How To Make A Claim On Multiple Health Policies

In recent years, there has been a considerable increase of innovation in medical procedures and treatments. With all the top-notch treatment options available out there comes the burden of ever-increasing expenses of the said procedures.

So it is quite often seen that people tend to buy more than one medical covers. However, while doing so, the experts suggest that one should always compare health insurance policies available in the market and decide which policies when brought together would benefit the buyer the most.

The Need To Buy Multiple Health Policies

There can be many reasons that may lead one to believe that they may need more than one health policy. However, it is sensible to compare health insurance policies first. The most prominent one is the ever increasing medical costs and treatment expenses.

Another one is that buying two or more smaller policies than investing in a bigger one lowers the amount payable as premiums. Apart from this, fear of claim rejection at the time of need can further make the purchaser think that it is better to be safe and buy multiple policies instead. In addition to these, some people buy special policies like fixed benefit plans and critical illness plans as they provide an additional cover to the holder.

Pay Attention While Buying Policies

While the reasons compelling to buy multiple health policies are many, precaution must be sought while getting them.  It is advisable to compare health insurance plans before going for them. There is a good chance that there may be some plans from different insurers that actually don’t provide any additional benefits.

This can be a nuisance to the customer. So it is always better to opt for the policies that give the clients additive benefits. So, one must always read all the clauses, terms and conditions when they compare health insurance policies.

Disclosing Existing Health Cover Policies

As an important fact, it is compulsory to mention all the present health covers of the individual while buying a new one. The reason for this is the presence of a “contribution clause” in most of the health policies. This is an important thing to look out for when one chooses to compare health insurance plans.  The process of contribution clause can be understood by a simple example:

If a person buys two different health covers, one for ₹ 1 lakh and another for ₹ 2 lakh and makes a claim of ₹ 50,000, the insurers will have to pay them proportionally - ₹16,666 and ₹ 33,333 respectively.

Although, it is worth mentioning that due to recent changes in rules, the contribution clause does not come into play if the amount claimed is less than the sum insured by one single policy a person holds. Contribution clause also doesn’t apply if the claim made is fixed in nature or has defined benefits like Critical Illness where the claim has no relation to the treatment cost and the amount payable is already fixed. 

The Process Of Claiming Multiple Health Policies

There can be two situations while claiming from multiple health insurers:

Setting 1:

If the claim is lesser than the sum insured by any one of the policies, then as said above, the contribution clause is not applied. For instance if Mr. A wants a claim of ₹ 2 lakh; and he has one health policy X of ₹ 2 lakh and another policy Y of ₹ 3 lakh, then he is free to choose from either of the insurers and the selected insurer cannot apply the contribution clause and has to settle whole of the claim as per the terms and conditions of the said policy.

Setting 2:

If the total claimed is more than the insured sum under a sole policy after calculating the deductibles and co-pays, the contribution clause will be applicable. However, even then the customer is free to choose the company they want to approach first. In this case, if Mr. A’s claim amount is ₹ 2.5 lakh; and he has one health policy X of  ₹ 2 lakh and another policy Y of 1 lakh, and he approaches X first, it shall pay about 80-90% of the claim, while the Y will pay the rest, i.e. 10-20% of the claimed amount.

Things To Keep In Mind

• It is advised to plan the claim properly because it generally takes about 30-45 days to claim the insurance amount, whereas it can take longer if the amount is larger- a basis to compare health insurance plans available.   
• The first insurer notes the deductions and sub-limits against the claim amount and then pays.
• The second insurer also follows the same process and then it subtracts the settled amount by the first insurer and clears the rest.
• A group cover must always be claimed first as they usually have simpler clauses and lesser waiting period.
• It is better to claim an older policy first as its waiting time for pre-existing diseases may have reduced over the time; this can again be noted when one chooses to compare health insurance plans.
• In case of cashless claims, the one paid by the first insurer is cashless while the remaining is reimbursed. 

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