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If the recent waves of Covid-19 and its cascading variant has taught us anything, it's the value of being prepared with health insurance. We all know countless instances where an unfortunate accident or disease was followed by a series of hefty hospital bills. The most recent examples could be traced to the last wave. People with co-morbidities suffered heavily in such scenarios as they had to spend more time in hospitals and pay extended medical bills.
People without health covers were found looking for new plans, while those with existing coverage either purchased new plans or boosted their policy cover through top-up or super top-up plans. At the same time, a lot of people holding multiple health insurance policies from the same or different insurers were able to adequately safeguard themselves and their loved ones. Owning multiple health plans is perfectly normal and can help you financially in pressing situations. These policies may be a combination of the Group health insurance plan provided by your employer, your health insurance, and your top-up health policy. The interesting part is that you can use a mix of any of these policies for a single claim.
Let’s assume that you have Group Health Insurance provided by your employer that reimburses a sum insured of Rs 3 lakh. Alongside, you also have reimbursement-based, personal Health Insurance with a sum insured of Rs 3 lakh. Now let's assume that you were in an accident that cost a hospitalization bill worth Rs 2 lakh. In such a case, you can choose either policy for the entire claim settlement process. However, if your hospitalization bill amounts to Rs 4 lakh, you can claim Rs 3 lakh under your group health plan and the remaining Rs 1 lakh under your personal health policy.
Additionally, in case one of your insurers does not cover a particular type of expense, say pre-hospitalization tests, then you could claim that expense from the other insurer. However, you cannot claim reimbursement for the same expense from multiple insurers. If one cover is not sufficient, the other cover can be used to cover the same expenses. Moreover, if you own two indemnity policies, you can choose whichever plan to make your claim to first. That way, if the claim amount is higher than the sum insured of your first policy, you can claim the balance amount on your second policy.
The thing to remember while lodging a claim under two policies is that both the insurers need to be informed about the other policy. Generally, it is mandatory to fill up proposal forms while getting health insurance, for disclosing any existing policy, due to a contribution clause in most policies. The contribution clause holds that in the event of an ‘insured interest’ with more than one policy, all the policies will contribute equally towards the claim.
So, if you have a reimbursement cover of Rs 3 lakh and a fixed-benefit policy of Rs 3 lakh and you undergo some surgery costing Rs 3 lakh, you can claim Rs 3 lakh from your reimbursement policy to meet treatment expenses. Simultaneously, you can claim this amount under the fixed-benefit policy for managing post-surgical recovery expenses, loss of income, etc. The claim process of fixed-benefit policies is easier as you only need to submit photocopies of treatment bills as proof of contracting the illness.
18 Apr, 2022