Navigating Claims on Multiple Health Policies: A Comprehensive Guide

Health care costs are ever rising, making adequate health insurance coverage of utmost importance. As more individuals opt for personal health plans along with group coverage, it's crucial to understand the process of claiming from multiple policies. This guide will walk you through the intricacies of making claims when you have insurance from different companies.

Understanding Claims with Multiple Health Insurance Plans

The process of claiming from multiple health insurance plans involves several key steps, ensuring that you maximize your coverage efficiently. Here’s a breakdown of how to manage claims when dealing with policies from different insurance companies.

Example Scenario

Suppose Ashok has a primary health plan of Rs 1 lacs from insurer A and a secondary plan of Rs 2 lacs from insurer B. During an unfortunate health issue, his medical bills reach Rs 60,000. With the contribution clause, he initially claimed Rs 20,000 from insurer A and Rs 40,000 from insurer B.

However, under a new regulation introduced in 2013, the contribution clause no longer applies. Ashok can now claim the entire Rs 60,000 from one of the insurers by submitting original documents. If he requires Rs 250,000, he can choose to get Rs 200,000 from the second insurer and then request Rs 50,000 from the first insurer after obtaining a settlement certificate.

Points to Remember Before Making Multiple Claims

Inform Both the Insurers

The most critical point to remember is the need to inform both insurance providers about the presence of multiple policies. You must explicitly mention in your claim form that you are claiming from both insurers. If you fail to disclose this, you will violate the terms and conditions of your insurance policies, which could lead to complications if an investigation commences.

Choosing Your Claim Source

Decide which insurer to claim from based on your immediate needs. If you have two plans, one with a Rs 2 lacs sum insured and another with a Rs 1 lacs sum insured, and you need Rs 75,000, you can claim the entire amount from either insurer. If your need exceeds the sum insured of a single plan, you can claim the maximum allowable amount from one insurer and the remaining from the other after obtaining a settlement certificate.

Fixed Sum Insured Plans

If you have a fixed sum assured plan like a critical illness insurance, you don’t have to worry about the contribution clause. The insurer will pay the full sum assured in a lump sum upon diagnosis, which you can use as needed without any restrictions.

Use an Older Policy First

Consider claiming from your older insurance policy first, as it often provides better coverage for specific issues, such as maternity or pre-existing illnesses due to its earlier purchase date. This approach ensures comprehensive protection for various potential health scenarios.

Conclusion

It's wise to have more than one medical insurance plan, especially if your primary coverage is through your employer's group plan. Ensuring adequate coverage for you and your loved ones is crucial. Maintain transparency in your claims process and inform all your insurers about the other policies you hold. Holding multiple policies won't result in penalties, and navigating the claims process will be smoother and more hassle-free for you. You retain the freedom to choose your insurer for claims and can opt to claim from one insurer or both if the claim amount is low. By following the rules and regulations, you can avoid any future issues and secure the best treatment options when needed.