Am I allowed to make a claim under more than one health insurance policy when the claim amount is more than the maximum sum assured of any one policy?
Health insurance is basically an indemnity insurance, which is designed to reimburse the amount spent in hospital, subject to various terms and conditions set by each policy. Ideally, one should disclose to the insurers that he or she holds multiple policies. In the event of a claim, provided it is admissible under both the policies, each insurer will pay according to the respective proportion of coverage to the total coverage.
Can I change my TPA for the health policy as I am not getting any service from them?
An immediate resolution on any concern on service deficit is possible by approaching your insurer. However, if the service levels are continuously lower than your expectations, then you may approach your insurer at the time of the renewal for changing the third-party administrator.
I have bought a health policy from an insurer. If I had a second policy from another insurer, how would I make my claim and on what basis would each of the insurers pass the claim?
Policyholders can make health claims either through the cashless or the reimbursement approach. If you choose the reimbursement mode, it is essential that you submit all hospital bills in original and other related records with the insurer of your preference and get a certified acknowledgement. The copies of the hospital documents, along with the acknowledgment, can be forwarded to the other insurer. The insurer who received the copies of the documents would wait for the settlement details from the preferred insurer with whom the originals have been submitted.
This is to ensure that there is no duplication of payment. If you the choose cashless mode, then you need to give details of both the policies to the hospital, which shall contact the respective third-party administrator or companies and arrange for further process of the request.
Suppose I don?t get hospitalised for two years. Can I get the premium amount which I paid during these two years on my health policy?
No. Health insurance is normally an annual contract, renewable every year. The premium charged under health insurance is a risk-premium to cover the probability of loss for a certain period, to an extent of the sum insured, and does not have any investment component. Most health insurance products sold today in the market fall under this category. Insurers do offer reward to claim-free customers by way of offering cumulative bonus or discount in the renewal premium, during renewal. There are a few health products from life insurers, which have an investment component that offers return, whether claim-free or not.
The writer is managing director, Royal Sundaram
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