Whether you have been insured for years or are new to your policy, it is important to understand the claim process. If you hold multiple health insurance policies, you have to be adept at juggling the different covers.
The insurance regulator has simplified the claim process by removing the contribution clause to a considerable extent. Earlier, with the contribution clause, you had to notify all your insurers who would contribute to the cover amount in the ratio of the sum assured. Now, you can approach any of your insurers to settle the claim. If you have two insurers – A and B who have a sum assured of Rs 2 lakh each and your claim amount is Rs 2 lakh – you can claim the amount from either of your insurers.
However, if your claim amount exceeds the sum insured of your single policy after factoring in deductibles and co-pay, you can then decide on which insurer to approach first. The insurer may use the contribution clause. So, if your claim amount is Rs 3.5 lakh and insurer A has a sum assured of R3 lakh, while insurer B has a sum assured of Rs 1 lakh, insurer A will reimburse about 80%-90% while insurer B will reimburse only 10% (i.e. Rs 50, 000) of the claim amount.
Streamlined claim process: Each claim process usually takes about 30-45 days. Claiming the entire amount from multiple insurers may take considerable time. In case of cashless claims, the claim settled by your first insurer will be cashless while the remaining claims would be reimbursed. When paying the claim amount, your first insurer will make a note of the deductions and sub-limits as against the claim amount and then settle the claim. Your second insurer will also follow the same process and once it decides on the claim amount, it will then deduct the amount that you received from your first insurer.
Maximising claim process: Claim from your group cover first. If you have a group cover as well as an individual cover, it is better to first approach your group insurer. The reason being group policies have less complicated clauses. For instance, group health cover comes with lower or zero waiting period and pre-existing diseases are covered from day one under group health plan, unlike individual policies. This makes the claim process faster. In addition, the number of claims made does not impact your future premiums. And, if you settle the entire claim through your group cover, the no-claim bonus (NCB) of your individual cover will not get impacted upon renewal.
Claim through your old cover first. If you have two individual health covers, it would be beneficial to leverage your older policy to settle your claim amount; the reason being, the waiting period for pre-existing diseases of your older cover may have reduced with time or is over.
Opt for a plan with a higher sum assured. Buying a health plan with a higher sum assured would not only give you an adequate cover but also save time on paperwork and the claim process.
Opt for a super top-plan. With a super top-up plan, you can make multiple claims in a given year as it covers your hospitalization expenses, including all the hospital bills in a policy year. Also, your insurer will reimburse the claim amount when your claims exceed the deductible limit.
Having multiple health insurance policies for financial protection during medical emergencies is a step which most of us take. However, it is imperative for you to understand each policy so that you are aware of its exclusions as this will expedite the claims process.
The writer is CEO & co-founder, Policybazaar.com