Do you have several health insurance plans? Here’s how to use them for a single claim

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By Anshul IST (Released)

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Insured persons can subscribe to an unlimited number of health insurance plans. The claims process depends on the size of the claim and the sum insured on each of the policies.

Several health insurance plans can be subscribed by an individual. Although purchasing more than one policy helps improve coverage, it is important to know how to use them and understand the claims process to ensure there are no setbacks at the time. of a medical emergency.

When do people buy more than one policy?

Usually, rising medical inflation and health care expenses prompt people to purchase more than one policy in order to increase their overall sum insured. In some cases, depending on the customer’s age, fitness level, and company underwriting guidelines, insurers may not issue policies with a higher sum assured at renewal. In such a scenario, the insured may need to buy a second policy to improve their coverage, said Sudha Reddy, head of health and travel at Digit Insurance, while speaking to CNBC-TV18.com.

“Also, some people may opt for a second policy if their corporate coverage is insufficient. For example, a few corporate health insurance policies come with a low insured amount and may not cover family or dependents. parents of the insured. This drives individuals to purchase another policy with a higher sum insured,” Reddy said.

It should be remembered that when buying health insurance, the client is required to complete application forms in which the insurer requests disclosure of any existing policies. Failure to disclose this may be considered a violation of the terms and conditions and may lead to the repudiation of the claim.

“If the policies are from two different insurers, both companies should be made aware of the other policy. This disclosure is important because many policies have a contribution clause, which means that if the customer has more one policy, all policies will be required to contribute an equal proportion to the sum insured in the event of a claim,” Reddy said. CNBC-TV18.com.

For example, if Ms. X has two health insurance policies (e.g. of Rs 3 lakh and Rs 6 lakh each) and she makes a claim of Rs 1 lakh, then she can choose any of her insurers. However, if the size of the claim exceeds Rs 9 lakh, insurers may opt to settle the claim in equal proportion to the sum insured.

How do I make a claim on multiple health policies?

The claims process depends on the size of the claim and the sum insured on each of the policies.

When the amount of the loss is greater than the sum insured for the same contract

The contribution clause will only be applicable when the amount of the loss is greater than the sum insured. However, the insured has the right to choose which insurer they want to make the claim with first and then claim the balance of the second policy.

For example, if Mrs. X has to make a claim of Rs 5 lakh and the sum insured from the first insurer she chooses to claim is Rs 3 lakh, then she can claim the remaining Rs 2 lakh from the second insurer.

When the amount of the loss does not exceed the sum insured of a single policy

In this case, it is entirely up to the preference of the insured and the contribution clause will not apply. For example, if one has two insurance covers from different insurers with sum insured of Rs 2 lakh and Rs 3 lakh each, and they want to make a claim of Rs 2 lakh, then the insured can choose between the two insurers to settle the claim.

The insurer will have to settle the loss and cannot impose any contribution clause in this case.

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