Due to this, individuals seeking expansive health coverage with high insured sums are posed with a problem, because no single health insurance policy can give them what they’re looking for. In such cases, these individuals have no other option but to go for multiple policies, the combination of which can give them the higher insured sums that they require.
An individual may also opt for multiple policies if they want health coverage for themselves, their spouse, parents and children. Also, employees of firms may buy additional individual health insurance because their employer’s insurance policies are not sufficient or do not cover certain illnesses.
So, even when one cannot get a high sum insured policy, they can take multiple policies. Doesn’t that solve their problem and give them extra financial cover? The answer is yes, it does provide additional cover, but the actual claims process is not so simple. One cannot simply claim an amount from one insurer and claim another amount from another insurer. There are certain protocols that need to be followed during the claims process. Read on to find out the exact process of claiming from multiple health insurance policies.
DisclosureThe first thing that multiple policy holders need to know is that it is mandatory to inform all of your insurers about the existence of the other. When you’re filing your claim and filling out the form, there is a disclosure section that specifically asks you whether you hold any other insurance policy and asks for details of the policy.
You must be honest and accurate about this disclosure, failing which you may be held responsible for misrepresentation and be in violation of the insurer’s terms and conditions. Non-disclosure can lead to a reduced insured sum which can put unnecessary financial burden on you to pay the rest of the medical expenses.
But what is the need for disclosure? Why do insurance companies need to be informed about all my policies? The answer lies in a clause called the contributory clause.
Contributory ClauseBefore we understand the process of claiming multiple policies, we must understand the contributory clause, which is a clause included in most insurance policies. The contributory clause states that if a person is holding multiple health insurance policies, then the claimed amount must be shared by all the insurers in equal proportion to the sum insured by each.
For eg. If Suresh has Policy A with a sum insured of Rs. 4 Lakh, and another Policy B with a sum insured of Rs. 2 Lakh, then according to the contributory clause, if a claim for Rs. 1 Lakh is made, then both Policies A and B will contribute in the following ways:
Policy A (4 lakh sum insured) will pay Rs. 66,666/-
Policy B (2 Lakh sum insured) will pay Rs. 33,333/-
Thus, the contributions of both policies are an equal proportion of their insured sums which is 16.666 %.
It must be noted, however, that recent rule changes regarding the contributory clause have simplified this process. According to the new rules, the contributory clause only comes into effect when the claimed amount exceeds the sum insured. If the claimed amount is less than the sum insured of either policy, then the insurer cannot impose a contributory clause.
How to claim multiple policies.Let us now understand the procedure that you must follow to claim multiple policies.
In this case, you have multiple health insurance policies, and your claim amount does not exceed the sum insured of any of your policies.
For eg.. Your claim amount is Rs. 1 Lakh, while both your Policies A and B have sum insured of Rs. 2 Lakh each.
Here you’re absolutely free to choose which insurer you want to choose for your claim. You may choose either one, and get the entire claimed amount settled. You must still disclose the details of all your other policies to the insurer from whom you’re claiming your insured sum.
In this case, your claim amount exceeds the sum insured of either policies.
For eg. Your claim amount is Rs. 2 lakh, while both your Policies A and B have sum insured of Rs. 1 Lakh each, and you want to use both of them to make the settlement.
Here you need to first make a claim with one insurer, you’re free to choose which one and inform them about the existence of your other policy. The insurer will impose the contributory clause and settle your claim based on their calculations. You need to then take the settlement certificate and submit it to the second insurer along with all other documents. The second insurer is now liable to pay the balance claim amount.
Point to remember:
- The contributory clause is not applicable when the cover or benefit is not related to the medical expenses, or if the cover is fixed in nature, like in critical illness insurance, where a fixed, lump sum amount is paid.
- If you have two individual policies, claim the older policy first, because the waiting period for pre-existing diseases will be over and you can benefit from it.
- In case you have a group health insurance policy as well as an individual insurance policy, then it is wiser to go for the group policy first. Group policies usually do not have waiting periods for pre-existing diseases and claiming them is less complicated. Also, if the entire claim is carried out by the group policy, the co-claim bonus of your second policy will remain unaffected.
In this way, you must keep the above situations in mind when claiming from multiple insurance policies. Getting more than one health insurance is a great idea, but one also needs to know how to best utilize them and follow the required procedure in order to make the most of them. Always remember to read all clauses, terms and conditions of any health insurance policy that you buy to understand them and avoid any unfortunate surprises in times of crisis.
The information contained herein is generic in nature and is meant for educational purposes only. Nothing here is to be construed as an investment or financial or taxation advice nor to be considered as an invitation or solicitation or advertisement for any financial product. Readers are advised to exercise discretion and should seek independent professional advice prior to making any investment decision in relation to any financial product. Aditya Birla Capital Group is not liable for any decision arising out of the use of this information.
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About Aditya Birla Capital
Aditya Birla Capital (‘the Brand’) is the single brand for financial services business of Aditya Birla Group. The trade logo “Aditya Birla Capital” and the URL www.adityabirlacapital.com is owned by Aditya Birla Management Corporation Private Limited (trade mark owner) and the same is used herein under the License by Aditya Birla Capital Limited (ABCL) and its subsidiary companies (collectively hereinafter referred to as “ABC Companies”). Aditya Birla Capital Limited is the holding company of all financial services businesses.
