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| 2 Policies of Health insurance – how to lodge claim? |
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| Yes, it was always possible to buy more than one health Insurance policy. Till Sep. 30, 2013 there was a provision that you could buy more than one Insurance policy but the claim could not be duplicated to two Insurance companies i.e. the claim amount used to be shared by both Insurance companies in the ratio of the sum insured. |
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| Effective Oct. 1 ,2013, IRDA has come out with revised guidelines for the benefit of customers under which an Insured can get the entire claim amount from any of the insurer up to the sum insured amount or can claim the balance amount from second insurer. These new guidelines will make the claim procedure hassle free as one can go to 1 insurance company, if the claim amount is small. |
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| Here is an example for comparative analysis of old & new provisions on the assumption that an insured is having policy for Rs. 2 Lakhs & Rs. 3 Lakhs i.e. total of Rs. 5 Lakhs. |
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| Scenario 1:- Claim amount Rs. 2 Lakhs |
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| Old provision |
New guidelines |
| Both insurers used to pay Rs. 1 lakh each. |
The insured can get the total claim amount of Rs. 2 Lakhs from any of the Insurer of his choice |
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| Scenario 2:- Claim amount 3 Lakhs |
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| Old provision |
New guidelines |
| Both Insurers used to pay Rs. 1.5 lakh each |
The Insured can get Rs. 2 Lakhs from one Insurer & Rs. 1 lakh from other insurer |
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| If we go into the minute detail we find that the new rules give the customer a choice of making a claim to the insurer of his choice. Suppose the person is having the two policies first policy from Oriental Insurance Company for Rs. 2 Lakhs and the second policy from Apollo Munich Health Insurance for Rs. 3 Lakhs. We know that Oriental Insurance is having a limit of Rs.2000 per day on room rent (1% of sum assured) but Apollo Munich does not have this limit so the Insured while lodging a claim for Rs. 3 Lakhs can go straight to the Apollo Munich & can get the whole claim amount from Apollo. We are assuming that room rent is Rs 7000 per day. Lodging of claim to Oriental will result in Rs 5000 per day being paid by the insured. |
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| Prior to Oct 1, 2013, an insured had to submit all the documents to two Insurance companies so the procedure of claim settlement was a cumbersome process. |
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| Therefore new guidelines issued by IRDA are highly in favour of policyholders in two aspects: |
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1. It gives the choice to get claim settled by any insurer of his choice until the sum insured with that insurer is exhausted and then he can move to the next insurer.
2. It makes the claim procedure hassle free especially for smaller claim amount. |
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| Let us compliment IRDA for these guidelines. Lakhs of Health Insurance customers join me in sending these compliments. |
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