Super Top Up Individual Claim
Hi Heath Policy Expert,
I have already purchase Base Mediclaim + Super Top Up Policy for my family.
I would like to clarify certain queries.
Can you please review and confirm the following?
Scenario / Example
Policy Details (Pre Assumptions)
Person 1 + Person 2 + Person 3 + Person 4 + Person 5 - Are covered under the Base policy of UIIC for Family Floater of 5 Lacs of Rs.
Person 2, Person 3, Person 4, and Person 5 - Are covered with a Super Top Up Individual Policy of 15 Lacs with a deductible of 5 lacs. (we are assuming we are taking from Care)
Person 1 is hospitalized and the total bill is 3 lacs
- in this case, Person 1 will claim 3 lacs from the Base policy of UIIC
Person 2 is hospitalized and the total bill comes to 6 lacs
- So in this case he will claim with the base policyholder first for 2 lacs (as 3 lacs already utilized)
- Then apply with Care super top-up policy for 4 lacs
Verdict - UIIC will pay 2 lacs to Person 2
Query - But will Super Top of Care policy will pay 4 lac to Person 2 ?
Person 3 hospitalized and the total bill comes to 3 lacs
- Since In this case base floater policy is already utilized by Person 1 and 2 in past claims, Person 2 will now directly apply with Care under Super Top Up for 3 lacs claim.
Query - Will Care pay 3 lacs to Person 3 under the super top-up policy?
Question 1 - Person 2 and Person 3 are holding Base Family Floater Policy of 5 lacs in total and Individual SuperTopUp Policy of 15 lacs with 5 lacs deductible.
Since Base Family Floater is shared by all 5 persons, the Actual deductable for person 2 and person 3 becomes limited and not the actual 5 lacs.
Under the Super top policy of Care will it be considered a combined 5 lacs deductible or they will go for the individual deductible?
Question 2 - If the hospital is in the Care hospital network then will the cashless facility be allowed under all the above claims?
Question 3 - Under any claim if there is some limitation or capping on some charges and due to this if they reduce overall claim under capping. Care will consider which amount for calculations original one which is submitted or Revised capped amount derived by Base Policy Company UIIC
I would be grateful if you can get confirmation from the Care team so that we can decide on the renewal of the existing SuperTopUp Policy.
Thanks in Advance