ModrinumTop-ups and flexible benefits
Voluntary cover only works if the choice is explained once, properly
A super top-up costs an employee a few thousand rupees a year and can carry a hospitalisation that would otherwise land on a personal loan. Take-up in most Indian corporate schemes sits low, and the reason is rarely price. It is that the deductible was never explained in a sentence anyone could repeat. This page is how we explain it, and how the election is administered afterwards.
The deductible, in one sentence
A super top-up pays hospitalisation costs after your total claims in the policy year cross a fixed threshold — and that threshold is normally set exactly equal to the base sum insured your employer already gives you. So if the base cover is five lakh and the top-up threshold is five lakh, the top-up starts the moment the base is used up. It is not a second policy you claim from separately, and it does not reset per hospitalisation. It is aggregate, across the year.
What the election actually costs and covers
Illustrative structure for an employer with a five lakh base group mediclaim. Exact rates are set by the insurer each year against the group's age profile and claims history; we publish the confirmed grid to employees before the window opens.
| Election | What it adds | Threshold / condition | Who pays | When it can be chosen |
|---|---|---|---|---|
| Super top-up, 10 lakh | Ten lakh of further hospitalisation cover for employee and enrolled dependants | Aggregate deductible equal to the base sum insured, per policy year | Employee, by monthly payroll deduction | Annual enrolment window, or within 30 days of joining |
| Super top-up, 20 lakh | Twenty lakh of further cover, same family definition | Same aggregate deductible | Employee | Annual window only |
| Parental cover | Parents or parents-in-law added to the base sum insured, usually with a co-pay of 10 to 20 per cent | Age bands priced separately; one set of parents, not both, in most schemes | Employee, or shared with employer where the plan is subsidised | Annual window; the choice of set is locked for the year |
| Enhanced sum insured | Base cover raised by one grade band, without a deductible | Available where the insurer offers a graded structure | Employee pays the differential premium | Annual window only |
| Voluntary GPA top-up | Additional accidental death and disablement cover above the employer block | Sum assured normally capped at a multiple of annual salary | Employee | Annual window, nomination confirmed at election |
Flexible benefit declarations
A flexible benefit plan gives each employee a defined annual allowance and lets them place it across a fixed menu of heads. In Indian practice the menu is usually a mix of insurance elections and tax-treated reimbursements — the second half of which is where the compliance detail sits.
Our part is the declaration cycle, not the tax advice: we publish the menu, run the window, validate that the total declared equals the allowance available, produce the deduction and reimbursement instruction for payroll, and hold the audit trail of what each employee chose and on which date. Where the head requires proof — rent receipts, fuel bills, an LTA travel claim — we run the document collection against the deadline your finance team sets, so unsubstantiated declarations do not reach the year-end tax computation unflagged.
Two rules we insist on, because they prevent almost every dispute: the declaration is locked once the window shuts except on a qualifying life event, and the menu shown to an employee is filtered by their own grade so nobody sees an option they cannot take.
Qualifying life events
Marriage, birth or legal adoption of a child, death of a covered dependant, a spouse losing their own employer cover. Each reopens the declaration for thirty days from the event, with documentary proof: marriage certificate, birth certificate, or a letter from the spouse's employer.
What the payroll file contains
Employee code, election head, monthly deduction or reimbursement amount, effective month, and a stop date where the election is mid-year. It is delivered in the format your payroll system ingests, on the cut-off date agreed at onboarding — most of our clients run the seventh or the twentieth.
The election window, week by week
- Week minus three Rate grid confirmed We get the year's rates from the insurer against the group's age profile, build the premium table by age band and family size, and have HR sign off the employer-subsidy split before anything is published.
- Week minus one Communication goes out A one-page explainer per election, in English and Bengali, plus two worked examples showing a five lakh claim and a fourteen lakh claim so the deductible stops being abstract. Sent by email and posted on the portal, not only announced in a town hall.
- Weeks one and two Window open Employees elect on the portal or in a floor session. Our helpdesk takes questions on the phone in Bengali, Hindi and English through the whole window, and we publish take-up counts to HR twice a week so a floor with no elections can be visited before it is too late.
- Week three Validation and lock Dependant records for every elected top-up are checked against the base policy master — a top-up on a dependant who is not on the base cover is the classic rejection. Declarations that fail validation get a call, not a silent drop.
- Week four Deduction file and endorsement The payroll deduction instruction goes to your finance team and the endorsement schedule goes to the insurer on the same day, so the deduction and the cover start in the same month. Confirmation of cover reaches each electing employee within two working days of the insurer accepting the schedule.
Where top-up claims fail
Three causes account for nearly all of it. The dependant claiming was never added to the base policy, so the top-up has nothing to sit on. The base sum insured was consumed by a claim that was never intimated to the TPA, so the deductible cannot be evidenced as met. Or the employee assumed the top-up covered a claim below the deductible entirely. All three are administration problems, and all three are avoidable at election time — which is why our validation runs before the window closes rather than at the claim.
Planning next year's window?
Tell us your renewal date and current base structure. We will draft the election menu, the premium grid and the employee explainer, and show you the take-up we would expect against comparable Kolkata employers.