While choosing from various family health insurance plans, we focus on buying a comprehensive policy that covers all the medical expenses. But, sometimes, a single policy might not suffice for the medical costs that you might incur when you file for a health insurance claim. This is where the concept of buying 2 health insurance plans comes into the picture.
By using 2 policies smartly, you can split the expenses and receive the maximum claim amount and get the total expenses (or close to it) covered.
Before going on to how having more than one policy can be beneficial, let’s learn about the scenarios that could lead to policyholders having one or more policies.
Scenarios under which a person may have more than one policies
- When an employee has a corporate policy given to him by his employer and they buy their own retail policy.
- When parents are covered under 2 policies – a retail policy and a corporate policy because of a working child.
- When parents are covered under 2 policies bought by their children.
- When a person who is already covered under a policy buys a family plan after getting married.
- When instead of increasing the coverage, a person buys another policy suggested by the insurance agent to save tax.
If you are planning to buy an additional cover or already have 2 policies, read below and understand how 2 policies can be useful when used together.
How to Use an Alternative Policy to Your Advantage
1. Claim Total Amount Even When the Sum Insured in One Policy is Exhausted
In case when the bill amount is higher than the sum insured in one policy and you end up exhausting it, you can use the second policy and claim the remaining amount. However, you must split your expenses and use your 2nd or 3rd policies in the right sequence to claim the total expense.
2. Claim Even When Claim from One Policy Gets Rejected
There could be many reasons for your claim to be rejected. Examples include:
- You filed a claim while the waiting period on the claim is still applicable.
- A particular treatment or surgical procedure is not covered under a policy.
- Day-care procedures are not covered, etc.
So, if your claim gets rejected, you can check if your other policy offers coverage in such conditions and file a claim if it does.
3. Claim Pre and Post Hospitalization Expenses
If you claim the hospital bill and end up exhausting the sum insured in the first policy, you can file a reimbursement claim and claim the pre and post hospitalization expenses using your 2nd or 3rd policy. This way your complete medical expenses will be covered.
4. Claim Complete Amount Despite Deductions
Many insurance policies have the Co-pay feature according to which the policyholder has to pay certain amount, as per policy terms and conditions, of the total hospitalization bill out of their pocket. Moreover, you may end up paying some hospitalization amount out of your pocket because of proportionate deduction. Hence, in such cases, you can use your 2nd or 3rd policies to claim the remaining amount.
Why is Sequence Important While Filing a Claim Under 2 Policies?
It is very important to choose the right sequence when claiming from 2 policies. Here’s a great example to show you exactly why it is so important.
Mr. Patel is insured under two health insurance policies. Policy A offers coverage of Rs 3 Lakh and Policy B offers coverage of Rs 2 Lakh. The maternity limit under Policy A is Rs.75000 and pre and post limit is 20000 (within maternity limit). Under Policy B the maternity limit is Rs.50000 with no pre and post benefits.
Mr. Patel and his wife decide to use their policy to cover maternity expenses. The expenses that need to be claimed:
Delivery expenses – Rs 100,000
Pre and post hospitalization expenses – Rs 25,000
Total expenses – Rs 125,000
Mr. Patel splits his claim and chooses to use policy A first to file a claim.
Against the hospitalization bill incurred due to delivery, he gets Rs 75,000 from policy A. He doesn’t get the pre and post hospitalization cost because of the maternity limit. Now, he files the remaining 25,000 of the hospitalization cost from policy B and receives the amount. Since policy B does not cover any pre and post hospitalization cost, he ends up paying Rs 25,000 from his own pocket.
In this case, the out of pocket expenses = Rs 25,000
Now, had he reversed the sequence of the claim, he could have claimed the complete amount. Here’s how:
On filing the hospitalization amount from policy B first, he would have received Rs 50,000. He could have then filed the remaining Rs 50,000 of the hospitalization bill from policy A and received the amount. Since policy A covers the pre and post hospitalization expenses within the maternity limit, he could claim Rs 20,000 of the total pre and post hospitalization expenses from policy A because of the cap.
In this case, the out of pocket expenses = Rs 5,000
This is the reason the sequence of the claim from different policies is very important. It helps you maximize the payout. I hope this article would help you make better insurance decisions and receive the maximum claim amount by using 2 policies to claim.
Anuj co-founded SureClaim to fix the broken claim experience of insurance customers. He believes technology can play a major role in empowering customers. His understanding is shaped by his decade long stint in healthcare and health-tech companies.