Now a day more than one health insurance cover is need of people .It is common for an individual to be covered by two or three health insurance policies.
One most prominent reason for this is the rising cost of health-care services in the past decade. Ten years ago, Rs 2-lakh health insurance cover was considered to be more but in present it is in sufficient for an entire family.
Today, it is not enough to pay for a five-day stay in a hospital. In that case medical insurance cover from employers is insufficient. In both condition, one has to buy another policy. Larger insurance cover is a good thing but at the time of claim multiple health insurance policies can lead to confusion.
Some important queries:
1. Should a person claim only from one insurer?
2. Does he need to inform his insurer about the additional covers?
3. Will the hospital allow two cashless claims for the same illness?
4. Will he get the no-claim bonus if the second policy is not invoked?
5. It's all quite confusing for the policyholder; he might be under strain due to the illness.
What to do:
1. The first thing to know is that it pays to inform all insurers whenever there is a hospitalization. This does not mean that one can separately claim the expenses from each of them. "You cannot profit from a medical insurance plan," says Joydeep Roy, chief executive of L&T General Insurance Company.
2. By informing all the insurers, the policyholder is able to desirably utilize the cover available to him. The claim has to be paid by the insurers in the same proportion as their health cover.
· For instance -a policy holder has two policies—one for Rs 2 lakh and the other for Rs 1 lakh. If he makes a claim of Rs 1.5 lakh, the first policy will pay 2/3rd of the amount (Rs 1 lakh) while the second policy will pay the remaining 1/3rd (Rs 50,000).This sharing is subject to the terms of the policies. "There is a contribution clause in most policies. The expenses are shared by the insurers proportionately," says Sanjay Datta, head of customer service (health and motor insurance) at ICICI Lombard General Insurance.
In mind may know why the person would claim from the second policy. After all, isn't his Rs 2 lakh cover from the first plan big enough to cover his expenses? Most health plans now have limits on the expenses under different heads.
There is usually a cap of 1% of the sum assured on the room rent per day. So, Rs 2-lakh policy will only reimburse up to Rs 2,000 a day. It means that an insurance plan may not fully cover your medical expenses .That’s why one should study the policy features in detail, before buying one especially the fine print on benefits.
Advise by financial planners:
Financial planners advise that whenever the need for hospitalization arises, one should inform the third-party administrators (TPAs) of all the health policies held by the person.
Say, if having three policies (one from employer, one from your spouse's employer and one bought on your own), you will need to mention that you have additional cover at the time of making a claim.
Claim forms require the policyholder to state if he is covered under any other medical policy or group insurance scheme. "The policyholder can choose to claim from only one insurer. If he has another policy but the claim has been made only with us, we will process and settle the claim as per norms. Later, we can pursue with the other insurer for their share of the claim," says Subrahmanyam B, vice-president & head, health vertical, Bharti AXA General Insurance.
However, if any of the policies have been bought recently and still in the waiting period, then the policyholder can claim only from one policy which is already in effect.
Things can help you:
Insurance companies require submitting original bills and documents at the time of making a claim. At the time under consideration you will be claiming from more than one insurer, request the hospital to provide you the following:
· Certified duplicate copies of the summary treatment
· Bills and discharge slips
Hospitals are particular about these things. If your hospital is not cooperative, submit the following documents:
· Originals to the primary insurer
· Attested photocopies to the others
In that way, if all insurers are in the loop, you will not face any problem.