Due attention bank retired employee----Please know the implications of Super Top Policies and how it works.

IBA-MIS//// Health Insurance-IBA Scheme for Retirees 2020-21 With Super Top Up

- Factors to be considered for selection of Slab Cover and Super Top up Cover
A write up by Vijayaraghavan r (Ex IOBian)

It is reported that National Insurance Company under IBA retirees’ Group Insurance Policy, is offering this year, flexible optional coverage for both base as well for Super Top Up policies.

Maximum base cover is Rs four Lakh and Super Top up cover is Rs 5 lakh.

Depending upon the base policy cover , Super Top Up Maximum is offered( Maximum Super Top up is Rs one Lakh+ Base Policy)

The advantage is cadre difference is abolished and it is left to the retiree to choose any option irrespective of Service cadre.

Another big advantage is that premium in concession rate for single cover policies.

Each Bank will issue a detailed circular on this.

Before opting for the Base Policy slab and Super Top up cover, retirees should go by the terms of the circular explaining the features of the proposed policy for the year 2020-21, to know the implications of Super Top Policies and how it works.

My write up on this, is based on the questions posed to me in last few days .

I hope this may help the reader to take a broader view on the subject to arrive at a correct decision for selecting the appropriate health insurance cover.

Based on the previous year Policy Terms and past experience the following questions are answered and the answer may vary depending upon the exact terms of the policy for this year.

1. If a retiree select a base amount of Rs 1 lakh and Super Top up of Rs 2 lakh , whether next year the base policy amount /Super Top Up amount can be increased /decreased ?

This is the first time slab system is being introduced. It will depend upon the Insurance Company and the Terms of the next year policy. No one can exactly predict now. But it is a normal industry practice to allow for increasing the cover on renewal or in periodic intervals and to opt for decrease in cover if there is change in the floater group composition.

2. What should be the basis for selecting the base amount and top up amount?

It depends upon the individual comfort , need and health issues. Being a floater policy health of the individual and spouse to be considered for selecting the slab for coverage. Considering the ever increasing cost of hospitalization and in view of pandemic thread , it will be prudent to go for maximum cover and top up subject to affordability. Individuals should take a call on this after assessing all factors.

3. How the super Top up Works?

Top up plans work on ‘per hospitalization’ basis. Super Top Up Policy Covers
aggregate of all claims made so far in that year. When the aggregate claims
exceeds the base policy limit , it will trigger the super top up policy limit ..

4. In Case of Super Top Up Policies offered on floater basis ie covering Self and Spouse-how it works?

The aggregate of Covered Expenses in respect of hospitalisation/s of insured person / all insured persons in case of Family Policy exceeds the Threshold Level.

5. What are the important points to be noted in the terms of Super Top Up Policies ?

Super Top up policies would trigger in when all limits of reimbursement under any other Health Insurance Policy/Reimbursement Scheme available to the insured person/s have been exhausted. Important point to be noted is that ,the breach of base policy limit in IBA retiree policy is not the only requisite , but if the individual is covered under any other health insurance policies the limits under such policies should also be exhausted.

6. What will be the coverage in Super Top up policies once the base limit is exhausted?

As per last year IBA Retiree Group Insurance Policy Super Top Up Policy claims are allowed as under
The claim payable under this Policy will be the amount by which the aggregate of such Covered Expenses in respect of hospitalisations with dates of admission falling within the policy period exceeds the higher of the following :

i. the Threshold Level opted for the insured person/family as applicable and stated in the schedule or

ii. ii. the amount received/receivable under any/all Health Insurance Policies (whether or not issued by the Company)/ Reimbursement Scheme and including any amount paid earlier under this policy covering the Insured person/family as applicable for such Covered Expenses.

iii. iii. Each claim, if more than one, during the period of this policy shall be separately subject to the above Basis of Payment.

iv. iv. In no case shall the Company be liable to pay any sum in excess of the Sum Insured in aggregate of all claims during the period of this Policy.

7. Pl explain with examples as how Super Top up Health Insurance Plans works with examples?

Super Top plans will be useful in cases where multiple claims or where a single claim exceeding the base policy limit..

Example –
Mr X has a family floater Group Health Insurance policy of Rs 4 Lakh and also has a Super Top up health cover of Rs 5 Lakh sum assured (total coverage Rs 9 Lakh), with the threshold limit of Rs 4 Lakh. It is assumed that he or his spouse is not having any other health insurance cover either Single or Group.

Scenario 1.– If there is a single claim of Rs 2 Lakh in a year, his regular policy will pay Rs 2 Lakh.

Scenario 2 – If there is a single claim of Rs 5 Lakh in a year, his regular policy will pay Rs 4 Lakh and super top up plan will pay the remaining Rs 1 Lakh.

Scenario 3 – If there is a single claim of Rs 9 Lakh in a year, his regular policy will pay Rs 4 Lakh and the remaining claim amount of Rs 5 lakh will be paid by the Super Top up medical insurance plan.

Scenario 4 – If there are two claims in a year, one for Rs 3 Lakh (Claim 1) for Self & another for Rs 2.5 Lakhs for Spouse (claim 2),
regular policy will pay the first claim amount (Rs 3 Lakh) and in Second Claim Rs one lakh will be paid by base policy,
As the claim limit exceeding the base policy amount , the remaining second claim amount of Rs 1.5 Lakh will be paid by his super top up plan.

Scenario 5 – If there are two claims in a year, one for Rs 5 Lakh (claim 1) & another for Rs 3 Lakh (claim 2),
regular policy will pay up to Rs 4 Lakh (claim 1) &
super top up plain will pay the remaining Rs 1 Lakh amount (a portion of claim 1). The entire second claim amount of Rs 3 Lakh will be paid by Super top up plan, as the regular policy coverage is exhausted.

*So, it is clear that Super Top up plans consider
‘the total of all the bills’ in a given year.
Super Top up plans cover ‘multiple’ hospitalizations and they look at the aggregate claim of both Self and Spouse.
This means they put together several cases of hospitalization to calculate the deductible limit (threshold limit)
At the same time, a person can not claim in Super Top Up for the claims disallowed due to ceiling fixed or due to proportionate clause or for any reason.

Vijayaraghavan R
04.10.2020 (Reproduced from fb News for BankPensioners)

Thanks Com. Perumal Maruthu