How to make a claim with multiple health insurance policies

These days, it is common for people to have multiple health insurance policies such as corporate, individual, family, critical illness, supplemental, and super supplemental plans. While multiple policies improve your ability to deal with any medical emergency, it also creates confusion when the real need to file a claim arises.

Here’s how to make a claim if you have multiple health insurance coverages.

Decide between two compensation plans

Indemnity plans are the insurance coverages that pay you for actual expenses within the policy’s sum insured. You cannot claim the same expense under two indemnity guarantees. “If you have two indemnity policies, you have the option of submitting your claim under one of them first. If the amount of the claim exceeds the sum insured under the first policy, you can claim the balance invoice amount under the second policy,” Amit said. Chhabra, Health Insurance Manager, If the expenses exceed the sum insured of one policy, you can claim the remaining amount of the second insurance coverage.

First use the plan without or with less co-payment: Before deciding which policy to claim first, you should assess the coverage offered by all policies. “You must first consider the total amount of the claim as well as the sum insured available under the different policies. Examine the policy for any deductible or co-pay clause. The policyholder must bear a percentage of the amount of the claim 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,” Chhabra said.

If it comes to choosing between a policy with or without a copayment, you can opt for the latter. “It is preferable to use the policy with no co-pays or deductibles because both of these provisions require the insured to pay a portion of the claim amount out of pocket or through another policy,” Chhabra said. .

Use company insurance coverage before the individual

If you have both a corporate plan and an individual plan with a similar sum insured, it is best to keep the individual plan for a later stage. “If you have both an employer-provided policy and an individual policy, it’s best to use the employer-provided policy first,” Chhabra said. Corporate plans are well-negotiated insurance coverages and generally offer better coverage and a better claims experience. In case there is a job change later, your individual plan will work as a reserve.

Individual vs family float

When deciding between individual and family floating insurance coverage, if the claim amount is high, it may be prudent to use the individual plan so that the family floating plan is not exhausted as this can leave other family members vulnerable in an emergency. .

Complete plans vs add-on packages

Super add-on plans come with a deductible clause, which means the policyholder will use another insurance policy or pay the expenses up to the deductible amount out of their own pocket. When the expense exceeds the deductible amount, the super top-up plan pays the amount above the deductible up to the sum insured of the policy. So choosing between the basic plan and the add-on or super add-on plan is easy because the add-on or super add-on plans come at a later stage because you have to use the basic plan first.

Simultaneous claims, defined benefit coverage

While the payment of a indemnity scheme is linked to the actual expenses, the defined benefit scheme pays the claim in the event of the occurrence of a predefined disease with a specific severity, regardless of the expense incurred. Most critical illness insurance plans and cancer coverage fall under the defined benefit category. If you have both types of plans, you can make a claim simultaneously using both types of policies if the medical condition is eligible for the same.


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