how you can choose an additional health insurance coverage:

Higher Sum Insured Amount

It is ideal to choose a sum insured that adequately covers potential medical expenses while complementing your existing health insurance coverage.

Deductible Option

Deductible refers to the highest amount you must pay or cover with the existing health insurance plan before the top-up cover activates. So, it is crucial to ensure that the deductible aligns with your current health requirements and financial capacity.

Network Hospitals

Insurers that have a wide network of hospitals make it easier for policyholders to access premium healthcare and cashless benefits conveniently. So, insurance experts recommend choosing insurers with a wide network of hospitals.

Coverage Benefits

It is important to review the policy inclusions, such as hospitalisation expenses, daycare procedures, and other covered medical treatments, along with exclusions, before investing.

Waiting Period

Since waiting periods vary from one insurer to another, comparing waiting periods based on a specific plan treatment is mandatory. That will help you access medical intervention whenever needed.

Claim Settlement Record

Consider the insurer's claim settlement ratio and its process to ensure a smooth claims experience during emergencies. IRDAI highlights that a higher claim settlement ratio indicates an insurer’s reliability.

Why Insure Your Health with Bajaj General?

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Cashless Coverage

Access 18,400+ hospitals, all cashless!

Quick Claim Settlement

Sixty minutes is all it takes!

Cumulative Bonus

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Claim-On-The-Go

Get instant claim payout upto INR 20,000 through our App.

Choice of Sum Insured

Custom-create a health plan for yourself

Why You Should Buy a Top Up Health Insurance Policy From Bajaj General Insurance?

1
Comprehensive Coverage: Both individual and family top-up insurance from Bajaj General have comprehensive coverage. Besides common hospitalisation expenses, it includes alternative, advanced, daycare and maternity treatments.
2
Cashless Coverage: With more than 18,400 network hospitals across India, availing cashless treatment benefits from Bajaj General’s top-up plan is extremely convenient.
3
Quick Claim Settlement: Whether it is a cashless or reimbursement claim settlement, we believe in settling claims faster with efficiency. This has contributed to our high claim settlement ratio.
4
Organ Donor Expenses: Since organ donation is expensive, it becomes hard to cover with only a base plan. Top-up health insurance from Bajaj General includes organ donor expenses, from harvesting to donation.
5
Cumulative Bonus: For each claim-free year, the cumulative bonus in top-up health cover contributes to an increased coverage amount, up to 50% without increasing the premium.
6
Wider Sum Insured: Bajaj General Insurance enables policyholders to opt for a higher sum insured at affordable premiums, ensuring additional financial protection for family members if medical expenses exceed the base policy coverage.

Step-by-Step Guide

To guide you through your insurance journey.

How to Buy

1

Visit Bajaj General website
2

Enter personal details
3

Compare health insurance plans
4

Select suitable coverage
5

Check discounts & offers
6

Add optional benefits
7

Proceed to secure payment
8

Receive instant policy confirmation

Buy Now

How to Renew

1

Login to the app
2

Enter your current policy details
3

Review and update coverage if required
4

Check for renewal offers
5

Add or remove riders
6

Confirm details and proceed
7

Complete renewal payment online
8

Receive instant confirmation for your policy renewal

Renew Now

How to Claim

1

Notify Bajaj General about the claim using app
2

Submit all the required documents
3

Choose cashless or reimbursement mode for your claim
4

Avail treatment and share required bills
5

Receive claim settlement after approval

Claim Now

How to Port

1

Check eligibility for porting
2

Compare new policy benefits
3

Apply before your current policy expires
4

Provide details of your existing policy
5

Undergo risk assessment by Bajaj General
6

Receive approval from Bajaj General
7

Pay the premium for your new policy
8

Receive policy documents & coverage details

Port Now

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Policy Wordings

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CIS Wordings

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What is the Top Up Health Insurance Terms You Need to Know About?

1
Aggregate Deductible: Aggregate deductible refers to the total deductible amount that accumulates during the policy year before the top-up starts to cover medical expenses.
2
Free Look Period: This is a 30-day period that an insurer provides a policyholder to review policy terms and conditions carefully. During this time, if the policyholder is dissatisfied with anything, they have the right to return the policy.
3
Policy Cancellation: After submitting a written notice to the insurer, a policyholder can cancel a policy. In that case, the insurer has to return the premium for the unexpired policy period as per the policy terms.
4
Grace Period: Grace period refers to the additional time a policyholder receives in case they have not renewed the policy on time. During this time, if a policyholder undergoes hospitalisation, the insurer is not liable to cover the expenses.
5
Portability: A policyholder can port their existing policy to another insurer at least 30 days before the renewal date. As per IRDAI guidelines, if the policyholder has maintained the policy without any break, they can retain the accrued waiting period.
6
Network Hospital: To avail the benefits of a cashless claim, a policyholder chooses a network hospital for medical treatment. Irrespective of planned or emergency hospitalisation, once notified, the insurer verifies and settles the bill directly with the hospital.
7
Pre-Existing Disease: A pre-existing disease refers to any disease, injury, or health condition of a policyholder that existed before purchasing the top-up health insurance policy.
8
Entry Age: The minimum entry age for a policyholder or a proposer needs to be 18 years. In the case of dependent children, the age criterion to avail the benefits of a top-up health insurance is 3 months.
9
Policy Exclusions: Policy exclusions refer to the medical conditions, treatments, or situations that a top-up coverage does not include. For example, surgical treatment for obesity, gender change treatments, cosmetic or plastic surgeries, etc.
10
Maternity or Newborn Care: Treatments related to pregnancy, childbirth, and pre- and post-natal care are included under top-up health insurance coverage. However, policyholders must complete the waiting period before availing coverage.

