Filing Claim With Two Insurance Companies

Filing claims with two insurance companies – Risk or necessity?

 

Filing Claim With Two Insurance Companies

To understand how to get the best out of health insurance policies, people pose many questions to experts. And one question that comes up frequently is, “Can I file a claim with two insurance companies?” Read on to know if you can.

What does it mean to have more than one medical policy?

People often opt for more than one health insurance policy. Employees are often covered by a group health insurance policy, spouses can have a family health insurance policy, and adults can be covered by a medical policy that their parents purchased.

Even so, you can and should purchase a policy separately. You may ask why? Because medical services are very expensive and may shoot up further in the coming years. Therefore, if you run up an exorbitant bill, your group or family policy may not suffice. Even if you are not covered by either of these policies, but have your own individual policy, we suggest you get a second one. This way when the sum assured from one policy does not meet the medical bill, you will not have to pay the remainder from your pocket.

Primary and secondary health policy

Since you have two policies, one will be primary and the other will be secondary. You can choose which will be which. When you are hospitalized, you have to file a claim with the primary insurer. If the bill exceeds the sum that the primary insurer pays, the secondary policy is activated. And now you will make a claim on this policy, following which the remainder will be paid by the secondary insurer.

This becomes especially necessary in an era when critical illnesses are on the rise. The treatment can be expensive and if you possess 2 policies, it will ease the financial burden.

Word of Caution

If you opt for two insurance policies, then you have to inform both the insurers regarding your decision. Otherwise, you will be violating an important regulation. And this could result in your medical claim being dismissed by both the primary and secondary insurers.

Conclusion 

Health insurance is a necessary investment. And considering the rising costs of medical services, it’s better to stay safe by taking two policies.

Confused about the type of policies to go for. To help you out, here is a small list with each one’s important features:

Sources:

  1.     Economic times

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Know About Proportionate Clause in Health Insurance

Let’s uncover – The proportionate clause in health insurance!

The claim settlement of your medical policy may not go your way if you are not careful. It turns out that quite a lot of people are disgruntled with their policies because the claims were settled partially and they were left bamboozled. At the core of the problems lie the proportionate clause in health insurance, and the whole room rent sub-limit bind. Read on to know how you can escape without any glitches.

The proportionate clause in health insurance

Sub-limits are the segments that build up the entire sum insured (the payout of your health insurance policy). They signify the extent to which your policy will pay for different aspects of your treatment such as room rent, nurses’ or doctors’ fees, charges for surgery, price of medicine, etc. No matter how much sum insured you are entitled to, you cannot exceed the cap or the sub-limit.

For example, if your room rent sub-limit is INR 2000 per day, you should adhere to it. If it exceeds by even a fraction, you’d have to pay the excess from your pocket.

In other words, a percentage will be deducted from your sum insured to meet each of the sub-limits. You can structure the sub-limits any way you like. There are no strict IRDA rules on it. It all depends on your insurer. There are health policies that come without sub-limits. But they are much more expensive.

How to calculate proportionate deduction?

The room rent sub-limit is really the most important. That is because insurers benchmark the reimbursement of the other expenses to the room rent. Usually, you are advised to cap the room rent at 1% of the total sum insured.

If your room rent actually exceeds your sub-limit, it will have an adverse effect on the rest of the payment too. The insurer will calculate the percentage by which you have gone beyond the limit, and proportionately deduct sums of money from the amount set aside for other sub-limits. This is called the proportionate clause in health insurance or proportionate deduction.

Suppose your room rent takes up 25% more than what was allotted for it, all the other sub-limits will go down by 25%. So you are incurring quite a loss here because your insurer pays your sum insured partially.

Naturally, this crafty little trick causes a lot of aggrievement and resentment and makes people lose their faith in health insurance policies.

What should you do?

If possible, opt for policies that don’t tie you down with sub-limits.

If you have to purchase a sub-limit policy, then enquire if the room rent sub-limit has a bearing on the rest of the claim settlement. If yes, steer clear from it.

Conclusion

All health insurance policies clearly stipulate sub-limits (the ones that contain them). So read the fine print carefully. Consult insurance experts if needed. This is not something you should rush into. Ponder everything out before signing the dotted line.

Now that we have laid the foundation for your awareness about the proportionate clause, delve deeper and learn about some other nitty gritties of health insurance, from another one of our blogs on the same.

 

Sources:

  1.     Economic times