New India Assurance - Floater with Topup query

[yogesharora2]

I was planning to buy New India health insurance. Lets say I buy a 5 lac base floater for my family and a 5 lac top up floater.
In case the base 5 lac is used by any member in a year, then can any other member directly use 5 lac top up floater, as base has already been used completely by me. OR if the base is over, no one can use top up.

[>take]

In case the base 5 lac is used by any member in a year, then can any other member directly use 5 lac top up floater, as base has already been used completely by me. OR if the base is over, no one can use top up.

It depends how you bought the policy. If it is floater then first option is ok, subject to exclusion.

The policy can be issued on Individual or Floater Sum Insured basis covering up to 6 members of the family. If the policy is to be issued on Individual Sum Insured basis, then separate document will be issued to each Insured. Family comprises of Self, Legal Spouse, dependent Children and dependent Parents.

New India's Top-up Policy: (http://newindia.co.in/newindia-topupmed.htm)
This policy will respond only when the aggregate of all Hospitalisation expenses (except Pre / Post hospitalization expenses) of one or all members of the policy, exceeds the “Threshold” stated in the policy.

Read More about - Top-up Plans (http://www.policywala.com/what-is-a-top-up-health-insurance-plan/)

[Manish_Kumar]

In case the base 5 lac is used by any member in a year, then can any other member directly use 5 lac top up floater, as base has already been used completely by me. OR if the base is over, no one can use top up.

You can use if it is a family floater top-up policy. Both the policies are separate and have their own conditions (check in the link provided by @>take)

[yogesharora2]

Hey,
I am still a little confused. correct me if wrong. so you are saying that if i have a base and top up of 5 lac each, with both as floater, then in case the whole base (5 lac) is consumed by a single person, the other can directly use top up, when required, even if there is nothing left in base?

[>take]

The top-up policy will start paying claim, when the insured hit the threshold. Insured having a Top Up of 5 Lakhs with Threshold 5 Lakhs, then in this case once the 5 lakh policy cover is exhausted then the top-up policy start paying. Second point of your question, if your top-up policy is family floater then your assumption is correct.

Threshold calculation under the Policy include:

The admission in the Hospital should have happened during the policy period.
The Insured should have been admitted as an inpatient (outpatient treatments are not to be considered).
The Hospitalisation should be for an Injury or Illness.
Pre–Hospitalisation and Post–Hospitalisation expenses will not be considered.


I would ask you to go through the example provided in the New India website (http://newindia.co.in/newindia-topupmed.htm) in CLAIMS ADJUDICATION Section.