Is Top-Up Health Insurance Better?

Yes, it provides additional coverage beyond the sum insured of a regular health policy. A top-up plan is cost-effective as it enhances protection without significantly increasing premiums, making it ideal for managing high medical expenses while keeping costs affordable.

Is There a Waiting Period for a Top-Up Health Insurance Plan?

Yes, pre-existing diseases are covered after a waiting period of 12 months from the policy start date. This means claims related to such conditions can only be made after completing this period, ensuring policyholders have long-term financial protection against high medical costs.

What Is a Deductible in a Top-Up Plan?

A deductible is the fixed amount the policyholder must pay before the top-up plan covers expenses. For example, if your deductible is ₹3 lakh and the hospital bill is ₹5 lakh, the insurer will pay ₹2 lakh, while you cover the initial ₹3 lakh from your base policy or out of pocket.

Why Are Top-Up Plans Cheaper?

Top-up plans have lower premiums because they only provide coverage after the deductible is met. Since the insurer covers expenses only beyond a certain threshold, their risk is lower, resulting in reduced policy costs. This makes top-up plans an affordable way to increase health coverage.

Who should consider buying a Top-up Health Insurance Plan?

Anyone who already has a base health insurance policy but wants additional coverage at a low premium should consider health insurance top-up plans. It is especially useful for people living in metro cities where treatment costs are high.

What is the coverage amount usually offered in Top-up Health Insurance Plans?

Most top-up medical insurance policies provide high sum insured options ranging from ₹5 lakh to ₹50 lakh or more. This ensures adequate protection against rising hospitalisation costs without paying very high premiums.

Is a Top-up Health Insurance Plan suitable for senior citizens?

Yes, top-up health insurance is beneficial for senior citizens as it adds extra coverage over their existing plan. Since medical expenses in old age are high, it helps reduce the financial burden while keeping premiums manageable.

Can I buy multiple Top-up Health Insurance Policies for extra coverage?

Yes, you may purchase more than one top-up medical insurance policy. However, you must understand the terms carefully and declare them to insurers at the time of claim to avoid complications.

Can I Buy a Top-Up Insurance Plan Without a Regular Health Policy?

Yes, you can buy a top-up plan without a regular health policy. It offers additional health coverage beyond a deductible, making it useful even if you don’t have a base plan. This ensures financial protection against high medical bills without needing standard health insurance.

What is the deductible in Top-up Health Insurance Plans?

A deductible in top-up health insurance is the pre-decided amount you must pay from your existing cover or out of pocket before the top-up plan becomes active. For example, if your deductible is ₹3 lakh and your medical expenses cross that, the top-up policy covers the rest.

Do Top-up Health Insurance Policies have network hospital lists for cashless claims?

Yes, most top-up health insurance plans offer cashless facilities at network hospitals, just like a base health plan. This ensures you can get treated without paying upfront during emergencies.

What documents are required to claim Top-up Health Insurance benefits?

To claim, you usually need the hospital discharge summary, medical bills, diagnostic reports, ID proof, and a copy of your health insurance policy. In case of a cashless claim, the insurer directly pays the bill at the hospital.

Can I avail of cashless treatment under a Top-up Health Insurance Plan?

Yes, you can use cashless treatment at network hospitals. The facility works like regular health insurance policies, subject to the deductible and other terms.

Is pre-authorisation required to file a Top-up Health Insurance claim?

Yes, most insurers require pre-authorisation for planned hospitalisations. This ensures faster approvals and a smooth cashless claim process.

Can I track the claim status for my Top-up Health Insurance Plan online?

Yes, insurers provide online portals and mobile apps where you can check claim status in real time by entering your policy or claim number.

Is there a grace period for Top-up Health Insurance Plan renewal?

Yes, insurers allow a grace period, usually 15–30 days, for health insurance policy renewal. During this period, you can renew without losing continuity benefits.

Can I increase my coverage amount during the renewal of a Top-up Health Insurance Plan?

Yes, you can opt for a higher sum insured while renewing your top-up health insurance. However, this may be subject to fresh underwriting and revised premiums.

Can I switch to a different Top-up Health Insurance Plan during renewal?

Yes, insurers allow portability. You can move to another plan if you feel another option better suits your needs, such as the best super top-up health insurance.

What happens if I fail to renew my Top-up Health Insurance Plan on time?

If you miss renewal even after the grace period, the policy will lapse, and you lose accumulated benefits like waiting period credits. To stay protected, always complete your health insurance policy renewal before the due date.

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