Claim Scenarios — Single Claim vs Multiple Claims in a Year

One difference, three patterns

The defining difference between a top-up and a super top-up is how the deductible meets the claims of a policy year. A top-up compares each claim with the deductible. A super top-up compares the year's total with it.

That one difference produces three patterns. On a single claim above the deductible, the claim and the year's total are the same figure, so both plans pay the same: the claim minus the deductible, up to the sum insured. Where several claims are each below the deductible but together exceed it, the top-up pays nothing and the super top-up pays the total minus the deductible. Where one claim is above the deductible and others are below it, both pay, but the super top-up pays more because the smaller claims also count.

Family floaters

A family floater super top-up commonly has a single deductible for the whole family. The admissible claims of all insured members in the policy year are then added together, and the plan pays once that combined total crosses the deductible.

Some products apply the deductible to each member instead. The two designs can give very different results on the same claims, so the policy wording decides which applies.

The policy year and the claim itself

An aggregate deductible starts afresh at the beginning of each policy year. Claims of an earlier year do not carry forward, so claims that fall on either side of the renewal date are counted in separate years.

Whichever plan pays, the claim is made in the usual way. A cashless request must be decided within one hour and final discharge authorisation given within three hours. A reimbursement claim must be settled within 15 days of submission; the limit was 30 days earlier.

Rules at a glance

Key points

• A top-up tests each claim against the deductible; a super top-up tests the year's total.
• On a single claim above the deductible, both pay the same amount.
• When several claims are each below the deductible but together above it, only the super top-up pays.
• In a floater with one family deductible, all members' claims are added together; some products apply the deductible per member.
• The aggregate deductible starts afresh each policy year.

Common misunderstandings

• The two plans do not differ on every claim: on a single claim above the deductible they pay the same.
• A large yearly total does not help under a top-up: only a claim that crosses the deductible alone is paid.
• A floater does not always pool the family's claims: some products apply the deductible to each member, and the wording decides.
• Claims do not accumulate across renewals: an aggregate deductible starts afresh each policy year.

Questions people ask