Making Health Insurance Claims

Make Multiple Health Insurance Claims

Today’s stressful and fast-paced life contributes to a number of diseases. And this is why investing in a health insurance policy is essential.

However, most insurance policies come with a limit on the sum assured, depending on the age of the insured and the insurance company’s underwriting guidelines. In such cases, the insured has no choice but to invest in more than one health insurance policy in case he is looking for a higher coverage. It also likely that you are looking to invest in a mediclaim policy for your spouse or your parent, apart from yourself. In such a case, investing in multiple policies is advisable. However, when you invest in multiple medical policies, it is important to follow the right steps, failing which, you might receive a reduced claim amount.

When you fill up a proposal form for a mediclaim policy, is it important to inform the same to the insurer of any other existing medical policy you may have. Not informing your health insurance company would mean violating the terms and conditions of your existing insurance contract on the grounds of misrepresentation, which could lead to some losses when you make a claim. This means contribution clause. It is a clause where if you have more than one existing medical policy and happen to make a claim, all your existing policies will contribute equally to your sum assured. However, this contribution clause only comes into existence if your claim amount is more than the sum assured of the insurance company with whom you are making the health insurance claim. However, if your insurance claim amount is not as much as the sum assured of the insurance company you are making the claim with, then the insurance company cannot impose the contribution clause.

To get a better understanding of this, let us have a look at a few different scenarios.

Scenario one

Raghu has two insurance policies of INR 2 lakh and INR 3 lakh from insurers A and B, respectively. He has recently undergone a medical emergency and makes a claim of INR 1 lakh. In this case, since the claim amount is not as much as the sum assured, the contribution clause is inapplicable and Raghu has the freedom to choose the insurer he would like to make the health insurance claim with.

 

Scenario two

Zahira has two insurance policies of INR 1 lakh and INR 2 lakh from insurers A and B, respectively. She has recently made a health insurance claim of INR 1.5 lakh, after all applicable deductibles. In this case, Zahira has the option of selecting which insurer she would like to make the claim from. If she selects insurer A, then the insurance firm will settle the claim only after taking into consideration the contribution clause, as the claim amount exceeds the sum assured.

 

Scenario three

Arpan has two health insurance policies that are Defined Benefit policies, which mean policies for specific issues like a critical illness or accident policy. He unfortunately happens to meet with an accident. In such a case, the contribution clause does not come into play. This is because a Defined Benefit policy pays out a lump sum on the occurrence of an event, while the policy is terminated. So, in this case, Arpan can avail of health insurance claim from both insurers, without the contribution clause.

 

Therefore, when you avail of multiple health insurance policies, it is important to keep in mind different scenarios while making multiple health insurance claims.