Most of the clients are having doubts on health policy having 2 or more policies for the claim settlement. There has been some recent change in the rules regarding claiming from multiple insurers. The IRDA (Health Insurance) Regulations 2013 announced this February changed the way claims are made from each of the multiple insurers. Prior to these rules any claim from multiple insurers had to be in the ratio of coverage. For example, one has a Rs 2 lakh policy from your employer and Rs 1 lakh policy bought on your own. There is a hospitalization for Rs 75000, then you would have to inform both the insurers and the claim settlement would be made according to the contribution clause. In this case, your employer insurance would pay Rs 50000 and Rs 25000 by the insurer of your private policy. This process was not customer friendly and presented many hurdles to the insured. However, after the new regulations have been put in place, there have been many changes. You can decide to against which insurer you would like to claim. If the amount of claim is less than or equal to the amount insured then you can claim the entire insurance from a single agency. Old Rule : Let us see in the above case, how would this work out. The claim amount is Rs 75000, so if you go the group insurance company (employer), the claimed amount is less than the sum insured, so they will pay the entire amount. In case you approach the second insurer (personal policy), this company would pay the entire amount, as the claim is less than the total amount insured. Let us also see an example where the claim amount is Rs 2,50,000. Here the claim amount is higher than the amount insured, then any single insurer cannot settle the claim, hence the contribution clause will have to be applied. Your company insurer will be pay Rs 1,66,667 and Rs 83,333 by your second insurer. Keep in mind that documentation will have to be complete with each of the insurers. You would need to submit the entire sets of documents to both the companies. Hospital would have to give you a certified set of copy of the bills and other documents in addition to the original documents. So keep in mind, more the number of policies you would have to deal with more documentation. The documents required by each insurer may also differ. New Rule : Now that the rule is simple, you should know the process that will have to be followed for claim settlement and the ways to maximize your claim. The process that would have to be followed is Inform all the insurance companies about hospitalization, at the same time you would also require to pick the company that you will claim first from. At the time of discharge, you would need to fill up the form for claim with all required documents. Remember you would need to submit the original documents to the insurer from who claim first. You would need to keep attested copies for your next claim. Here, an important thing that you would need to keep in mind is that, only after the claim from the first insurer is settled, you can submit your claim with the second insurer. The first insurer will issue a claim settlement certificate, which will have to be submitted to the second insurer. Accordingly, the third claim can be claimed only after the second is cleared. Each claim may take around 30-45 for clearing, more the number of claims, more time taken in entire claim to be settled. Very Very Very Important : In case if it is a cashless claim, only the claim from first insurer is settled cashless and subsequent claims will have to be claimed on a reimbursement basis.
Posted on: Sat, 17 Aug 2013 08:09:15 +0000
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