Optima Plus Health Insurance TopUp Plan
What Is a TopUp Health Plan?
A topup health insurance plan is a supplemental cover that activates only after the sum insured of your primary health policy has been exhausted. It works like a safety net, providing additional financial protection for highcost medical treatments, extended hospital stays, or unexpected complications.
Optima Plus Health Insurance offers a dedicated TopUp Plan designed to complement existing health cover, giving policyholders confidence that even the most expensive medical expenses are taken care of.
Key Features of Optima Plus TopUp Plan
- Flexible Sum Insured: Choose from INR2lakh, 5lakh, 10lakh, or 20lakh as per your familys needs.
- Coverage After Primary Limit: The topup activates once the primary policys limit is fully utilized.
- Comprehensive Hospitalisation Benefits: Inpatient expenses, ICU charges, surgeons fees, and diagnostic tests are covered.
- PreExisting Disease Waiting Period: 2year waiting period, same as most standard health policies.
- No SubLimits on Room Rent: You can stay in a private or semiprivate room without additional charges.
- Coverage for DayCare Procedures: Includes chemotherapy, dialysis, and advanced surgical procedures performed on an outpatient basis.
- Cashless Hospitalisation: Network of over 12,000 empanelled hospitals across India.
- Free Health CheckUps: Annual wellness checkup up to INR2,500.
- Easy Claim Process: Online claim submission, track status in real time.
Who Should Consider a TopUp Plan?
The Optima Plus TopUp Plan is ideal for:
- Families already holding a basic health insurance policy but needing higher coverage for potential catastrophic illnesses.
- Individuals with chronic conditions who anticipate higher medical costs beyond their primary policys limit.
- Young professionals who want to keep premiums low while still securing a large sum insured for future emergencies.
- Seniors (aged 60+) who have a primary policy with a modest limit and wish to protect against expensive hospital stays.
Eligibility & Enrollment
Eligibility is straightforward:
- Age between 18 and 65 years at the time of purchase.
- Must own a primary health insurance policy (any insurer) with a minimum sum insured of INR1lakh.
- Indian residents with a valid ID proof and address proof.
Enrollment can be completed online or at any authorized Optima Plus branch. The entire processfrom quotation to policy issuancetakes less than 24hours for most applicants.
Premium Structure
Premiums are calculated based on the selected sum insured, age, and the sum insured of the underlying primary policy. Because the topup activates only after the primary limit is exhausted, premiums are significantly lower than buying a standalone highsuminsured policy.
| TopUp Sum Insured | Age 2535 | Age 3645 | Age 4655 | Age 5665 |
|---|---|---|---|---|
| INR2lakh | 1,200 | 1,450 | 1,750 | 2,200 |
| INR5lakh | 2,400 | 2,900 | 3,500 | 4,300 |
| INR10lakh | 4,300 | 5,200 | 6,500 | 8,200 |
| INR20lakh | 8,000 | 9,700 | 12,200 | 15,500 |
All premiums are payable annually. Discounted rates are available for families purchasing the topup for multiple members.
How Claims Work
StepbyStep Process
- Hospitalisation: Inform the hospitals billing department that you hold a primary policy and a topup plan. They will verify cashless eligibility.
- Primary Policy Settlement: The primary insurer processes the claim up to its limit.
- TopUp Activation: Once the primary limit is exhausted, the Optima Plus TopUp claim is triggered.
- Document Submission: Upload the discharge summary, original bills, and the primary insurers claim settlement letter through the online portal.
- Claim Assessment: Optima Plus reviews the documents within 48hours.
- Payment: The approved amount is transferred directly to the policyholders bank account.
For cashless admissions, the claim is settled at the hospital itself. The insurer authorises the hospital to directly bill Optima Plus after confirming the primary policys exhaustion.
Why Choose Optima Plus?
- CostEffective Supplementation: Provides high coverage at a fraction of the cost of a standalone highsuminsured plan.
- Wide Hospital Network: More than 12,000 empanelled hospitals, including toptier corporate and specialty centers.
- Transparent Processes: Realtime claim tracking and 24/7 customer support.
- ValueAdded Services: Free annual health checkup, telemedicine consultations, and wellness programs.
- Seamless Integration: Works with any primary health policy, making it a truly universal topup solution.
Frequently Asked Questions
- Can I buy the topup plan for a senior who already has a primary policy?
- Yes, provided the seniors age is 65 years or below at the time of purchase and they have a valid primary health policy.
- What happens if the primary policys limit is not exhausted?
- The topup will not be triggered, and you will not be billed for the topup premium for that year.
- Is there a waiting period for preexisting diseases?
- Yes, a standard 2year waiting period applies for preexisting conditions, the same as most primary health policies.
- Can I increase my topup sum insured later?
- Yes, you can upgrade the sum insured during the policy renewal window. Premiums will be adjusted accordingly.
- Does the plan cover maternity expenses?
- Maternity expenses are covered only if they exceed the primary policys limit and the waiting period for maternity (usually 9 months) has been fulfilled.
Comparing TopUp vs. StandAlone High Sum Insured Policies
| Feature | Optima Plus TopUp | StandAlone High Sum Insured |
|---|---|---|
| Premium Cost | Lower (supplemental) | Higher (full coverage) |
| Activation | After primary limit exhausted | From day one |
| Flexibility | Can be added to any primary policy | Requires separate policy purchase |
| Coverage Scope | Same as primary but higher limit | Same as primary, higher limit |
| Renewal Simplicity | Renewed along with primary policy | Independent renewal |
For most families, the topup model offers the best balance between affordability and comprehensive protection.
How to Purchase
Buying the Optima Plus Health Insurance TopUp Plan is a quick threestep process:
- Get a Quote: Use the online calculator, enter your primary policys sum insured and your age, and select the desired topup cover.
- Complete Application: Fill in personal details, upload ID proof, address proof, and the primary policy document.
- Pay Premium & Receive EPolicy: Pay via net banking, credit/debit card, or UPI. The epolicy is emailed instantly, and a physical copy is mailed within 710 days.
For assistance, call our 24hour hel
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