Making claims from multiple Health Insurance Policies

Health Insurance Policies
Health Insurance Policies

Having a sufficient amount of health insurance coverage is the very essence of a health insurance policies. Many individuals have realized this important nugget of wisdom and have gone ahead and bought multiple health insurance policies to supplement their existing cover. While their awareness and actions are praiseworthy, they feel confused at the time of claim. Despite having sufficient coverage amount, many don’t know how to claim their multiple policies. Do you know how?

Insurance is a technical concept. While the plan features stump many, the claim process is not understood by almost everyone. In case of having multiple policies the confusion increases. If you also have multiple policies of health insurance but are clueless about the claim settlement process here is a complete lowdown on making a claim –

For multiple indemnity health plans

Indemnity health plans are those plans which pay for the actual expenses incurred on hospitalization. If you have multiple indemnity plans, you can make a claim on any one or more plan as per requirement.

Let’s understand this with the help of an example:  Suppose, you have three plans A, B and C. The sum insured under these plans are Rs.2 lakhs, Rs.2.5 lakhs, and Rs.4 lakhs respectively. Let’s now understand the different scenarios –

Scenarios Possible solutions
#1 – You incur a claim of Rs.1.5 lakhs You can make a claim under any of the three policies as the claim amount is lower than the sum insured of all three.
#2 – You incur a claim of Rs.2 lakhs You can, again, make a claim on any plan as the sum insured is either equal to or greater than Rs.2 lakhs
#3 – You incur a claim of Rs.3 lakhs You can make a claim on Plan A for Rs.2 lakhs and the remainder can be met from Plan B or C. Alternatively, you can claim entirely from Plan C.
#4 – You incur a claim of Rs.5 lakhs For this you would have to make multiple claims. You can claim from Plans A+B+C or B+C or C+A

The process is simple. Insurers require the original medical bills and reports and a discharge certificate. If you are claiming from multiple companies, you should submit the original documents to the first company and avail a Settlement Letter from it. This letter along with the self-attested copies of the documents should then be submitted to the other company for claim settlement. The process is also applicable if you have a group health plan and an independent indemnity plan.

For fixed-benefit health plans

Fixed benefit health insurance plans pay a fixed amount irrespective of the actual costs incurred. Some popular plans include critical illness plans, hospital cash plans, etc. If you have multiple fixed benefit plans, you can claim from each insurer. For instance, if you have two critical illness plans of Rs.2 lakhs and Rs.5 lakhs, you can get a benefit of Rs.7 lakhs if you are diagnosed with a covered illness and claim from both the plans.

Important points to remember

Though making claims from multiple policies is easy, there are some points which you should remember. These are as follows –

  • If you have a Group Mediclaim Policy, always make the first claim from it. This is because group plans do not have No Claim Bonus. Thus, when you make a claim you don’t lose out on the NCB in a group plan which is applicable to an independent health plan.
  • If any plan gives you benefit from a specified number of claim-free years, avoid making a claim from that plan if possible. You can avail such benefits if you don’t make a claim.
  • Compare the NCB feature of all plans you hold. The plan with the lowest NCB deduction in case of a claim should be preferred for making a claim.
  • Always furnish the details of your existing health insurance cover when buying new policies. This informs the insurer of your multiple plans and avoids any possible disputes at the time of a claim.
  • If your insurer does not pay your claim for specific health expenses you can get such disallowed claims settled with another insurer. Try approaching the other insurer for any claim excluded by the previous one.

So, having multiple health insurance plans is good if you want a complete settlement of your claims. The claim process is also easy. Educate yourself of the process and enjoy the benefits of having a comprehensive coverage through multiple policies.

Also See:- Health Insurance Portability 

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