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Non Life Insurance - Twin health covers need not ensure double protection

14 May 2012

Many individuals these days do not hesitate to buy a separate health cover even if they have an employers’ group health cover. This is a wise move because a standalone health cover may prove invaluable when one is between jobs or has lost the job. This is because the cover of group scheme stops the moment you leave your job. voluntary or otherwise. Needless to say, a medical emergency is the last thing you are prepared for -- both mentally and financially -- when you are without a job, and the spiralling healthcare costs can topple your entire financial plan.

However, don’t be under the illusion that covered under two policies - a group and an individual cover- mean that you are doubly covered. It is very important to know the procedure for filing claims when you have two health insurance policies. Suppose you have two health insurance covers of, say, Rs 2 lakh and Rs 1 lakh, and you want to make a claim of Rs 1 lakh. Here, you cannot expect both the policies to disburse a claim of Rs 1 lakh each. Also, you cannot choose to lodge the claim under any one policy.

The contribution clause in an insurance contract stipulates that a claim should be split between two policies as per the ratio of the sum insured. Put simply, the Rs 2 lakh policy will pay you the claim of Rs 67,000, and the other policy will pay the balance. Likewise, if your claim amounts to Rs 3 lakh, the two policies will sanction a claim of Rs 2 lakh and Rs 1 lakh respectively. However, this clause will not come into the picture if one of your policies operates on the fixed benefit principle. Such policies, which promises to pay a pre-defined sum, are typically issued by life insurance companies. Lastly, don’t forget to disclose it to the insurers If you have two health insurance policies. It will help you avoid claim rejection on the ground of suppression of facts in future.

Source: ET Bureau BACK