When it comes to making multiple health insurance claims, there are several things that you should ideally keep in mind.
Making multiple health insurance claims? It is nothing unnatural since many people are holders of multiple health insurance plans. If you are thinking how it is possible to get more than one health insurance policy, consider the following scenarios:
- Health insurance coverage is given by the employer through a group insurance policy and also by the employer of the spouse, father or mother.
- You may buy health insurance personally over and above the employer’s coverage.
- You may have purchased an online health insurance policy way back and may have bought another plan to boost up your coverage.
- You may be covered under a group health insurance policy offered by a bank or even a club/association/government scheme and so on and also have your own personal coverage.
- You may have also purchased a critical illness policy separately or a hospital cash policy yourself.
Now comes the big question- in case of any claim, can it be made from several insurance companies? The answer is a resounding YES as per the guidelines issued by the IRDA. This works in several scenarios-
- When amount claimed is lower than sum assured- In this case, one can claim from any one insurance company.
- When claim amount exceeds sum assured- Suppose someone has two policies from two different health insurance companies where the claim amount surpasses the sum assured. In this case, the companies will be applying the contribution clause. In such a scenario, both insurers will pay their proportionate share of the claim amount. The whole amount cannot be claimed multiple times from multiple insurance companies. You cannot be paid in excess of the actual amount for hospitalization.
Every claim made should be done after settlement of the earlier claim. There are policies which have benefits clearly defined, i.e. critical illness policies or hospital cash policies which pay up lump sum amounts if any specific event takes place and there is a termination of the policy in question. The amount paid will be fixed and will not be linked to the treatment cost. In case there are two policies, the person insured can claim with both companies for the amount specified. When applying for any new policy, declare your existing ones since if you do not, your claims may be rejected on misrepresentation grounds in the future. Preference should be your employer’s insurance policy or group insurance policy when making a claim since processing is swifter in these cases and lower restrictions such as waiting periods and so on. If you can get the whole claim settled from the employer’s insurance policy then your no-claim bonus will remain unaffected during the time of renewal. If you have two individual policies, claim from the older one first since waiting periods may have got over in this case.