Get more from your health insurance

With the regulator changing the claims processing rules, policyholders can now settle their claims quicker and keep premium costs lower

cover given by one insurer, he can approach the other insurer to claim the balance amount |This will reduce paperwork for insurers and policyholders also |This will be applicable to both individual and group covers provided by employer

If you have been running from pillar to post to make your health insurance claims, you must be heaving a sigh of relief. The new health insurance regulations, effective from October this year, have made it easier for policyholders to claim for expenses which arise from hospitalisation or treatment. To top it, insurance companies are going out of the way to make the claims process simple and easy for individuals with minimum documentation and a quicker turn- around time.

Till now, individuals who held multiple health insurance policies had to make multiple claims with all the health insurance companies they had taken policies from. Here the claims process would take months as individuals were expected to file multiple claims from several insurers. Not any more.

The new health insurance regulations, effective from this October, and the abolition of contribution clause that dealt with claims under multiple policies, have made life simpler for health insurance customers.

Policyholders will benefit from fewer delays in claim settlement and less paperwork.

Earlier, those with multiple policies were required to approach both ( or all) insurers and the insurance companies used to settle claim in the ratio of the sum assured from different health insurance companies.

In other words, the amount spent on medical expenses had to be recovered from various insurance companies in proportion to the insurance covers taken.

For instance, you have two policies from insurers A and B, with sums insured of ₹ 1 lakh each. Now, say you make a claim of ₹ 1 lakh, then in such a case both the insurers A and B will have to shell out ₹ 50,000 each. Insurers will have to shell out equal claims because the policyholder had the same amount of cover taken from both the insurers. However, here the policyholder had to go through the same paperwork twice, apart from going through the hassle of approaching multiple insurers.

Now, with changed rules, an individual can just approach one insurer A, while the existing policy taken from insurer B will continue to remain in operation or active. In other words, a policy holders trackrecord of 'no- claims' from insurer B will continue as before.

When an individual doesn't make any claims in a given year, he gets the status of no- claim bonus. As one retains the ' no- claim bonus' on apolicy that is not used, it enhances the health cover at no extra cost. That means insurers cannot insist that the claim burden be divided as long as the amount does not exceed the sum insured.

If the claim amount is higher than the cover under one policy, then the policyholder has the right to exhaust the limit and make a claim for the balance from the other insurer.

For instance, in the above case if the insurance amount is ₹ 1.50 lakh, then the policyholder has the option of approaching insurer A with a ₹ 1 lakh claim and insurer B with the remaining ₹ 50,000 claim.

This will also help those who have an individual cover plus group cover from the employer. The process of claims would be similar as both the policies would be treated as independent policies irrespective of whether it is group or retail.

The contribution clause will not be applicable if you have a regular health cover and a fixed benefit cover. Reason: The regular health covers promise to reimburse expenses incurred by you, while the fixed benefit covers that are usually sold by life insurers ma k i n g cl a i m s .

For instance, utilising the health insurance policy that gives the maximum benefits when you make a claim, at the same time it will help keep your benefits in other plans intact. Some policies cover certain ailments better with higher benefits.

A short self- note on the policies that can during certain situations go along way in maximising the benefits of all your health insurance policies.

At the same time, it can also help reduce the premium cost of your health insurance. By not making multiple claims, individuals can keep some plans going for a longer time at cheaper premiums.