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All of the ABC Companies have their own separate legal identities and webpages (details about which are embedded in their respective web pages/sites) but in this Website they may sometimes use "Group", "we" or "us" when we refer to ABC Companies in general or where no useful purpose is served by identifying any particular ABCL Affiliate.
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You also agree and authorize ABC Companies / its third-party service providers to contact you at the contact information provided for service related communication relating to your product or facilities offered even if your number is in National Do Not Call Registry.
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No fee or consideration or economic benefit either directly or indirectly is associated for availing the assessment through MoneyForLife Planner and therefore it is not to be considered as an investment advice or financial planning and / or investment advisory services.
You agree and understand that use of MoneyForLife Planner does not assure attainment of your investment objectives and there is no assurance that the money objectives will be achieved, as the same is subject to performance of the securities, the forces affecting the securities market and your risk profile. You are advised to consult an investment advisor in case you would like to undertake financial planning and / or investment advice for meeting your investment requirements.
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If you come across any breaches/violation or offensive material you must report to us at email@example.com
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The information provided on or through the Website is for general guidance and information purposes only and they do not in any manner indicate any assurance or opinion of any manner whatsoever. Any information may be prone to shortcomings, defects or inaccuracies due to technical reasons. Certain information on Website may be on the basis of our own appraisal of the applicable facts, law and regulations in force at the date hereof.
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No Information at this Website shall constitute an invitation to invest in ABCL or any ABC Companies. These are meant for general information only or to meet statutory requirements or disclosures. ABCL or any of its employees are in no way liable for the use of the information by you, when making any decision or investing or trading through any investment vehicles or ABC Companies, or any other third party which may be engaged in offering of these services.
The information contained on this Website does not represent and should not be used to construe (i) the terms on which a new transaction would be entered into by ABCL or ABC Companies, (ii) the terms on which any existing transactions could be unwound by ABCL or ABC Companies, (iii) the calculation or estimate of an amount that would be payable following an early termination of any past/existing transactions or (iv) the valuations given to any transactions by ABCL or ABC Companies in their books of account for financial reporting, credit or risk management purposes.
ABCL and ABC Companies are engaged in a broad spectrum of activities in the financial services sectors. You understand and acknowledge that Aditya Birla Money Limited (‘ABML’), Aditya Birla Finance Limited (‘ABFL’) and Aditya Birla Sun Life Asset Management Company Limited and trustees and sponsor of Aditya Birla Sun Life Mutual Fund (‘ABSLMF’) are group companies and ABML / ABFL also acts as a distributor of ABSLMF. Any recommendation or reference of schemes of ABSLMF if any made or referred on the Website, the same is based on the standard evaluation and selection process, which would apply uniformly for all mutual fund schemes. You are free to choose the execution facilities in the manner deemed fit and proper and no commission will be paid by ABSLMF to ABML / ABFL if you choose to execute a transaction with ABSLMF on the Website, unless otherwise agreed by you and ABML/ABFL separately. Information about ABML/ABFL, its businesses and the details of commission structure receivable from asset management companies to ABML/ABFL, are also available on their respective Website.
Similarly Aditya Birla Money Insurance Advisory Services Limited and Aditya Birla Insurance Brokers Limited are insurance intermediaries and engaged in the distribution of Insurance Products and it may services may include products of Aditya Birla Sun Life Insurance Company Limited and Aditya Birla Health Insurance Company Limited. However there is no conflict on these services and commissions if any payable are in accordance of the extant regulations.
The Facilities Provider, ABC Companies and any of its Third Party Service Providers shall not be liable for any delay or failure in performance resulting directly or indirectly from acts of nature, forces, or causes beyond their reasonable control, including, without limitation, Internet failures, computer equipment failures, telecommunication equipment failures, other equipment failures, electrical power failures, strikes, virus, other malicious computer code, hacking, labour disputes, riots, insurrections, civil disturbances, shortages of labour or materials, fires, flood, storms, explosions, acts of God, war, earthquake, governmental actions, orders of domestic or foreign courts or tribunals, non-performance of third parties, or loss of or fluctuations in heat, light, or air conditioning.
The Facilities Provider, ABC Companies or any of its third party service providers and processor bank/merchants etc. shall not be deemed to have waived any of its/their rights or remedies hereunder, unless such waiver is in writing. No delay or omission on the part of Facilities Providers and ABC Companies, in exercising any rights or remedies shall operate as a waiver of such rights or remedies or any other rights or remedies. A waiver on any one occasion shall not be construed as a bar or waiver of any rights or remedies on future occasions.
Either party can terminate this Agreement by notifying the other party in writing. Upon such termination You will not be able to use the facilities of this Website.
Governing Law and Jurisdiction
These Terms and Conditions are governed by and to be interpreted in accordance with laws of India, without regard to the choice or conflicts of law provisions of any jurisdiction. You agree, in the event of any dispute arising in relation to these Terms and Conditions or any dispute arising in relation to the Website whether in contract or tort or otherwise, to submit to the jurisdiction of the courts located at Mumbai, India for the resolution of all such disputes.
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