With the ever-increasing medical expenses, it is a wise decision to enrol in a health insurance plan. It is indeed difficult to choose from a wide variety of plans offered by numerous companies. One has to be well informed about the different plans. Then depending on the needs and affordability, an appropriate plan can be chosen. It is always better to choose a plan from well-reputed health insurance companies. Star health insurance is one such company, which is completely into health insurance. You can choose from a range of Star health mediclaim insurance plans.
In some cases, we may need to go for multiple insurance plans. For example, most people have employer coverage. This usually covers spouse and the dependent kids. The employer coverage might not be comprehensive or might have a low sum insured. In such cases, it is advisable to take separate policies from companies like Star Health Insurance. For example, if the wife is covered under the husband’s policy, she might also be enrolled in a separate policy specific for women. Or if any of the kids has a special condition, a separate policy might be required. Or if one is a heart patient or has a critical illness like cancer, a specific policy is required. By having multiple policies, the risk of claim rejection can also be mitigated. The claim rejected by one insurer can be approved by another based on the terms and conditions. It is true that multiple policies offer benefits, but taking multiple policies alone can’t ensure maximum coverage. Many things should be taken care of while making claims on multiple policies.
It is very important that the insured person is transparent and honest in all the dealings. If the person already has a policy, it should be disclosed while enrolling in the second policy. And the first insurer should be informed of the second policy also.
If a person has multiple plans offered by different companies like Star Health Insurance, he can choose with which insurer the claim should be made. The insurer will process the claim and make payments according to the sum insured and the terms and conditions. If the expenses are more than the sum insured of the first plan, he can also lodge a claim with the second insurer. But the second insurer must be informed of the claim made with the first. The first company then will issue a claim settlement notice and certified copies of the original documents. The second company will then pay based on the policy.
Different Scenarios can come up if a Person is enrolled in Multiple Policies.
For example consider person X who has two policies A and B, A with a sum insured of 1.5 lakhs and B with a sum insured of 1 lakh. If the expenses are below 1 lakh, X can make a claim with any of the two companies, which suits his needs. They are bound to settle the entire claim as per the policy. Star Health Insurance has a high claim settlement ratio. In the case of multiple policies, a company with high claim settlement ratio should be the first choice.
Consider that the expenses came to 2 lakhs and he lodged a claim with A. Here A may apply the Contribution Clause. That means A and B have to contribute in proportion to the sum insured. As per the Contribution Clause, A has to settle the claim for 1.2 Lakhs and B for the rest of 80,000(in proportion to the sum insured amounts, i.e. 1.5:1). For this, while filing the claim with A, the insured is bound to inform of the policy he is holding with B. If he doesn’t, A’s liability is only up to the sum insured.
X can also choose to make a claim with A for 1.5 lakhs and for the rest of the amount with B., But B must be informed of the claim settlement with A. Then receiving all the certified copies of the documents and the claim settlement notice from A, B will process the claim and make payment as per the policy.
If the person holds an individual and group policy, it is better to choose the group policy first. Group policies are liberal, and it is unlikely that the premium goes up due to the claims.
Next scenario to be analysed is when a person has both a reimbursement plan and a fixed benefit plan. Fixed benefit plans are usually for critical illnesses or disability. In fixed benefit plans, mostly the lump sum amount is released on the diagnosis of the conditions and the policy lapses.
Whereas the usual reimbursement plans settle the claims based on the actual expenses. In such cases, claims can be made with both the plans.
Another factor to be considered while filing claims on multiple plans is that older plans should be given preference. In most of the plans, the entire coverage will be obtained only after a waiting period of 2 or 3 years. So there are chances of some claims getting rejected during the waiting period. So an old plan, of which the waiting period is over, will be an obvious choice.
A person can enrol in multiple plans offered by the same company. For example, a person who has taken the Star Health Insurance’s Family Health Optima plan for the entire family might also enrol himself in the Star Health Insurance’s Diabetes policy if he is a diabetic patient. In such cases also, multiple claims can be made. The advantage here is that claim settlement will be easier, as the documents will be dealt with by the same organisation. But in the proposal of one policy, the other policy should be disclosed.
In the multiple plans scenario, knowingly or unknowingly hiding information can result in a reduced claim settlement. Companies like Star Health Insurance have all their policies, terms and conditions described clearly on the website. So by being well informed and choosing health insurance wisely, one can reap the benefits of having multiple plans.