Healthcare costs have increased at an unprecedented pace. Employees are slowly warming up to the idea of having an additional individual health insurance policy alongside their group insurance health plans. The pandemic brought to light the growing instances of group insurance schemes. Group insurance being insufficient to cover the costs of medical treatment.
Many with multiple health insurance policies, are caught with the dilemma of which one to exhaust first. It is important to know how to claim appropriately so that you do not face the situation of claim rejection or reduced claim settlement. Here is a list of considerations while you apply for claims under multiple health insurance policies
Speed of settlement
If you have availed the treatment in a network hospital, then it is fairly simple. The settlement takes place in a cashless manner. Cashless is available in personal health insurance plans, but typically, a group insurance policy settlement is usually smoother. If the insurer doesn’t have a TPA, then cashless claims in a group and an individual health plan are equally smooth.
If you have availed outside of network hospitals, then you will have to submit relevant papers and claim for reimbursement. Unless there are specific clauses or the line of treatment is out of scope. There should not be any problems in claims. The time taken for claim settlement in personal health plans is slightly more elaborate.
Further, unlike a company led claim settlement where there is enough assistance to ensure that you submit the required documents and avail treatment; within the scope of the group insurance policy, you will have to figure out most of the stuff on your own in personal health policies. In group health plans, the intermediary takes care of servicing and the same experience does not happen in personal health. As most intermediaries may or may not support the customer. Hence becomes very critical to buy from folks who will support you to bridge this time gap. OneAssure ensures that all its customers get complete support at the time of need, especially for settling a claim!
No claim bonus
Since a group insurance policy does not provide any no-claim bonus, there is no risk involved. Thus, exhausting the group insurance policy first will also ensure that you do not utilize your no-claim bonus. It will help you to enhance your health insurance coverage when you renew the personal health insurance policy.
No claim bonus can enhance the sum insured. Thus enabling one to gain a higher quantum of coverage with lower premiums. As group insurance schemes do not have no claim bonus, exhausting group insurance health plans first is appropraite.
Coverage in group insurance schemes
Group insurance schemes have a very wide coverage as compared to individual health policies. Thus, the chances of claim rejection are minimal in group insurance health plans as compared to personal health plans. There are minimal clauses that govern group insurance plans thereby offering a wider range of coverage.
Reserve claims for senior citizen parents with a group insurance policy
If your group insurance policy offers coverage for your parents, then it is advised that you reserve the group insurance scheme. Claims for senior citizen parents under personal health insurance can not only be tough. The premiums to cover your senior citizen parents will be expensive.
Also, group insurance schemes honour claims on pre-existing diseases for your parents without any waiting period. In this scenario, it is better to use personal health plans for your medical claims so that the coverage is available for your senior citizen parents.
Co-pay and room rent restrictions
Often, there may be sub-limits or co-pay clauses in health insurance plans. There are instances of basic policies having restrictions concerning room rent eligibility etc. Many times, the group insurance scheme offered by employers could have these sub-limits. It can have restrictions to bring down the overall premium costs. It is important to evaluate these clauses and choose the plan that honours the claims completely.
In such a scenario, you may choose to utilise your personal health insurance without any room rent limits first. So that your entire claim is admitted before opting to claim from your group insurance policy with sub-limits.
Also, you can choose to claim from both plans, partly from your group plan with sub-limits and then the rest from your personal health plan without limits.
In a nutshell:
The choice of the right plan to exhaust first should be led by your current requirements and future medical requirements. To understand more about this, visit https://blog.oneassure.in/