Here’s how to go about making a claim if you have multiple health insurance covers.
Deciding between two indemnity plans
Indemnity plans are the insurance covers that pay you for the actual expense within the overall sum insured of the policy. You cannot make a claim for the same expense from two indemnity covers. “If you have two indemnity policies, you have the option of submitting your claim under one of them first. If the claim amount exceeds the sum insured under the first policy, you can claim the balance bill amount under the second policy,” said Amit Chhabra, Head-Health Insurance, Policybazaar.com. If the expenses are higher than the sum insured of one policy then you can make the claim for the remaining amount from the second insurance cover.
Use the plan with no or least co-payment first: Before deciding which policy to claim first, you must assess the coverage offered by all policies. “You must first consider the total claim amount as well as the sum insured available under the various policies. Examine the policy for any deductibles or co-payment provisions. The policyholder must bear a percentage of the claim amount under the co-payment clause, whereas the deductible refers to the fixed amount of deduction on the claim amount above which the insurer will pay up,” said Chhabra.
If it comes to deciding between a policy with or without copayment you can go with the later. “It is best to use the policy without a co-payment or deductible because both of these provisions require the policyholder to pay a portion of the claim amount out of pocket or through another policy,” said Chhabra.
Use corporate insurance cover before individual
If you have both a corporate plan and an individual plan with similar sum insured, then saving the individual plan for a later stage is a better option. “If you have both an employer-provided policy and an individual policy, it is best to use the employer-provided policy first,” said Chhabra. Corporate plans are well bargained insurance covers and typically offer better coverage and claim experience. In case there is a job change later your individual plan will work as a reserve.
Individual vs family floater
When it comes to deciding between individual and family floater insurance cover, if the amount of claim is high it may be prudent to use the individual plan so that the family floater plan is not exhausted as this can leave other family members vulnerable in case of emergencies.
Comprehensive vs top-up plans
Super top-up plans come with a deductible clause which means that the policyholder will either use another insurance policy or pay the expenses up to the deductible amount from his/her own pocket. When the expense goes above the deductible amount the super top-up plan pays the amount above the deductible up to the sum insured of the policy. So, the choice between basic plan and top-up or super top-up plan is easy as top-up or super-top up plans come at a later stage as you need to use the basic plan first.
Claim simultaneously from indemnity, defined benefit covers
While the payment of an indemnity plan is linked to actual expenses the defined benefit plan pays the claim on occurrence of a pre-defined disease with specific severity irrespective of the expense incurred. Most of the critical illness plans and cancer covers fall under the defined benefit category. If you have both types of plans, you can make claim simultaneously using both types of policies if the medical condition qualifies for the same.