Know How to Make Claims With Multiple Health Insurance Policies

December 24, 2021 Mutual Fund

Nowadays, having multiple health insurance policies has become very common as people are aware of its benefits, such as increased coverage and flexibility in claims. Therefore, in spite of having corporate insurance, most people purchase Individual Health Insurance, Family Floater Health Insurance, Critical Illness Insurance Cover, a Top-up Plan, etc. However, despite having several policies, most policyholders are clueless about making claims with multiple health insurance policies. This article will elucidate how you can make claims with multiple health insurance policies and make most of the policies you own.

Here are a few tips to make claims with Multiple Health Insurance Policies:

1. Choosing between the Indemnity Plans:

Most people generally buy Indemnity Health Insurance Policies that pay you the actual medical expenses incurred during the treatment instead of paying the overall sum insured of the policy like the fixed benefits plans. The Indemnity Health Insurance Policies could be an Individual health insurance plan, Family floater health insurance plan, Senior citizen health insurance plan, etc. However, these policies do not allow you to make two or more claims for the same medical expense. For example, let’s say you have two health insurance policies of two different companies with a coverage of Rs 3,00,000 each. If you are undergoing medical treatment and the total expenses come to Rs 4,00,000, you will be able to claim a maximum of Rs 3,00,000 from one policy. You cannot claim Rs 3,00,000 from each of the policies, which is your sum insured. However, if your medical expenses are more than the sum insured, you can claim the entire sum insured of one policy and the remaining amount from another policy. So, for instance, you can claim Rs 3,00,000 from one policy and Rs 1,00,000 from another. Hence, You should decide to use the policy based on the claim amount and sum insured. In the above example, if you had one policy with a sum insured of Rs 3,00,000 and another of Rs 4,00,000, instead of claiming from both the policies, it makes sense to use the policy with a higher sum insured.

2. Choosing between the Indemnity Plans and Fixed Benefit Plans:

Fixed benefit health insurance plans have gained awareness over the past few years. In case of detection of a pre-defined disease, the Fixed benefit health insurance plans offer a fixed sum assured to the policyholder, irrespective of the medical expenses incurred. Some examples of these plans are Cancer Care Policy, Critical Illness Cover, COVID Rakshak Policy, etc. that offer the policyholder a fixed benefit (sum assured) on a medical diagnosis of a particular disease. At the same time, indemnity-based health insurance pays for the actual medical expenses incurred. So, in such a case, when you have to choose between an indemnity based health insurance plan and a fixed benefit health insurance plan, you can claim both policies if it fits into the terms and conditions of the policies.

3. Choosing between the Corporate Plans and Personal Plans:

The salaried individuals have health insurance coverage under corporate plans offered by their employers. However, in order to have sufficient coverage for themselves and their families, most individuals buy a personal health insurance plan. When you have to choose between a corporate plan and a personal plan, it is advisable to use your corporate plan first. Corporate health insurance plans usually have more benefits than individual plans. Moreover, by using the corporate plan, you can take advantage of the No Claim Bonus on your personal plan or ensure to keep coverage for your family members, which otherwise would not be possible. Apart from these direct benefits, it makes sense to use your corporate plan first because in case you change the employer, the plan won’t be of any use.

4. Choosing between the Individual Plan and Family Floater Plan:

When you have an individual health insurance plan as well as a family floater plan, it is a good idea to use your individual plan first so that the coverage of a family floater plan can be used for your family members. They will not be short of coverage if they are required to make a high amount of claims.

5. Choosing between Basic Plan and Top-up Plan:

In case if you have opted for a top-up health insurance plan and a super top-up health insurance plan, you should know that the top-up plans generally come with a higher deductible clause and are designed to be used after the basic plan is exhausted. Hence, you should not get confused about which one to use first when making a claim.

6. Co-payment Clause:

While considering the claim amount, sum insured, and the type of plan should be the essential criteria to decide which policy to use first, it should not be the only criteria. It is possible that your health insurance policy that has maximum coverage also has deductibles or a co-payment clause, which might be out of budget for you to pay for a large amount of claim.

Health Insurance Deductible is a claim amount that a policyholder has to pay before the insurance company begins to pay for your healthcare expenses. The deductible amount is always specified in the policy document, and the insurance company does not pay/ reimburse your claims unless you have paid the deductible.

Co-insurance is a fixed percentage of the claim amount that the policyholder needs to pay from his own pocket to avail of medical treatments when the medical emergency arises. Many insurance companies insist on opting for co-insurance if a policyholder is a senior citizen or has any existing health issues. It discourages policyholders from filing frequent and unnecessary claims. The policyholder has to pay their share of co-insurance after meeting the deductible.

Click here to know what is deductible, co-payment, and co-insurance and the difference between them.

So, it is advisable to first use the policy with zero or low deductible and co-payment so that you will not have to pay anything from your pocket for the insurance company to start paying for your claim.

To Conclude:

Having multiple health insurance policies helps you get maximum coverage and benefits. However, it is crucial to choose the right policy for the first claim as it significantly affects the total coverage you will be left with. It is advisable to consider the points mentioned above while choosing the policy to make a claim. Moreover, you should also consider other points such as ease to claim, cashless vs reimbursement claim, claim settlement process, service offered by the insurer, policy terms and conditions, etc. to make the claim settlement process smoother.

This article first appeared on PersonalFN here