How to make claims on multiple health insurance policies

Naval GoelPolicyx.comThe steep rise in the cost of medical treatments has triggered the need for multiple health insurance policies. People are in dire need for a higher sum assured hence they go out for having more than one insurance policy that secures them against any unforeseen medical circumstances.Another reason why people have to take multiple health insurance policies is because of the reluctance of insurers to issue policies beyond a limit. The insurance policies offered by the employer is not sufficient, therefore, people these days go for multiple policies keeping in mind the members of their family.It is quite easy to purchase two policies but people often find themselves stuck when it comes to claiming the sum assured. Not knowing the proper procedure of claiming the amount may also lead to reduction in the amount. Disclose or get the amount decreasedWhen purchasing a policy, one needs to disclose the information if they hold an existing policy. If one does not disclose the amount, it is considered as a violation of the terms and conditions. In that case, the insurer’s liability automatically gets limited to the sum insured and the insured will have to bear the remaining amount. Other important detailsThe contribution clause makes it mandatory to share the details about other policies, if any. This clause states that if an insured holds multiple policies, all insurers can share the claim equally under the conforming policies. Furthermore, the insurer who is supposed to pay the claim has all right to enforce the said clause. To exemplify, if a person has two insurance policies of Rs 2 and 4 lakhs and he/she makes a claim of Rs 1lakh, the insurers will pay an amount of Rs 33,333 and Rs 66,666 respectively. All necessary documents will have to be submitted by the policy holder. He/she will then have to take the settlement certificate from the first insurer to claim the amount from the second insurer. Recent events show that the claiming procedure has been simplified by removing the contribution clause to an extent. Previously, the insured had to notify all the insurers who would contribute to the claim amount as per the ratio of the policy purchased. Now, the insured can simply approach any of the insurers and claim the amount.In the scenario where the amount claimed exceeds the sum insured of one policy after considering deductibles and co-pay, the insured can take a decision on which insurer should be approached first as per the need. The insurer may then apply the abovementioned contribution clause to settle the claim. However, it must be remembered that the clause is not applicable where the benefit is either fixed in nature or does not have any relation to the treatment expenses.The claim process and durationAny type of insurance claim is settled within a month or 45 days. If anybody is making a cashless claim in case of multiple policies, the first insurer will do a cashless settlement. Generally when the first insurer calculates the amount to be paid, it takes the applicable sub-limits and deductions into account and then pays the claim amount. The remaining amount is paid at a later date. The second insurer will then follow the same process and after deciding an amount, it will deduct the amount that has already been paid by the first insurer and then pay the remaining balance. If anybody has a group cover and an individual cover, they are advised to claim their former first. It is in the best interest because a group policy has lower or ZERO waiting period and it also covers pre-existing diseases, right from day one. The number of claims done in a group policy does not affect the value of future premiums and if the entire claimed amount is settled through such a policy, then the individual cover’s no claim bonus stays unaffected when renewed. If anybody has two individual health covers, they should first ask for the claim of the older policy. It is so because the waiting period for pre-existing diseases of an older policy gets exhausted as the time passes. Also when somebody is claiming from two policies, they should first settle the claim from the policy that has sub-limits applicable. This will help in understanding the deductions made under several heads like hospital charges, doctor’s fees, etc. For the remaining balance, the insured can approach the second insurer. Other tipsIncreasing the sum assured or getting top-up/super top-up plans is the best way to avoid the problem of claiming multiple small covers. If anybody has opted for a super top-up plan, they can make several claims in a year because such a plan covers all types of hospitalization expenses and bills incurred in a year. Doing so is also beneficial because the insurer then reimburses the amount claimed even when it crosses the limit. A few steps to keep in mind• Inform both the insurers when admitted in a hospital, immediately• Select the first insurer who will pay the amount and do all the formalities• Keep all the bills and documents handy• Acquire additional attested copies from the hospital according to the number of claims you want to make• Get a claim settlement summary from the first company before moving to the secondPurchasing two or more health insurance policies is quite common to ensure financial security in times of medical emergency. However, one needs to understand the policies and the attached terms and condition minutely as it helps in expediting the claim process. If one does not want to go through the process of making multiple claims, they should go for having a single health insurance plan with a higher assured sum.