As a tool to mitigate risks related to financial worries, insurance is gaining prominence. With the availability of a variety of policies and with increased awareness about insurance, it has become common to find people who have multiple insurance policies—especially health insurance and personal accident cover. Many of us end up with multiple covers through employers, individual policies or under floater covers of parents, which might be bought through agents, banks or online. While having multiple policies can ensure appropriate coverage as per the needs of the customers, one also needs to understand the claim procedure to make claim in multiple policies, so that it is approved without hassles.
Below are a few things one needs to keep in mind while making claims in multiple polices of health insurance and personal accident (PA) cover:
Generally people are covered under employer’s group medical policies. They may also have individual health insurance policies. In some cases, a person may have individual cover and may also be covered under their parents' policy. Let us take two scenarios:
A person is covered under group policy with employer and also has personal health cover. The personal health cover may be a base cover or top-up. In this scenario, it is always beneficial to claim under group policy first as the cover is more inclusive. Also the cumulative bonus under the personal policy remains untouched. In case the expenses cross the group sum assured, other cover or top-up can be triggered. However, it is completely up to the customer to decide on which policy to claim from first.
A person has two different base covers or a base + top-up policy. In such a scenario, the person can claim under his policy of choice depending on room rent and other facilities offered. The other policy may be utilised after exhausting the first cover. Top-up policy always triggers after expiry of base cover only.
The basic rule is same expenses cannot be claimed under two different policies. If the claim amount is more than the sum insured under the policy on which the claim has been made, the balance amount can be claimed from the second health insurance policy. For this, the customer should submit attested claim documents and the settlement letter specifying the amount settled under the first policy to claim for the remaining amount from the second policy.
However, it is typically noted that most customers who buy two health policies go in for a top-up policy as their second, so that if their base sum insured is exhausted the top-up can take over seamlessly. It is important to note that the base policy and the top-up can be taken from different insurers keeping in mind aggregate deductible limits. Additionally, people should always look to upgrade their health insurance in line with medical inflation rather than add new policies. Better to be safe than sorry!
PERSONAL ACCIDENT COVER
Personal accident insurance gives financial protection to the policyholder and family in case of an unfortunate accident that may lead to death or disability. Unlike other general insurance policies which are indemnity based, PA cover is a benefit policy and claim can be made under all the PA policies unless the policy has a cap on maximum payment. Claim can be made from multiple PA policies on the basis of submission of photocopies of the necessary claim documents like FIR, death certificate and original claim form.
No matter how many policies you have; always opt for adequate cover. Regardless of the number of policies, it should be declared in good faith to the insurer while buying a new policy. This helps you get an appropriate premium and a hassle-free claims experience.
The author is head, health & travel administration team, Bajaj Allianz General Insurance.