The number of COVID-19 cases in the country is increasing with each passing day, leading to more people getting treated in hospitals or make-shift facilities. For individuals with co-morbidities, the period of hospitalization, due to COVID or other diseases, can be longer, leading to huge medical bills.
But if you have multiple health policies, don't worry. You are allowed to use multiple policies, such as an employer group policy, your individual health policy, and additional health policy, for a single claim.
We tell you how to do it and the terms and conditions to keep in mind.
If you have two policies, you have the right to choose which policy you want to file a claim first. If the claim amount is greater than the insured amount under the policy on which the claim was first filed, you can claim the balance amount on the second policy.
Remember that when purchasing health insurance, you must complete the proposal forms where the insurer requires disclosure of any current policy. "If the policies are from two different insurance companies, then the two companies should inform them of the other policy," said Naval Goel, CEO, and founder of PolicyX, an online insurance aggregator. Nerurkar said this is important because your claim may be rejected because the nondisclosure of documents is a violation of the insurance contract.
Insurance companies need this information because most policies come with a contribution clause. This clause means that if the same insured has more than one policy, all documents will contribute a percentage equal to the sum insured in the event of a claim.
For example, if you have two health insurance policies with an insured of ₹3 lakh (policy A) and ₹4 lakh (policy B) and you want to make a claim of ₹2 lakh, you have the right to choose either of the two policies. However, if the total value of the claim is $ 7 lakh, the insurance companies may choose to settle the claim in a proportion equal to the insured amount.
Additionally, you will need to claim a settlement summary and certified bills from the first insurance company before moving on to the second insurance company.
You must first find out the total amount of the claim and the amount of insurance available in the different policies. Check the refund or copayment conditions. According to the co-payment clause, the policyholder must assume a percentage of the claim amount, while the liability refers to the fixed amount of deduction on the claim amount after which the insured will pay.
It is advisable to use the policy without any copayments or deductions because both elements require the policyholder to carry a portion of the claim amount out of pocket or through another policy. "Always remember to review the old policy first, as the waiting period and pre-existing exceptions are likely to have been completed in the old policy," said Nerurkar.
If you have a policy from your employer and individual policy, it is recommended to use the policy provided by the employer first. Nirorkar said claims settlement is usually faster and easier for group policies. He added, "Once you choose your group policy, the no-claim bonus will be retained for the individual policy, which is an added bonus for not choosing the individual policy first."
Also, if you have two policies with a cashless facility, the hospital may only offer you this option on one of the policies and ask you to pay the remaining amount and the other insurance company will reimburse you for the money.
Also, not all purchased policies can have a cashless claims service. You can choose the policy with non-cash claims first or claim reimbursement. In either case, you will need to obtain a claim summary from the first insurance company along with approved hospital bills and submit them to the second insurance company for a claim for reimbursement.
It is recommended that you first follow the policy with the non-cash claims service, as you can avoid out-of-pocket payments and later recover the excess amount under the second policy.
There is no maximum number of health insurance policies that can be purchased, but experts suggest sticking to a maximum of two documents with an insured amount (a basic policy and a top-up) in addition to what the employer offers to avoid confusion in the time of settlement of the claim.
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