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Sunday, March 20, 2016

FLOATER GROUP MEDICLAIM POLICY


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)  
(Definition No. 12)

  • 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