WHY YOUR HEALTH COVER NEEDS A PLAN B

Getting more than one health plan is your security against fat hospital bills

While there is a growing preference for multiple health insurance policies, many questions and doubts arise while making claims. Follow these guidelines and you won’t go wrong.

WHY MULTIPLE POLICIES

Medical treatment in India is getting costlier by the day and the coverage offered under one health insurance plan may not be enough to cover the entire expense. Advisors say an additional health plan is a good backup in the event of a major medical emergency.

This is because a claim rejected by one insurer may well be accepted by another. Buying multiple health insurance policies therefore acts as a hedge against rejection of claims.

Some people may also prefer to have separate policies for parents, spouse and children.

HOW TO CLAIM FROM MULTIPLE POLICIES

If you have more than one policy (assuming all of them are indemnity-based plans) and the claim amount is less than the sum insured under all the policies, you can choose any insurer to file your claim.

If the claim amount exceeds the sum insured under one policy after considering the deductibles and/ or the co-pay clause, you still get to choose the first insurer that the claim will be sent to. However, the insurer will settle the claim after applying the contribution clause—the claim will be settled in proportion to the sum insured. For instance, one may have bought a policy of Rs 2 lakh from insurer A and another Rs 1 lakh policy from insurer B. If the claim amount is Rs 4 lakh, insurers A and B will settle it in the ratio of two-thirds and one-thirds respectively.

Any amount not paid by an insurer due to limits in the policy may be claimed under other policies. But under no circumstances can the policyholder get more than what has been spent on treatment.

While making claims from the second insurer, the policyholder has to submit original copies of the documents along with the original settlement letter from the first insurer.

While buying a health insurance policy, it is necessary to declare all other health plans one has purchased. This is necessary even while making claims. Withholding these details can amount to violation of the terms and conditions of a health plan and, in case of an investigation, be termed a misrepresentation.

KNOW THE FINE PRINT

If you have purchased more than one health insurance policy, be thorough with the terms and conditions of each policy, know the coverage limit and the dos and don’ts of each for settlement of claims. The policy you choose first to make the claim should be based on factors such as waiting period after purchase of plan, coverage of pre-existing diseases, maximum coverage available, no-claim bonus and discounts, if any.