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Star Super Surplus Policy

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08 Apr, 2021 by  Maze Runner

Hi,


I have star super surplus policy for amount 25L (deduction limit: 5L). Also i have star policy of 10L with another accumulated bonus of 2.5L and recharge benefit of 1.5L. As on today I have exhausted 9.8L and will exhaust another 3L for my mothers cancer treatment.


Now i had to admit my father because of an emergency. I have applied for cashless on my surplus policy since i have crossed the deductible limit of 5L on my base policy. My claim has been rejected by star saying the below reason.


"We note that you have made a request for Rs.159070 for the treatment of the above disease. The pre authorization amount sought is lesser than the deductible amount of Rs.500000 opted by the insured patient, as per the policy issued to him/her."


Please help if this is genuine rejection. My understanding is that once the 5L is completed on my base policy i can use my surplus policy.

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2 Answer

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09 Apr, 2021

Hi,


The policy, star super surplus policy, opted by you is a top up policy and not a super top up policy.


In a super top up policy, the deductible is once per year. So if in a year you have run up hospitalization expenses upto the deductible amount, then the super top up policy gets triggered, irrespective of the number of hospitalizations done.


However, In a top up policy, the deductible is for every admissible claim.


Therefore, in your case unfortunately the rejection is genuine.


Below are the wordings from the Star super surplus policy.


"Under this plan an admissible claim gets paid only when it exceeds the deductible. Amount payable

is only in excess of the deductible opted for each and every hospitalization."


Hope this helps in clarifying.


Cheers!

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12 Apr, 2021
Maze Runner
Hi Sir, Thank you. I have spoken with Star. In this case there are two options- Silver and Gold. Silver is a top-up and Gold is a super top-up policy. Mine is gold policy. However as per them, In my case, the rejection reason is because of the policy period. The base policy is from Apr-Mar and Super Top-up is from Oct-Sep. Now since the deductible is 5L. As per them in the base policy from October, I should be exhausting 5L only then I can claim the super top-up.
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09 Apr, 2021

Dear

My agreement with Mr Kiran .

Each claim will need deduction limit of Rs 5 lakh .

Company is right in their decision .

Why don't you apply your father claim under your other policy of Rs 10 lakh .

Shailesh

Co founder

Insurance Samadhan

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