An increasing number of people are looking to buy multiple health policies these days for a number of reasons. Here are some reasons why people prefer to have more than one health cover.
Circumstances Under Which People Avail Multiple Health Plans
- Many people get health cover from either their own employer or from their spousesâ€™, mothersâ€™, fathersâ€™ employers.
- A lot of health-conscious people avail a personal health cover in addition to the health policy provided by employers to remain extra-safe.
- Some people buy another health plan in addition to an already existing one to enhance the coverage.
- Some policyholders receive additional health cover through their bank or through any scheme offered by state and central government.
- Some people who are armed with a life policy also opt for critical illness to stay protected from rising health care cost.
These are the typical scenarios when people posses multiple health plans. Now the million dollar question, how to get claims from multiple health insurance plans
According to the IRDA Regulations in 2013 pertaining to health insurance, it is possible to make claims with more than one health insurers. However, the process is different for different scenarios. Letâ€™s discuss the process according to the policyholdersâ€™ situations.
The Claim Is Less Than The Sum Assured Of Both Health Policies
Let us suppose, you have two different health insurance plans with sum assured amount of Rs. 2 Lakhs and 1Lakh respectively. The claim request you made is for Rs. 70,000. Since the claim amount is lower than the sum assured amount of both policies you can get the claim from either of the two insurers. Both of your insurers can settle your entire claim amount as it is less than the sum assured amount.
However, what will happen when the claim amount is more than the sum assured amount of any of two health covers.
The Claim Is More Than The Sum Assured Of Any Of The Two Health Policies
Let us assume, your claim amount is 6.5 Lakhs and the two policies you have are with sum assured amount of Rs. 6 Lakh and Rs. 2 Lakh respectively. Since the claim amount you registered is higher than the individual sum assured amount of both health cover you possess, the previous process will not be applicable here. Instead, the clause related to contribution will be applied here to resolve the claim issue. You can lodge your first claim with either of these two insurers.
Letâ€™s consider you make the first claim with the first insurer with sum assured amount of Rs. 6 Lakhs. Your first insurer is supposed to pay its due share of the entire claim. Your total health cover from both health insurers is Rs. 6 Lakh (in the proportion of 6:2 or 75%:25%). So, your first health insurer will pay 75% of the claim amount which is Rs. 487500. Then, your second insurer with 25% share of the total sum assured amount will pay the rest of the claim which amounts to Rs. 162500.
Many people prefer to stick to a single health policy with high sum assured to avoid the hassle. However, the downside of having a single health policy is in time of a claim you may lose out on NCB or No Claim Bonus. Moreover, it is not feasible for all to have just one health plan. This is why this blog aims at helping people with multiple health policies learn ways of making claims.
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