Dear Editor,
Namaskar, hope this first communication from me shall be received by you in your good health.
I am an Pre.AUG,1997 HGA retiree from BHARUCH BRACH, BARODA DIVISION (GUJARAT). I thought it fit to approach you for clarification.
- TAILOR-MADE FLOATER GROUP MEDICLAIM POLICY (Floater Benefits)
- Floater benefits means the sum insured as specified for a particular Insured and the members of his/her family as covered under the policy and is available for any or all the members of his/her family for one or more claims during the tenure of the policy.
To
the above definition, I would like to have your opinion for following query.
A
pensioner has opted for Rs.15,00,000/- cover and paid premium for self and
two dependent members (premium
separately paid for all as per schedule TABLE-A & B)
To
the extent of my understanding, the pensioner has paid premium separately as
per Tables A and B for all the three persons covered, and therefore cover of
Rs.15,00,000/- is available to each member separately, for one or more claim to
the extent of S.A. If it is so, here it
is fixed that all the three members will get cover of a fixed S.A. for one or
more claim to the extent of S.A. What shall then the Floater Benefit be?
Now, if a pensioner or any member covered under this cover, happens to have
hospitalisation expenses more than the cover (SA), here 15,00,000/-, what shall
be the position?
Whether
the pensioner has to bear the expenses above the SA cover for self or the said
member? Or anything shall float to cover
the excess expenses incurred, from cover for other members of the family when
the policy is titled as FAMILY FLOATER GROUP MEDICLAIM POLICY.
If
the answer of this query is negative to say that the over-expenses shall be borne by the
pensioner, I feel the policy should be called Fixed Cover Policy and not the floater cover policy. Will somebody give me a clarification ?
DINESH NAIK
DINESH NAIK